Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K.
Stirling Community Hospital, Stirling, U.K.
Br J Dermatol. 2019 Apr;180(4):715-729. doi: 10.1111/bjd.17131. Epub 2018 Oct 30.
Topical photodynamic therapy (PDT) is widely used to treat superficial nonmelanoma skin cancer and dysplasia, and is generally well tolerated. However, as with all treatments, adverse effects may occur and awareness may facilitate approaches to prevention and management.
To review the available evidence relating to the adverse effects of topical PDT, to help inform recommendations in updated clinical guidelines produced by the British Association of Dermatologists and British Photodermatology Group, and the efficacy of preventative and therapeutic approaches.
This review summarizes the published evidence related to the adverse effects of topical PDT and attempts to interpret this evidence in the context of patient risk and management.
Pain and discomfort during PDT are acute adverse effects, which can be minimized through the use of modified and low-irradiance PDT regimens and do not therefore usually limit successful treatment delivery. Other adverse effects include the risk of contact allergy to photosensitizer prodrugs, although this is rare but should be kept in mind, particularly for patients who have received multiple PDT treatments to larger areas. There are no other significant documented longer-term risks and, to date, no evidence of cumulative toxicity or photocarcinogenic risk.
Topical PDT is usually well tolerated, reinforcing the utility of this important therapeutic option in dermatology practice. The main acute adverse effect of pain can typically be minimized through preventative approaches of modified PDT regimens. Other adverse effects are uncommon and generally do not limit treatment delivery.
局部光动力疗法（PDT）广泛用于治疗浅表非黑色素瘤皮肤癌和发育不良，通常具有良好的耐受性。然而，与所有治疗方法一样，可能会出现不良反应，提高认识有助于预防和管理。
综述与局部 PDT 不良反应相关的现有证据，为英国皮肤科医师协会和英国光动力学会制定的更新临床指南中的建议提供信息，并评估预防和治疗方法的疗效。
本综述总结了与局部 PDT 不良反应相关的已发表证据，并尝试根据患者风险和管理来解释这些证据。
PDT 过程中的疼痛和不适属于急性不良反应，可以通过改良和低辐照 PDT 方案来最小化，因此通常不会限制成功的治疗实施。其他不良反应包括对光敏剂前体药物产生接触过敏的风险，尽管这种情况很少见，但应牢记在心，特别是对于接受过多处大面积 PDT 治疗的患者。目前没有其他明显的长期风险记录，迄今为止，也没有累积毒性或光致癌风险的证据。
局部 PDT 通常具有良好的耐受性，这强化了这种重要治疗选择在皮肤科实践中的实用性。疼痛这一主要急性不良反应通常可以通过改良 PDT 方案的预防措施来最小化。其他不良反应并不常见，通常不会限制治疗的实施。
