Therapeutic Revolution In Dermatology

Main Category: Dermatology
Article Date: 01 May 2010 - 1:00 PDT


At the 10th Congress of the European Society for Photodynamic Therapy (Euro PDT), held in Monaco on March 12-13, 2010, Professor Lasse Braathen (Tromso, Norway), president of the Euro PDT, described the current state of topical photodynamic therapy, a revolutionary treatment for precancerous skin lesions and superficial skin carcinomas. He also underscored the major role played by the Euro PDT, whose objective is to promote research, development, and clinical applications of PDT in Europe.

What are PDT's indications and advantages?

Professor Lasse Braathen: Today, PDT is the treatment of choice for non-melanoma skin cancers. Euro-PDT's recommendations specify that topical PDT could be one of the treatments of choice for actinic keratoses, Bowen's disease, and superficial and even nodular baso-cellular skin cancers, which are the most common skin cancers and are caused by exposure to the sun (1).

PDT avoids recourse to surgery and its scarring after effects. Hence its advantages are obvious: this treatment allows recovery in five years in more than 80% of cases with no visible scar; this is an essential advantage in cosmetic terms for lesions in open areas of the skin, especially those on the face and neckline. This represents undeniable therapeutic progress that is also very simple to apply. This treatment is also very specific in that it destroys only cancerous cells. It also makes it possible to treat large areas of skin in a single session with excellent tolerance and perfect cosmetic results, which is especially appreciated by patients.

Can several PDT sessions be applied if lesions recur?

Professor Lasse Braathen: Yes, because phototherapy involves no ionizing toxicity. When lesions reappear, the patient can again be offered treatment by PDT, and the treatment can be repeated as many times as necessary. In rare cases of failure, all therapeutic options are available because of the absence of local or general toxicity from PDT, with no loss of the patient's chances. When skin lesions are extensive, treatment by PDT makes it possible to pinpoint the "PDT-resistant" lesions that require some other therapeutic approach.

Are there other possible uses of PDT?

Professor Lasse Braathen: Yes, but they have not been validated by the AMM; some skin lymphomas can benefit from it, with remarkable effectiveness. PDT can also be used preventively in transplant patients, in whom skin cancer appears in 15% of cases after the transplant.

Cosmetic use of PDT is also practiced outside AMM for its "rejuvenating" effect. Patients presenting an actinic keratosis also benefit from this positive secondary effect of PDT.

The relatively recent concept of "field cancerization" could become an indication for PDT. A field cancerization around actinic keratosis lesions forms an area with pre-neoplastic anomalies and infra-clinical and multifocal genetic mutations that can evolve into primitive new tumours and local recurrences. It seems logical to treat all of this area preventively rather than to treat an isolated lesion. Applying Metvix makes it possible to more easily see the non-visible lesions, which glow under black light. This method is very much appreciated by patients, who can use it to see their skin risk and easily understand the need for treatment.

With regard to the development of PDT, what are Euro PDT's main activities?

Professor Lasse Braathen: The European Society for Photodynamic Therapy (Euro PDT) is a clearinghouse for practitioners and researchers; its objective is to promote research, development and clinical applications for photodynamic therapy in Europe. Every year for the past 10 years, Euro PDT has held an international conference to inform specialists about the results of international research on the use of PDT in dermatology. Euro PDT also participates in most international and national dermatology conferences. Euro PDT holds regular training sessions in order to teach practitioners how to properly use photodynamic therapy. This instruction with certification takes an entire day. In particular, we stress optimal management of the pain associated with the treatment, which the patient must be informed of. This training has led to the creation of excellent PDT research and treatment centers, for example at Saint Louis Hospital in Paris.

With photodynamic therapy being used worldwide, in 2007 Euro PDT published international recommendations in order to define its instructions and standardize its clinical application in treating non-melanoma skin cancers (1). Finally, Euro PDT creates many partnerships with university research labs, the pharmaceutical industry and clinical research teams.

(1) Braathen L, Szeimies RM, Basset-Seguin N, et coll.: Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: An international consensus. J AM Acad Dermatol 2007; 125-143.

10th Congress of the European Society for Photodynamic Therapy (Euro PDT) (Nice): March 12 -13, 2010

Source: European Society for Photodynamic Therapy

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