Objectives: Daylight-PDT (DL-PDT) is a soft and progressive, painless, mode of PpIX activation as it is produced (30 min of incubation of topical ALA or MAL, 2h continuous exposure). The clinical adventure of DL use for PDT began in the early 20th century but this technique was forgotten until Pr Wulf et al revived it. The first proof of concept study on the efficacy to treat actinic keratoses of the face and scalp was published in 2008. Its non-inferiority has now been proven in numerous multicenter randomized clinical trials. Photorejuvenation (PR) and acne are possible off-label cosmetic uses of PDT

Introduction: PR-PDT ( based on clinical, histological and, with immunohistochemical markers assessment, studies) can both normalize UV-induced atypical keratinocytes and markers (decrease of baseline epidermal p53 level ...) and induce a dermal reshaping by direct effect on dermal FB (ERK signaling pathway ) and indirect epithelial- mesenchymal interactions (IL, TNF, MMPs, ARNm coll…) even for low-level PDT (6J/cm²). Clinical results, even with daylight use, show that tone, lentigos, skin roughness, texture and fine wrinkles can be improved.

Materials / method: Protocols of prior microporation -microneedling, sandpaper abrasion or fractional laser) of the treated skin before ALA or MAL application (assisted delivery – ‘’intensified’’ PDT) are used to enhance PpIX formation and efficiency of PDT sessions but with severe pain rated from 6 to 8 on 10 visual analogic scales. These scores are not acceptable for rejuvenation techniques. The combination of ALA or MAL-assisted delivery and daylight exposure offers a dual benefit: increased efficiency and very low pain scores (0-1 on VAS). It can also be used on extrafacial areas such as the decolletage.

Results: For acne, PDT is always a 2nd or 3rd line of treatment. In the last Cochrane review, among all light therapies, only red-LED MAL-PDT has demonstrated a low-to moderate evidence of efficacy. Applied this way it can be efficient on inflammatory and non inflammatory lesions but adverse effects range from severe to unbearable (intense pain during illumination, volcanic eruption and social eviction of up to 8-10 days, prolonged risks of erythema or post-inflammatory hyperpigmentation…). Daylight use could be an alternative but there is no reference in the literature except for 1 recent Korean study

Conclusion: reporting the absence of significant effect in non inflammatory lesions (Tae In Kim et al., 2017). In the future it could interesting to use creams containing photosensitizers at low dosage and daily...daylight use ! (as it has been published by Kwon et al in 2016 J dermatol.)

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Off-label use is a posibility to provide therapeutic alternatives to patients with procedures and/or drugs which have not been approved so far in the given indication.
Off-label use is generally legal unless it violates Ethical Guidelines or safety regulations.

Introduction: In the field of Photodynamic Therapy in Dermatology, so far in-label use of registered drugs (aminolevulinic acid or its methyl ester) is restricted to dermatooncologic indications like actinic keratoses, Bowen's disease and basal cell carcinoma. However, several peer-reviewed studies exist which demonstrate its usefulness in other indications. It is doubtful, that all indications will receive registrational status in the near future, but the most interesting ones will be discussed in this presentation.

Materials / method: This work is based on a review in depth of the recent published papers and congress reports utilizing PDT for various skin conditions.

Results: Since PDT demonstrates both in vitro and in vivo anti-inflammatory effects, delivers anti-infectious effects and provides effects on metabolism of connective tissue, relevant diseases are also prone to be treated with PDT. Since PDT also influences keratinization of normal keratinocytes and maturation processes of sebaceous glands and hair follicles, emerging indications will be also present in this area.

Conclusion: Off-label use of PDT plays an important role in Dermatology. It is obvious that in the near future at least some indications like treatment of acne vulgaris and photochemorejuvenational procedures will reach in-label status.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To emphasize the need of treatment of actinic keratoses (AKs)
To compare efficacy, safety, tolerability, protocols, direct costs, indirect costs and cost/ effectiveness of the pharmacological treatment options
To help clinicians to choose the most suitable treatment for each single patient to optimize adherence
To compare the costs from the in the perspectives of patients, doctors and national health system

Introduction: The treatment of multiple AKs is a growing issue because of the aging of the population, the increase of cumulative sun exposure and a greater awareness of skin cancer prevention.
Many treatment approaches are approved in Europe and they differ each other for their pharmacological mechanism of action

Materials / method: Data of efficacy, safety and tolerability were obtained from meta-analysis and comparative clinical studies that were available on PubMed
Costs and treatment protocols were obtained from the official EMA approval statuses

Results: Broad differences in efficacy, safety, tolerability, protocols, direct costs, indirect costs and cost/ effectiveness of the pharmacological treatment options

Conclusion: The removal of multiple AKs is needed to prevent morbidity and mortality of squamous cell carcinoma. Many treatment options are available and the doctor can suggest to each patient the most suitable treatment.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
Yes
Please specify entities (individual, company, society): Leo, Galderma, Meda, Almirall, Pierre Fabre.

