| DERMATOLOGY | PEER-REVIEW
contributes to induce a superficial PDT effect, also effectively photo-bleaching the porphyrins accumulated within external skin layers. This primary PDT effect will therefore also allow for a more efficient penetration of the two subsequent red LED irradiations. Red LED will, therefore, be allowed to produce a deeper and more efficient PDT effect. The 20 minute resting intervals between each irradiation allows a ‘replenishing’ of O2
tissue reservoirs, necessary to
absolutely generate
efficient PDT effects on deeper skin layers. SBRR-MAL-PDT is not a
pain-free procedure. The sequential triple irradiation series — one blue and two red LED — was perceived as painful by all patients enrolled in the study, even if pain levels stabilized little above level 5 on a 10-point VAS scale. Pain was more intense during LED irradiation and progressively faded once PDT reactions subsided. Patients who underwent a second SBRR-MAL-PDT session confirmed a relative reduction in pain level possibly due to a reduced number of inflammatory lesions and as a progressive ‘accustomisation’ to PDT treatments. Similar behaviour has been described in other clinical studies15
. During SBRR-MAL-PDT a non-contact
epidermal cooling device was used in order to minimise discomfort during LED irradiations, since pain associated with PDT represents an important patient-related limitation factor in PDT procedures22
advised to all dermatologists performing PDT procedures. Even if all SSF measurements are important, the final SSF assessment, performed immediately after the last light irradiation, bears two clear advantages: Objective control of PDT efficiency through a objective photo-bleaching effect Patient safety before discharging due to objectively perceived reduction of intra- tissue levels of photosensitizer. According to the authors’ results, this new therapeutic protocol seems to constitute a safe and effective alternative to oral medications, even in countries with plenty of sunshine. SBRR-MAL-PDT could be proposed as a valid alternative strategy to oral medications for patients affected by congenital h yper li p i da emia, neuropathy, hepatopathy, and psychotic/depressive disorders, as well as those with elevated alcohol
consumption, blood donors, and all those involved in strenuous physical activities. Patients resistant to conventional acne therapies, with multiple antibiotic allergies/resistance, and all those who are unable or unwilling to take oral isotretinoin, as well as women who are planning a pregnancy, could all benefit from this innovative photo-chemical
bio-modulative treatment strategy.
In conclusion, SBRR-MAL-PDT can be considered a safe and effective alternative treatment to control the
clinical manifestations of moderate-to- severe acne vulgaris.
. So far the use of epidermal freezing or
cooling devices is considered the best way to decrease and control pain induced by PDT procedures23
.
Side-effects perceived by patients were similar to those reported in other studies14
even if SBRR-MAL-PDT
was associated with fewer profound, shorter duration, and self-resolving post-treatment alterations. Fluorescence monitoring was achieved using a hand-
held fluorimeter. Measurements performed at three key stages during SBRR-MAL-PDT allowed for perfect awareness of the immediate tissue response before and after PDT. As noticed by other investigators, monitoring PpIX fluorescence might allow a better standardisation of tissue concentrations of photosensitizers before light irradiation, potentially leading to improved success rates through optimization of treatment parameters24 Therefore, SSF-PDT monitoring should be strongly
.
Effective and long-lasting control Cost-effectiveness is of primary importance, particularly in times of global recession. Comparing costs related to oral isotretinoin treatments, inevitably associated with costly laboratory monitoring, possible management of side-
effects, and potential complications with those of SBRR- MAL-PDT and other acne-PDT procedures, overall investments might be cheaper for PDT strategies, although more studies are necessary to establish long- term costs of PDT acne control strategies25
. It is important to consider that achieving an effective
and long lasting control of acne vulgaris associated with minimal side-effects, complications, and pain remains a difficult therapeutic challenge even if various alternatives exist to cover almost all clinical manifestations of this complex and widespread skin condition. Treatment strategies should be aimed not only at controlling the clinical manifestation of acne, decreasing the number of active lesions, but also preventing scaring26
while
controlling anxiety, depression, and other psychological problems that might lead to a progressive modification of social interactions27
.
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