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Author: Vanessa Ngan, Staff Writer, 2003.
Photodynamic therapy (PDT) is a treatment used mainly for superficial types of skin cancer. PDT is effective in treating actinic keratoses and superficial basal cell carcinomas. It may also be used for treatment of small, thin, low-risk nodular basal cell carcinomas outside of the head and neck area.
Skin lesions suitable for photodynamic therapy
PDT is also sometimes used off-label for facial rejuvenation and to treat mild to moderate acne. Several other conditions have also been studied and may respond to PDT such as psoriasis, warts, mycosis fungoides and extramammary Paget's disease.
PDT utilises photosensitising agents, oxygen and light, to create a photochemical reaction that selectively destroys cancer cells. Photosensitising agents are drugs that are administered into the body through topical, oral or intravenous methods. In the body, they concentrate in cancer cells and only become active when light of a certain wavelength is directed onto the area where the cancer is. The photodynamic reaction between the photosensitising agent, light and oxygen kills the cancer cells.
Aminolevulinic acid hydrochloride topical solution
BF-200 ALA gel
Benzoporphyrin derivative monacid ring A
Tin ethyl etiopurpurinLutetium texaphyrin
Light sources used in PDT include laser or nonlaser light.
Laser light has the advantages of being:
Laser light is suitable for small skin lesions whilst nonlaser light is better for the treatment of large skin lesions as the field of illumination is larger. Nonlaser light that emits polychromatic light is also suitable when using different photosensitisers with different absorption maxima.
Natural daylight is used successfully as a light source for the treatment of actinic keratoses.
PDT is currently being used or investigated as a treatment for the following skin conditions:
Side effects from PDT are due to the treated area being sensitive to light. The photosensitivity usually lasts about 24 hours (depending on the specific agent). Side effects may include:
The treated area should be protected from light exposure using a dressing. A local anaesthetic such as lignocaine (lidocaine) spray may be applied to the treatment area before or during Stage 2 of the procedure to help relieve pain.
The treated skin lesion may blister and ulcerate as the cancer cells die off. This may take several weeks to heal. Scarring is generally minimal (but can be moderate). Loss of pigmentation may occur sometimes and can be permanent.
Although photosensitising drugs concentrate in cancer cells, they can also make healthy cells more sensitive to light. This is not a problem when photosensitising creams are used as they are localised to the treatment site. It is more of a problem when photosensitising drugs are given by mouth or injected intravenously. These patients may find all parts of their body sensitive to light and should take precautions to protect themselves from light for the necessary period of time (may be days or weeks depending on the photosensitising drug used).
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