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: To obtain an overview of the effect and appliance of photodynamic therapy to prevent skin dysplasia

Introduction: Field-directed photodynamic therapy (PDT) has shown to be effective for secondary prevention of new actinic keratoses (AK) in skin with multiple lesions compared with lesion-directed treatment. However the potential of PDT for primary prevention of skin dysplasia in normal skin is poorly described.
We provide an overview of prophylactic PDT, bridging basic experimental studies with primary prevention in high risk patients.

Materials / method: Prophylactic PDT with methyl aminolevulinate (20% MAL) was assessed in hairless mice by 20% MAL-PDT (n=2) or repeated 0.02 - 0.1% hexyl aminolevulinate (HAL)-PDT (n= 3 times per week). Renal transplant recipients with normal skin were randomized to split-side MAL-PDT of the face, forearm and hand, the contralateral side serving as untreated control. PDT treatment was performed at 6-month intervals and evaluations were blinded.

Results: In hairless mice, SCC onset was delayed at median 89 days by 20% MAL-PDT (p<0.001) and median 19 days by 0.02-0.1% HAL-PDT (p<0.01). Renal transplant recipients developed AK in 63% of cases in untreated skin compared to 28% in PDT-treated skin (p=0.002) at 3-year follow-up with a total number of cumulated AK in untreated skin (n=43) compared to PDT-treated skin (n=8) (p=0.005).

Conclusion: Murine and preliminary data in OTRs propose PDT for early prevention of skin dysplasia and may reduce morbidity from multiple AK in OTR.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
Yes
Please specify entities (individual, company, society): Allergan, Galderma, Merz Aesthetics, Revance, Croma

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work is presented thanks to the support of: Allergan, Galderma, Merz Aesthetics, Revance, Croma

Objectives: Actinic cheilitis (AC) is a chronic neoplastic disorder of the lower lip vermillion. It is considered a precursor of squamous cell carcinoma (SCC), since it can progress from the in-situ into the invasive phase of SCC. Therefore, early and effective treatment is mandatory to reduce the risk of malignant transformation. Various therapeutic strategies, including local ablation, topical immunomodulation or chemotherapy, and surgical resection, have been proposed as therapeutic interventions for AC. Photodynamic therapy (PDT) with different treatment protocols and photosensitizers has been recentl

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Topical photodynamic therapy using methyl aminolevulinate is a non-invasive treatment option suitable to treat clinical and subclinical actinic keratosis (AK) over a large area (field cancerization). The illumination commonly causes pain, and very often patients cannot complete the treatment.

Introduction: This study aims i) to introduce a novel protocol, so-called the Phosistos protocol (P-PDT), which includes irradiation with a fabric-based biophotonic device, ii) to assess the non-inferiority, in terms of efficacy for PDT of AK , of the P-PDT compared to the conventional protocol (C-PDT).

Materials / method: A randomized, controlled, multicentre, intra-individual clinical study was conducted. Forty-six patients with grade I-II actinic keratosis of the forehead and scalp were treated with the P-PDT on one area (n=280 actinic keratosis) and with the C-PDT on the contralateral area (n=280 actinic keratosis). The primary endpoint was the lesion complete response rate at three months with an absolute non-inferiority margin of -10%. Secondary endpoints included patient-reported pain scores, emergence of new actinic keratosis, incidence of adverse events and cosmetic outcome.

Results: Three months following treatment, the lesion complete response rate with the P-PDT was non-inferior to the C-PDT (79.3% vs. 80.7%, respectively) Moreover, the patient-reported pain score was significantly lower with the P-PDT compared to the C-PDT(mean ± standard deviation: 0.3 ± 0.6 vs. 7.4 ± 2.3; p<0.0001). At six months, there was a lower incidence of new actinic keratosis for the area treated by the P-PDT compared to the C-PDT(8.6%).of patients vs. 39.1%

Conclusion: The Phosistos protocol (P-PDT) is non-inferior in terms of efficacy than the conventional protocol (C-PDT)in treating actinic keratosis of the forehead and scalp while leading to much lower pain scores and fewer adverse events.

Disclosures

Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): The Phosistos project was funded by the European Commission under the Competitiveness and Innovation Framework Programme (CIP) (Project identifier: CIP-ICT-PSP-2013-7-621103).

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability