Residents Forum
Daylight Photodynamic Therapy
FR - Terapia fotodinámica luz de día
T. Salas-García
, A. López-Gómez, M. Dorado-Fernández, J. Ruiz-Martínez
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Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, Spain
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Salas-García, A. López-Gómez, M. Dorado-Fernández, J. Ruiz-Martínez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Salas-García" "email" => array:1 [ 0 => "tania.sgg@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "López-Gómez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Dorado-Fernández" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Ruiz-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Terapia fotodinámica luz de día" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Photodynamic therapy (PDT) is one of the treatment options for nonmelanoma skin cancer and is considered to be the first-line treatment for multiple actinic keratoses (AKs) and field cancerization.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Various studies in recent years have described the use of daylight PDT in the treatment of nonhyperkeratotic AKs. The technique has also been reviewed in a consensus statement by the International Society for Photodynamic Therapy in Dermatology.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As we know, PDT consists in applying of a photosensitizer that causes the accumulation of protoporphyrin <span class="elsevierStyleSmallCaps">IX</span> (PpIX) in the cell interior and then using light of an appropriate wavelength to activate the PpIX, causing cell death. PpIX has its highest absorption peak at 410<span class="elsevierStyleHsp" style=""></span>nm as well as other peaks in the visible spectrum. It is therefore possible to activate PpIX with the blue light (440-500<span class="elsevierStyleHsp" style=""></span>nm) and red light (625-740<span class="elsevierStyleHsp" style=""></span>nm) lamps that are normally used, as well as with visible light (400-700<span class="elsevierStyleHsp" style=""></span>nm).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Studies on the use of daylight PDT have reported similar results to those obtained with conventional PDT in the treatment of grade <span class="elsevierStyleSmallCaps">I</span> or <span class="elsevierStyleSmallCaps">II</span> AKs (71% reduction in lesions with conventional PDT vs 79% with daylight PDT).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Daylight PDT is also less painful for the patient and less laborious and time-consuming for health professionals. The main limitations of daylight PDT are the difficulty of planning due to weather variations and the climate in some geographical areas<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> and the loss of medical control during the irradiation period.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first studies on the use of this new PDT modality in the treatment of AKs were carried out in Nordic countries.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Later studies carried out in Australia,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Spain,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Brazil,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and Italy<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> obtained similar results and the same safety levels, despite the fact that solar radiation is stronger in these countries.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The first step in administering daylight PDT is to apply organic sunscreen to the treatment area as well as all other exposed skin. The purpose is to avoid exposure to UV radiation, which is unnecessary for PDT and inadvisable for patients with severe actinic damage. The second step is curettage of the lesions and application of the photosensitizer. After this, the patient must receive 2<span class="elsevierStyleHsp" style=""></span>hours of exposure to daylight.</p><p id="par0035" class="elsevierStylePara elsevierViewall">One of the possible limitations of daylight PDT is the weather. Studies have shown that a minimum fluence of 8<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> must be reached in the PpIX absorption range within the solar radiation spectrum in order for an adequate response to be achieved. Studies have shown that it could be possible to reach the necessary dose year round in Spain.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Daylight PDT is mainly appropriate for patients who have multiple grade <span class="elsevierStyleSmallCaps">I</span> or <span class="elsevierStyleSmallCaps">II</span> AKs in sun-exposed areas.