Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Department of Biomedical Engineering, Cleveland Clinic, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
Photodiagnosis Photodyn Ther. 2024 Feb;45:103838. doi: 10.1016/j.pdpdt.2023.103838. Epub 2023 Oct 14.
Photodynamic therapy (PDT) is a safe, non-mutagenic, and non-scarring treatment for actinic keratoses (AK).
'Painless' photodynamic therapy (p-PDT) is a regimen for AK that employs simultaneous aminolevulinate incubation and blue light illumination. The efficacy of p-PDT resembles that of traditional PDT, but detailed mechanisms of action for p-PDT are not well understood.
To characterize the inflammatory effects of the p-PDT procedure 48 h following treatment and determine the association of inflammation with precancer burden, we performed a retrospective cohort study of 104 patients with AK of face or scalp treated with p-PDT between 2017 and 2019. Patients self-reported their side effects 48 h following p-PDT and took photographs of their face and scalp. Photographs were edited to define seven anatomic regions, and erythema was scored by four investigators.
Ninety-eight patients provided photographs suitable for erythema evaluation. Most patients experienced 2 or more side effects and some pain 48 h post-procedure. Females experienced more pain (p = 0.01) and side effects (p = 0.002) compared to males. AK burden was positively associated with post p-PDT erythema response (p < 0.0001) at all sites, but particularly in the temples (p = 0.002) and supralabial area (p = 0.009).
This study confirms a strong clinical inflammatory response after p-PDT. Severity of inflammation is positively associated with AK tumor burden, suggesting that post-treatment inflammation may be a pre-requisite for p-PDT efficacy. Interestingly, the results also identify certain gender-related differences in the severity of side effects experienced by patients post-PDT.
光动力疗法（PDT）是一种安全、非诱变和无瘢痕的治疗光化性角化病（AK）的方法。
“无痛”光动力疗法（p-PDT）是一种 AK 的治疗方案，它采用同时进行氨基酮戊酸孵育和蓝光照射。p-PDT 的疗效类似于传统 PDT，但 p-PDT 的详细作用机制尚不清楚。
为了描述治疗后 48 小时 p-PDT 程序的炎症效应，并确定炎症与癌前负担的关联，我们对 2017 年至 2019 年间接受 p-PDT 治疗的 104 例面部或头皮 AK 患者进行了回顾性队列研究。患者在接受 p-PDT 后 48 小时内自行报告副作用，并对面部和头皮拍照。对照片进行编辑以定义七个解剖区域，并由四位研究者对红斑进行评分。
98 例患者提供了适合红斑评估的照片。大多数患者在治疗后 48 小时内出现 2 种或多种副作用和一些疼痛。女性比男性经历更多的疼痛（p=0.01）和副作用（p=0.002）。AK 负担与所有部位（p<0.0001），尤其是在太阳穴（p=0.002）和上唇区（p=0.009）的 p-PDT 后红斑反应呈正相关。
本研究证实了 p-PDT 后强烈的临床炎症反应。炎症的严重程度与 AK 肿瘤负担呈正相关，这表明治疗后炎症可能是 p-PDT 疗效的前提。有趣的是，结果还确定了患者在接受 PDT 后经历副作用严重程度的某些与性别相关的差异。
