Morton Colin A, Brown S B, Collins S, Ibbotson S, Jenkinson H, Kurwa H, Langmack K, McKenna K, Moseley H, Pearse A D, Stringer M, Taylor D K, Wong G, Rhodes L E
Department of Dermatology, Falkirk Royal Infirmary, Falkirk FK1 5QE, U.K.
Br J Dermatol. 2002 Apr;146(4):552-67. doi: 10.1046/j.1365-2133.2002.04719.x.
Topical photodynamic therapy (PDT) is effective in the treatment of certain non-melanoma skin cancers and is under evaluation in other dermatoses. Its development has been enhanced by a low rate of adverse events and good cosmesis. 5-Aminolaevulinic acid (ALA) is the main agent used, converted within cells into the photosensitizer protoporphyrin IX, with surface illumination then triggering the photodynamic reaction. Despite the relative simplicity of the technique, accurate dosimetry in PDT is complicated by multiple variables in drug formulation, delivery and duration of application, in addition to light-specific parameters. Several non-coherent and coherent light sources are effective in PDT. Optimal disease-specific irradiance, wavelength and total dose characteristics have yet to be established, and are compounded by difficulties comparing light sources. The carcinogenic risk of ALA-PDT appears to be low. Current evidence indicates topical PDT to be effective in actinic keratoses on the face and scalp, Bowen's disease and superficial basal cell carcinomas (BCCs). PDT may prove advantageous where size, site or number of lesions limits the efficacy and/or acceptability of conventional therapies. Topical ALA-PDT alone is a relatively poor option for both nodular BCCs and squamous cell carcinomas. Experience of the modality in other skin diseases remains limited; areas where there is potential benefit include viral warts, acne, psoriasis and cutaneous T-cell lymphoma. A recent British Photodermatology Group workshop considered published evidence on topical PDT in order to establish guidelines to promote the efficacy and safety of this increasingly practised treatment modality.
局部光动力疗法（PDT）在某些非黑素瘤皮肤癌的治疗中有效，目前正在其他皮肤病中进行评估。其不良事件发生率低且美容效果好，促进了该疗法的发展。5-氨基酮戊酸（ALA）是主要使用的药物，在细胞内转化为光敏剂原卟啉IX，然后通过表面照射引发光动力反应。尽管该技术相对简单，但PDT中的精确剂量测定因药物配方、给药方式和应用持续时间等多个变量而变得复杂，此外还有光的特定参数。几种非相干和相干光源在PDT中有效。针对特定疾病的最佳辐照度、波长和总剂量特征尚未确定，而且由于比较光源存在困难而更加复杂。ALA-PDT的致癌风险似乎较低。目前的证据表明，局部PDT对面部和头皮的光化性角化病、鲍温病和浅表基底细胞癌（BCC）有效。当病变的大小、部位或数量限制了传统疗法的疗效和/或可接受性时，PDT可能具有优势。单独使用局部ALA-PDT对于结节性BCC和鳞状细胞癌来说是一个相对较差的选择。该疗法在其他皮肤病中的经验仍然有限；可能有益的领域包括病毒疣、痤疮、银屑病和皮肤T细胞淋巴瘤。英国光皮肤病学小组最近举办了一次研讨会，审议了关于局部PDT的已发表证据，以便制定指南，提高这种越来越常用的治疗方式的疗效和安全性。
