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Biomedicines 2018, 6, 18 5 of 8 Biomedicines 2018, 6, x 5 of 8 All of the patients experienced mild pain during lesion irradiation as well as slight warmth after All of the patients experienced mild pain during lesion irradiation as well as slight warmth after treatment for less than 20 s; however, in no case was treatment interruption required. After each treatment for less than 20 s; however, in no case was treatment interruption required. After each session, all of the patients experienced transient mild edema and erythema, followed by appearance of session, all of the patients experienced transient mild edema and erythema, followed by appearance crusting with healing within 1 week. of crusting with healing within 1 week. At six months follow-up the cosmetic outcome was excellent in 29 of 29 (100%), of which two At six months follow-up the cosmetic outcome was excellent in 29 of 29 (100%), of which two cases are demonstrated in Figures 1 and 4. cases are demonstrated in Figures 1 and 4. Figure 4. 3D images of complete clinical response of AK at the nose treated with MAL-PDT using IPL Figure 4. 3D images of complete clinical response of AK at the nose treated with MAL-PDT using IPL as light source: (A) before treatment and (B) at six months follow-up. Cosmetic outcome was rated as as light source: (A) before treatment and (B) at six months follow-up. Cosmetic outcome was rated excellent. as excellent. 4. Discussion 4. Discussion Our observations confirm that IPL might be a potential alternative light source for PDT in the Our observations confirm that IPL might be a potential alternative light source for PDT in the treatment of NMSC. The six-month complete response rate of 89.6% is consistent with published treatment of NMSC. The six-month complete response rate of 89.6% is consistent with published short-term treatment results after IPL-PDT for NMSC [8]. However, the outcome of this treatment is short-term treatment results after IPL-PDT for NMSC [8]. However, the outcome of this treatment is difficult to compare, since different methods, treatment schedules, and evaluation criteria of clinical difficult to compare, since different methods, treatment schedules, and evaluation criteria of clinical benefit have been used. benefit have been used. The use of IPL for ALA or MAL activation in PDT of NMSC has been addressed in a few The use of IPL for ALA or MAL activation in PDT of NMSC has been addressed in a few studies. studies. IPL has been mostly described as light source for the PDT of AK as part of IPL has been mostly described as light source for the PDT of AK as part of photorejuvenation process photorejuvenation process reporting high clearance rates. reporting high clearance rates. Ruiz Rodriguez et al [8] evaluated the combined use of ALA-PDT and IPL for the treatment of Ruiz Rodriguez et al [8] evaluated the combined use of ALA-PDT and IPL for the treatment of AKs and photodamage. Seventeen patients with a total of 38 AKs and varying degrees of AKs and photodamage. Seventeen patients with a total of 38 AKs and varying degrees of photodamage photodamage underwent therapy with IPL-ALA-PDT. Two sessions with a one-month interval were underwent therapy with IPL-ALA-PDT. Two sessions with a one-month interval were performed. performed. At three months follow-up, 87% of AKs disappeared [8]. Likewise, Avram and Goldman At three months follow-up, 87% of AKs disappeared [8]. Likewise, Avram and Goldman [9] used an [9] used an IPL device for ALA-PDT to treat 17 patients with AK and photodamage resulting in a IPL device for ALA-PDT to treat 17 patients with AK and photodamage resulting in a 69% decrease in 69% decrease in AK with one IPL treatment. In both studies, photorejunative effects on the treated AK with one IPL treatment. In both studies, photorejunative effects on the treated areas of the skin, in areas of the skin, in terms of skin texture, wrinkling, pigmentary changes, and teleangiectasias, were terms of skin texture, wrinkling, pigmentary changes, and teleangiectasias, were noted [9]. However, noted [9]. However, markedly lower rates than averages have been reported by Kim et al. in a study markedly lower rates than averages have been reported by Kim et al. in a study on the combined use on the combined use of ALA-PDT with IPL for the treatment of AK exclusively [10]. Seven Korean of ALA-PDT with IPL for the treatment of AK exclusively [10]. Seven Korean patients with a total of 12 patients with a total of 12 facial AKs underwent one session treatment with ALA-PDT using IPL. A facial AKs underwent one session treatment with ALA-PDT using IPL. A clinical clearance rate of 50% clinical clearance rate of 50% was achieved at 12 weeks follow-up. A possible explanation for the was achieved at 12 weeks follow-up. A possible explanation for the lower AK clearance rate may be lower AK clearance rate may be the fact that this study was performed in patients with darker skin the fact that this study was performed in patients with darker skin types. Indeed, it has been reported types. Indeed, it has been reported that differences in skin pigmentation could influence PDT that differences in skin pigmentation could influence PDT response, as melanin might moderate the response, as melanin might moderate the photodynamic effect by absorbing free radicals and light [11]. The possible synergistic effect of IPL and PDT for the treatment of AK has been, also, addressed The possible synergistic effect of IPL and PDT for the treatment of AK has been, also, addressed in several comparative studies. Gold et al. conducted a split face comparative study using ALA-IPL vs. in several comparative studies. Gold et al. conducted a split face comparative study using ALA-IPL IPL alone for photorejuvenation, and showed an increased clearance rate of AK with a short-contact vs. IPL alone for photorejuvenation, and showed an increased clearance rate of AK with a short-contact (30 to 60 min) ALA-PDT and IPL vs. IPL alone (78% vs. 53.6%) after three sessions with photodynamic effect by absorbing free radicals and light [11].PDF Image | Photodynamic Therapy Pulsed Light Treatment of Nonmelanoma
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