Department of Dermatology, University Heidelberg, Heidelberg, Germany.
J Am Acad Dermatol. 2010 Aug;63(2):213-8. doi: 10.1016/j.jaad.2009.08.062. Epub 2010 Jun 9.
Topical photodynamic therapy is a good treatment option for extensively photodamaged skin with multiple actinic keratoses. Pain is one of the major adverse effects during and after the treatment.
We sought to determine the pain intensity and its influencing factors during the extensive photodynamic treatment of complete cosmetic units.
In total, 104 patients with 411 treated fields were enrolled in this retrospective monocentric study. All patients had multiple actinic keratoses on the face, scalp, or back of hands and received an extensive treatment of the complete photodamaged area in our dermatologic outpatient department between February and May 2009. Pain was rated using a visual analog scale directly and 8 hours after photodynamic therapy.
Multifactorial analysis of the data shows that pain intensity is dependent on sex of the patient (P = .030) and location of the treated field (P < .001). Visual analog scale scores were independent of the age and skin type of the patient. No significant difference in pain between the use of 5-amino-4-oxo-pentanoate (methylaminolevulinate) and 5-aminolevulinic acid was noticed. During treatment, mean visual analog scale scores +/- SEM of the different locations were 2.5 +/- 0.36 (hand), 3.6 +/- 0.35 (occiput), 5.2 +/- 0.19 (forehead), 5.9 +/- 0.20 (cheeks), and 7.4 +/- 0.48 (lips). Eight hours after treatment the mean pain +/- SEM in all locations was reduced significantly (P < .001) from 5.2 +/- 0.14 to 3.0 +/- 0.14. The rate of therapy interruptions showed a significant correlation (P = .044) with the location of the treated field. In all, 71% of the patients showed a good and 29% a poor clinical outcome.
Because of the retrospective study design not all factors that may influence pain (eg, protoporphyrin IX fluorescence) were recorded.
These results show that pain intensity is dependent on the location of the treated field. Pain intensity is higher in male patients. After 8 hours pain decreases significantly.
局部光动力疗法是治疗广泛光损伤皮肤伴多发光化性角化病的有效方法。疼痛是治疗过程中和治疗后主要的不良反应之一。
我们旨在确定在广泛的光动力治疗中治疗完整美容单位时的疼痛强度及其影响因素。
本回顾性单中心研究共纳入 104 例患者的 411 个治疗区。所有患者面部、头皮或手背均有多发光化性角化病，于 2009 年 2 月至 5 月在我院皮肤科门诊接受了广泛的光损伤区域治疗。治疗后直接和 8 小时时使用视觉模拟评分法评估疼痛。
多因素数据分析显示，疼痛强度与患者性别（P =.030）和治疗区部位（P <.001）有关。视觉模拟评分法评分与患者年龄和皮肤类型无关。使用 5-氨基-4-氧代戊酸（甲氨基酮戊酸）和 5-氨基酮戊酸时，疼痛无显著差异。治疗期间，不同部位的平均视觉模拟评分法评分±SEM 分别为 2.5±0.36（手部）、3.6±0.35（枕部）、5.2±0.19（额部）、5.9±0.20（面颊部）和 7.4±0.48（唇部）。治疗 8 小时后，所有部位的平均疼痛±SEM 均显著降低（P <.001），从 5.2±0.14 降至 3.0±0.14。治疗中断率与治疗区部位显著相关（P =.044）。总的来说，71%的患者临床疗效良好，29%的患者临床疗效较差。
由于本研究为回顾性研究设计，并非所有可能影响疼痛的因素（如原卟啉 IX 荧光）都被记录。
这些结果表明疼痛强度与治疗区部位有关。男性患者疼痛强度更高。治疗 8 小时后疼痛明显减轻。