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Some studies, albeit with fewer cases, have reported acceptable results with daylight PDT in the treatment of other skin lesions, such as basal cell carcinoma<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> and actinic cheilitis<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> (the latter study described only 2 cases).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-30" "fechaAceptado" => "2015-05-05" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec577805" "palabras" => array:2 [ 0 => "Photodynamic therapy" 1 => "Actinic keratosis" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Salas-García T, López-Gómez A, Dorado-Fernández M, Ruiz-Martínez J. FR - Terapia fotodinámica luz de día. Actas Dermosifiliogr. 2014;106:672–673.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Daylight photodynamic therapy for actinic keratosis: An international consensus. International Society for Photodynamic Therapy in Dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.R. Wiegell" 1 => "H.C. Wulf" 2 => "R.M. Szeimies" 3 => "N. Basset-Seguin" 4 => "R. Bissonnette" 5 => "M.J. 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Enk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Photodermatol Phtotoimmunol Photomed" "fecha" => "2013" "volumen" => "29" "paginaInicial" => "268" "paginaFinal" => "271" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000008/v1_201510011018/S1578219015002085/v1_201510011018/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000008/v1_201510011018/S1578219015002085/v1_201510011018/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002085?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 11 | 17 |
| 2024 Octubre | 77 | 43 | 120 |
| 2024 Septiembre | 71 | 44 | 115 |
| 2024 Agosto | 94 | 62 | 156 |
| 2024 Julio | 81 | 27 | 108 |
| 2024 Junio | 75 | 28 | 103 |
| 2024 Mayo | 58 | 34 | 92 |
| 2024 Abril | 64 | 21 | 85 |
| 2024 Marzo | 56 | 25 | 81 |
| 2024 Febrero | 54 | 30 | 84 |
| 2024 Enero | 54 | 29 | 83 |
| 2023 Diciembre | 46 | 17 | 63 |
| 2023 Noviembre | 65 | 25 | 90 |
| 2023 Octubre | 73 | 26 | 99 |
| 2023 Septiembre | 58 | 28 | 86 |
| 2023 Agosto | 43 | 13 | 56 |
| 2023 Julio | 24 | 37 | 61 |
| 2023 Junio | 16 | 9 | 25 |
| 2023 Mayo | 43 | 23 | 66 |
| 2023 Abril | 32 | 20 | 52 |
| 2023 Marzo | 54 | 12 | 66 |
| 2023 Febrero | 50 | 21 | 71 |
| 2023 Enero | 30 | 20 | 50 |
| 2022 Diciembre | 47 | 35 | 82 |
| 2022 Noviembre | 34 | 23 | 57 |
| 2022 Octubre | 31 | 20 | 51 |
| 2022 Septiembre | 24 | 34 | 58 |
| 2022 Agosto | 21 | 30 | 51 |
| 2022 Julio | 25 | 32 | 57 |
| 2022 Junio | 19 | 25 | 44 |
| 2022 Mayo | 40 | 30 | 70 |
| 2022 Abril | 41 | 43 | 84 |
| 2022 Marzo | 48 | 41 | 89 |
| 2022 Febrero | 27 | 21 | 48 |
| 2022 Enero | 35 | 34 | 69 |
| 2021 Diciembre | 30 | 37 | 67 |
| 2021 Noviembre | 31 | 43 | 74 |
| 2021 Octubre | 35 | 61 | 96 |
| 2021 Septiembre | 32 | 48 | 80 |
| 2021 Agosto | 32 | 25 | 57 |
| 2021 Julio | 29 | 16 | 45 |
| 2021 Junio | 29 | 28 | 57 |
| 2021 Mayo | 47 | 29 | 76 |
| 2021 Abril | 87 | 52 | 139 |
| 2021 Marzo | 57 | 24 | 81 |
| 2021 Febrero | 62 | 31 | 93 |
| 2021 Enero | 49 | 19 | 68 |
| 2020 Diciembre | 32 | 14 | 46 |
| 2020 Noviembre | 20 | 15 | 35 |
| 2020 Octubre | 20 | 8 | 28 |
| 2020 Septiembre | 39 | 12 | 51 |
| 2020 Agosto | 27 | 19 | 46 |
| 2020 Julio | 21 | 14 | 35 |
| 2020 Junio | 44 | 34 | 78 |
| 2020 Mayo | 31 | 19 | 50 |
| 2020 Abril | 23 | 21 | 44 |
| 2020 Marzo | 27 | 20 | 47 |
| 2020 Febrero | 4 | 9 | 13 |
| 2020 Enero | 0 | 9 | 9 |
| 2019 Diciembre | 0 | 5 | 5 |
| 2019 Noviembre | 2 | 2 | 4 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 3 | 1 | 4 |
| 2019 Julio | 0 | 12 | 12 |
| 2019 Junio | 0 | 38 | 38 |
| 2019 Mayo | 1 | 58 | 59 |
| 2019 Abril | 0 | 16 | 16 |
| 2019 Marzo | 1 | 6 | 7 |
| 2019 Febrero | 0 | 3 | 3 |
| 2018 Diciembre | 1 | 3 | 4 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 4 | 1 | 5 |
| 2018 Septiembre | 8 | 1 | 9 |
| 2018 Agosto | 0 | 5 | 5 |
| 2018 Julio | 0 | 10 | 10 |
| 2018 Junio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 3 | 0 | 3 |
| 2018 Febrero | 55 | 5 | 60 |
| 2018 Enero | 26 | 5 | 31 |
| 2017 Diciembre | 67 | 7 | 74 |
| 2017 Noviembre | 31 | 9 | 40 |
| 2017 Octubre | 30 | 8 | 38 |
| 2017 Septiembre | 15 | 10 | 25 |
| 2017 Agosto | 28 | 15 | 43 |
| 2017 Julio | 20 | 14 | 34 |
| 2017 Junio | 33 | 27 | 60 |
| 2017 Mayo | 26 | 13 | 39 |
| 2017 Abril | 25 | 9 | 34 |
| 2017 Marzo | 30 | 45 | 75 |
| 2017 Febrero | 19 | 6 | 25 |
| 2017 Enero | 17 | 13 | 30 |
| 2016 Diciembre | 31 | 17 | 48 |
| 2016 Noviembre | 35 | 23 | 58 |
| 2016 Octubre | 25 | 24 | 49 |
| 2016 Septiembre | 0 | 6 | 6 |
| 2016 Agosto | 0 | 2 | 2 |
| 2016 Julio | 0 | 2 | 2 |
| 2016 Junio | 3 | 2 | 5 |
| 2016 Mayo | 1 | 0 | 1 |
| 2016 Marzo | 1 | 0 | 1 |
| 2015 Noviembre | 0 | 7 | 7 |
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