Conflicts of interest CAM has received honoraria for speaking, organized educational events and conducted research for Galderma, PhotoCure and Phototherapeutics Ltd.
Guidelines for topical photodynamic therapy: update
Article first published online: 13 OCT 2008
© 2008 The Authors. Journal Compilation © 2008 British Association of Dermatologists
British Journal of Dermatology
Volume 159, Issue 6, pages 1245–1266, December 2008
How to Cite
Morton, C.A., McKenna, K.E., Rhodes, L.E. and on behalf of the British Association of Dermatologists Therapy Guidelines and Audit Subcommittee and the British Photodermatology Group (2008), Guidelines for topical photodynamic therapy: update. British Journal of Dermatology, 159: 1245–1266. doi: 10.1111/j.1365-2133.2008.08882.x
These guidelines represent an update, commissioned by the British Association of Dermatologists (BAD) Therapy Guidelines and Audit Subcommittee, of those originally produced from a workshop held in November 2000 by the British Photodermatology Group. Members of the BAD Therapy Guidelines and Audit Subcommittee are: H.K. Bell (Chair), D.J. Eedy, D.M. Mitchell, R.H. Bull, M.J. Tidman, L.C. Fuller, P.D. Yesudian, D. Joseph and S. Wagle. British Photodermatology Group contributors to the first report: C.A. Morton, S.B. Brown, S. Collins, S.H. Ibbotson, H. Jenkinson, H. Kurwa, K. Langmack, K.E. McKenna, H. Moseley, A. Pearse, M. Stringer, D. Taylor, G. Wong and L.E. Rhodes.
- Issue published online: 19 NOV 2008
- Article first published online: 13 OCT 2008
- Accepted for publication 29 August 2008
- 5-aminolaevulinic acid;
- methyl aminolaevulinate;
- nonmelanoma skin cancer;
- protoporphyrin IX;
- topical photodynamic therapy
Multicentre randomized controlled studies now demonstrate high efficacy of topical photodynamic therapy (PDT) for actinic keratoses, Bowen’s disease (BD) and superficial basal cell carcinoma (BCC), and efficacy in thin nodular BCC, while confirming the superiority of cosmetic outcome over standard therapies. Long-term follow-up studies are also now available, indicating that PDT has recurrence rates equivalent to other standard therapies in BD and superficial BCC, but with lower sustained efficacy than surgery in nodular BCC. In contrast, current evidence does not support the use of topical PDT for squamous cell carcinoma. PDT can reduce the number of new lesions developing in patients at high risk of skin cancer and may have a role as a preventive therapy. Case reports and small series attest to the potential of PDT in a wide range of inflammatory/infective dermatoses, although recent studies indicate insufficient evidence to support its use in psoriasis. There is an accumulating evidence base for the use of PDT in acne, while detailed study of an optimized protocol is still required. In addition to high-quality treatment site cosmesis, several studies observe improvements in aspects of photoageing. Management of treatment-related pain/discomfort is a challenge in a minority of patients, and the modality is otherwise well tolerated. Long-term studies provide reassurance over the safety of repeated use of PDT.