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International Journal of Molecular Sciences Article Alternatives to Outdoor Daylight Illumination for Photodynamic Therapy—Use of Greenhouses and Artificial Light Sources Catharina M. Lerche *, Ida M. Heerfordt, Jakob Heydenreich and Hans Christian Wulf Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark; ida.marie.heerfordt.02@regionh.dk (I.M.H.); Jakob.heydenreich@regionh.dk (J.H.); h.wulf@regionh.dk (H.C.W.) * Correspondence: catharina.margrethe.lerche@regionh.dk; Tel.: +45-3531-2778 Academic Editor: Ying-ying Huang Received: 21 December 2015; Accepted: 14 February 2016; Published: 29 February 2016 Abstract: Daylight-mediated photodynamic therapy (daylight PDT) is a simple and pain free treatment of actinic keratoses. Weather conditions may not always allow daylight PDT outdoors. We compared the spectrum of five different lamp candidates for indoor “daylight PDT” and investigated their ability to photobleach protoporphyrin IX (PpIX). Furthermore, we measured the amount of PpIX activating daylight available in a glass greenhouse, which can be an alternative when it is uncomfortable for patients to be outdoors. The lamps investigated were: halogen lamps (overhead and slide projector), white light-emitting diode (LED) lamp, red LED panel and lamps used for conventional PDT. Four of the five light sources were able to photobleach PpIX completely. For halogen light and the red LED lamp, 5000 lux could photobleach PpIX whereas 12,000 lux were needed for the white LED lamp. Furthermore, the greenhouse was suitable for daylight PDT since the effect of solar light is lowered only by 25%. In conclusion, we found four of the five light sources and the greenhouse usable for indoor daylight PDT. The greenhouse is beneficial when the weather outside is rainy or windy. Only insignificant ultraviolet B radiation (UVB) radiation passes through the greenhouse glass, so sun protection is not needed. Keywords: artificial daylight; photodynamic therapy; greenhouse; daylight PDT; methyl aminolevulinate 1. Introduction Daylight photodynamic therapy (daylight-PDT) has become an established treatment for actinic keratoses [1]. The daylight PDT regimen includes superficial curettage, application of methyl aminolevulinate (MAL) and two hours outdoors in daylight starting 30 min. after MAL application [2,3]. During daylight PDT the photosensitizer protoporphyrin IX (PpIX) is produced and photobleached continuously resulting in much less pain than conventional PDT and an excellent cosmetic outcome [2,4–6]. However, the treatment is very dependent on geographical location (latitude), weather conditions and time of year [3,7]. In Denmark it is only possible to perform daylight-mediated PDT from April to November due to low temperatures and insufficient daylight doses the rest of the year [3,7]. Treatment rooms with artificial “daylight” would enable us to treat patients all year round, also on rainy days during summer. In the infancy of PDT, slide projectors were used as a light source before LED technology became easily available [8,9]. Attempts have been made to develop other artificial daylight illumination systems, but these are not yet commercially available [10]. All PpIX absorption peaks are within the visible spectrum of light (Figure 1) [11]. Therefore, a range of light sources can be used to photobleach PpIX [1]. Besides artificial “daylight” Int. J. Mol. Sci. 2016, 17, 309; doi:10.3390/ijms17030309 www.mdpi.com/journal/ijmsPDF Image | Alternatives to Outdoor Daylight for Photodynamic Therapy
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