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Clinical, Cosmetic and Investigational Dermatology Dovepress open access to scientific and medical research Open Access Full Text Article Current evidence and applications of photodynamic therapy in dermatology RevIew Marilyn T wan1 Jennifer Y Lin2 1Melanoma Program, Dana-Farber Cancer Institute, 2Department of Dermatology, Brigham and women’s Hospital, Harvard Medical School, Boston, MA, USA Abstract: In photodynamic therapy (PDT) a photosensitizer – a molecule that is activated by light – is administered and exposed to a light source. This leads both to destruction of cells targeted by the particular type of photosensitizer, and immunomodulation. Given the ease with which photosensitizers and light can be delivered to the skin, it should come as no surprise that PDT is an increasingly utilized therapeutic in dermatology. PDT is used commonly to treat precancer- ous cells, sun-damaged skin, and acne. It has reportedly also been used to treat other conditions including inflammatory disorders and cutaneous infections. This review discusses the principles behind how PDT is used in dermatology, as well as evidence for current applications of PDT. Keywords: photodynamic therapy, skin cancer, actinic keratosis, acne, aminolevulinic acid, methylaminolevulinate Introduction Photodynamic therapy (PDT) is a therapeutic method used with increasing frequency in dermatology. In the US, PDT is approved for the treatment of thin actinic keratoses, but off-label uses continue to increase.1 The concept of PDT is deceptively simple, in that it requires only three ingredients, ie, a photosensitizer, a light source, and oxygen. The therapeutic effect is achieved by light activation of a photosensitizing agent, and in the presence of oxygen, reactive oxygen intermediates are formed. These intermediates irreversibly oxidize essential cellular components, causing apoptosis and necrosis.2,3 PDT is safe and effective, and produces excellent cosmetic results with few adverse effects. It has the advantage of allowing application to multiple lesions. Pain, edema, erythema, pigmentation, and pustules are among the main complications, with the most common complaint being pain during delivery of treatment.4,5 In this paper, we review the evidence for current applications of PDT in dermatology. Correspondence: Jennifer Y Lin Department of Dermatology, Brigham and women’s Hospital, Harvard Medical School, Boston, MA 02115, USA Tel +1 617 264 5943 email jylin@partners.org submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/CCID.S35334 History At the beginning of the 20th century, Oscar Raab, a medical student, serendipitously discovered the toxic effect of cumulative acridine orange (a photosensitizer) and light on Paramecium caudatum cells. He confirmed his findings by testing the components individually, with no apparent damaging effect on the protozoa separately. His profes- sor, Von Tappeiner, worked in collaboration with Jesionek, a dermatologist, on the first clinical trial, which was conducted in 1903 using eosin and light to treat the cutane- ous manifestations of diseases such as condylomata lata, lupus vulgaris, psoriasis, stage II syphilis, and non-melanoma skin cancer.6,7 Von Tappeiner referred to this as “photodynamic therapy”.8,9 Despite this breakthrough, PDT was not widely used until Clinical, Cosmetic and Investigational Dermatology 2014:7 145–163 145 © 2014 Wan and Lin. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpPDF Image | applications of photodynamic therapy dermatology
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