Shen Julia J, Jemec Gregor B E, Arendrup Maiken C, Saunte Ditte Marie L
Department of Dermatology, Zealand University Hospital, Sygehusvej 5, DK-4000, Roskilde, Denmark.
Department of Dermatology, Zealand University Hospital, Sygehusvej 5, DK-4000, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark.
Photodiagnosis Photodyn Ther. 2020 Sep;31:101774. doi: 10.1016/j.pdpdt.2020.101774. Epub 2020 Apr 25.
Fungal infections in skin, hair and nails affect up to 25 % of the global population. Conventional antifungal treatment is effective but due to resistance, treatment failure, drug interactions, and treatment related toxicity, there is a need for alternative treatments. Photodynamic therapy (PDT) has shown antimicrobial properties and is used increasingly for fungal infections. This review investigates the reported efficacy and side effects of PDT of superficial mycoses.
Pubmed and Embase were searched 26-01-2020 for "superficial fungal infections" and "photodynamic therapy" in "Human subjects" using a predefined search string. Criteria for inclusion were: clinical trials and cases involving PDT-treated patients with primary fungal infections in skin, hair and nails. Criteria for exclusion were: languages other than English, animal models, in vitro trials, secondary fungal infections, reviews and guidelines.
541 records were identified and 34 papers fulfilled the criteria. PDT of onychomycosis (n = 380 patients) found treatment with methylene blue (MB) photosensitizer (PS) more efficacious with complete cure rates of 70 %-80 % than 5-aminolevulinic acid (ALA)-PDT (mycological cure rates of 17 %-57 %) and methyl aminolevulinate (MAL)-PDT (mycological cure rate of 32 %). Other PDT-treated fungal diseases included (n = 55): foot infections (n = 19), tinea cruris (n = 10), scalp infections (n = 2), Malassezia infections (n = 9) and subcutaneous fungal infections (n = 15) achieved promising effect.
PDT-treatment of superficial mycoses can be efficacious as salvage therapy. In the light of increasing resistance and few licensed treatment alternatives, larger randomized controlled trials investigations and optimization of the PDT-treatment protocol are warranted to evaluate PDT's potential as a future antifungal treatment.
皮肤、毛发和指甲的真菌感染影响着全球高达25%的人口。传统的抗真菌治疗虽有效果，但由于耐药性、治疗失败、药物相互作用以及治疗相关毒性，需要替代治疗方法。光动力疗法（PDT）已显示出抗菌特性，并越来越多地用于真菌感染。本综述调查了光动力疗法治疗浅表真菌病的报道疗效和副作用。
于2020年1月26日在Pubmed和Embase数据库中，使用预定义的搜索字符串在“人类受试者”中搜索“浅表真菌感染”和“光动力疗法”。纳入标准为：涉及光动力疗法治疗皮肤、毛发和指甲原发性真菌感染患者的临床试验和病例。排除标准为：非英语语言、动物模型、体外试验、继发性真菌感染、综述和指南。
共识别出541条记录，34篇论文符合标准。甲真菌病的光动力疗法（n = 380例患者）发现，使用亚甲蓝（MB）光敏剂（PS）治疗更有效，完全治愈率为70%-80%，高于5-氨基酮戊酸（ALA）-光动力疗法（真菌学治愈率为17%-57%）和甲基氨基酮戊酸（MAL）-光动力疗法（真菌学治愈率为32%）。其他接受光动力疗法治疗的真菌疾病包括（n = 55）：足部感染（n = 19）、股癣（n = 10）、头皮感染（n = 2）、马拉色菌感染（n = 9）和皮下真菌感染（n = 15），均取得了有前景的效果。
光动力疗法治疗浅表真菌病作为挽救疗法可能有效。鉴于耐药性增加且可用的许可治疗选择较少，有必要进行更大规模的随机对照试验研究并优化光动力疗法治疗方案，以评估其作为未来抗真菌治疗方法的潜力。
