Piaserico Stefano, Mazzetto Roberto, Sartor Emma, Bortoletti Carlotta
Dermatology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy.
Pharmaceutics. 2022 Aug 18;14(8):1726. doi: 10.3390/pharmaceutics14081726.
Photodynamic therapy (PDT) is a highly effective and widely adopted treatment strategy for many skin diseases, particularly for multiple actinic keratoses (AKs). However, PDT is ineffective in some cases, especially if AKs occur in the acral part of the body. Several methods to improve the efficacy of PDT without significantly increasing the risks of side effects have been proposed. In this study, we reviewed the combination-based PDT treatments described in the literature for treating AKs; both post-treatment and pretreatment were considered including topical (i.e., diclofenac, imiquimod, adapalene, 5-fluorouracil, and calcitriol), systemic (i.e., acitretin, methotrexate, and polypodium leucotomos), and mechanical-physical (i.e., radiofrequency, thermomechanical fractional injury, microneedling, microdermabrasion, and laser) treatment strategies. Topical pretreatments with imiquimod, adapalene, 5-fluorouracil, and calcipotriol were more successful than PDT alone in treating AKs, while the effect of diclofenac gel was less clear. Both mechanical laser treatment with CO and Er:YAG (Erbium:Yttrium-Aluminum-Garnet) as well as systemic treatment with Polypodium leucotomos were also effective. Different approaches were relatively more effective in particular situations such as in immunosuppressed patients, AKs in the extremities, or thicker AKs. Conclusions: Several studies showed that a combination-based approach enhanced the effectiveness of PDT. However, more studies are needed to further understand the effectiveness of combination therapy in clinical practice and to investigate the role of acitretin, methotrexate, vitamin D, thermomechanical fractional injury, and microdermabrasion in humans.
光动力疗法（PDT）是一种针对多种皮肤病，尤其是多发性光化性角化病（AK）的高效且广泛应用的治疗策略。然而，PDT在某些情况下无效，特别是当AK发生在身体的肢端部位时。已经提出了几种在不显著增加副作用风险的情况下提高PDT疗效的方法。在本研究中，我们回顾了文献中描述的用于治疗AK的基于联合治疗的PDT；考虑了治疗后和预处理，包括局部（即双氯芬酸、咪喹莫特、阿达帕林、5-氟尿嘧啶和骨化三醇）、全身（即阿维A、甲氨蝶呤和白藓）以及机械物理（即射频、热机械微损伤、微针、微晶磨皮和激光）治疗策略。用咪喹莫特、阿达帕林、5-氟尿嘧啶和骨化三醇进行局部预处理在治疗AK方面比单独使用PDT更成功，而双氯芬酸凝胶的效果不太明确。用CO和Er:YAG（铒:钇铝石榴石）进行机械激光治疗以及用白藓进行全身治疗也有效。不同的方法在特定情况下相对更有效，例如在免疫抑制患者、四肢的AK或较厚的AK中。结论：几项研究表明基于联合治疗的方法提高了PDT的有效性。然而，需要更多的研究来进一步了解联合治疗在临床实践中的有效性，并研究阿维A、甲氨蝶呤、维生素D、热机械微损伤和微晶磨皮在人体中的作用。
