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Topical photodynamic therapy with porphyrin precursors—assessment of treatment-associated pain in a retrospective study

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Abstract

Photodynamic therapy (PDT) with aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) is an approved modality for the non-invasive treatment of actinic keratoses (AK) and basal cell carcinoma (BCC) offering excellent cosmetic outcome. However, pain during and after illumination is the most frequent and limiting side effect. The aim of this study was to precisely assess how reported pain during PDT is influenced by sex, age, treatment site, disease (AK/BCC) as well as the photosensitizer used. 467 lesions consisting of AK (primary treatments: n = 158; follow-up: n = 47) or BCC (primary treatments: n = 138; follow-up: 124) were treated by ALA- or MAL-PDT using metal halide lamps (580–750 nm). Pain was assessed during illumination using a continuous visual analogue scale (VAS). Factors predictive for higher pain levels during PDT are treatment of the head, treating AK and using ALA. The observed results may improve patient management and predict which level of pain to expect, and what kind of pain relief to prepare.

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References

  1. P. Babilas, M. Landthaler, R. M. Szeimies, Photodynamic therapy in dermatology, Eur. J. Dermatol., 2006, 16, 340–348.

    CAS  PubMed  Google Scholar 

  2. P. Babilas, S. Karrer, A. Sidoroff, M. Landthaler, R. M. Szeimies, Photodynamic therapy in dermatology—an update, Photodermatol. Photoimmunol. Photomed., 2005, 21, 142–149.

    Article  CAS  Google Scholar 

  3. C. Abels, C. Fritsch, K. Bolsen, R. M. Szeimies, T. Ruzicka, G. Goerz, A. E. Goerz, Photodynamic therapy with 5-aminolaevulinic acid-induced porphyrins of an amelanotic melanoma in vivo, J. Photochem. Photobiol., B, 1997, 40, 76–83.

    Article  CAS  Google Scholar 

  4. E. H. Tschen, D. S. Wong, D. M. Pariser, F. E. Dunlap, A. Houlihan, M. B. Ferdon, Phase IV ALA-PDT Actinic Keratosis Study Group, Photodynamic therapy using aminolaevulinic acid for patients with nonhyperkeratotic actinic keratoses of the face and scalp: phase IV multicentre clinical trial with 12-month follow up, Br. J. Dermatol., 2006, 155, 1262–1269.

    Article  CAS  Google Scholar 

  5. P. Foley, Clinical efficiacy of methyl aminolevulinate (Metvix) photodynamic therapy, J. Dermatol. Treat., 2003, 14, 15–22.

    Article  CAS  Google Scholar 

  6. C. A. Morton, Methyl aminolevulinate actinic keratoses and Bowen’s disease, Dermatol. Clin., 2007, 25, 81–87.

    Article  CAS  Google Scholar 

  7. C. Morton, S. Campbell, G. Gupta, S. Keohane, J. Lear, I. Zaki, S. Walton, N. Kerrouche, G. Thomas, P. Soto, Aktion Investigators, Intraindividual, right-left comparison of topical methyl aminolaevulinate-photodynamic therapy and cryotherapy in subjects with actinic keratoses: a multicentre, randomized controlled study, Br. J. Dermatol., 2006, 155, 1029–1036.

    Article  CAS  Google Scholar 

  8. M. Berker, B. Hughes, Using a tool for pain assessment, Nurs. Times, 1990, 86, 50–52.

    CAS  PubMed  Google Scholar 

  9. C. A. Morton, Realizing the cosmetic potential of topical photodynamic therapy, J. Cosmet. Dermatol., 2002, 1, 66–71.

    Article  CAS  Google Scholar 

  10. G. Dragieva, J. Hafner, R. Dummer, P. Schmid-Grendelmeier, M. Roos, B. M. Prinz, G. Burg, U. Binswanger, W. Kempf, Topical photodynamic therapy in the treatment of actinic keratoses and Bowen’s disease in transplant recipients, Transplantation, 2004, 77, 115–121.

    Article  Google Scholar 

  11. S. Fijan, H. Hönigsmann, B. Ortel, Photodynamic therapy of epithelial skin tumours using delta-aminolaevulinic acid and desferrioxamine, Br. J. Dermatol., 1995, 133, 282–288.

    Article  CAS  Google Scholar 

  12. S. R. Wiegell, I. M. Stender, R. Na, H. C. Wulf, Pain associated with photodynamic therapy using 5-aminolevulinic acid or 5-aminolevulinic acid methylester on tape-stripped normal skin, Arch. Dermatol., 2003, 139, 1173–1177.

    Article  CAS  Google Scholar 

  13. A. Kasche, S. Luderschmidt, J. Ring, R. Hein, Photodynamic therapy induces less pain in patients treated with methyl aminolevulinate compared to aminolevulinic acid, J. Drugs Dermatol., 2006, 5, 353–356.

    CAS  PubMed  Google Scholar 

  14. S. M. Langan, P. Collins, Randomized, double-blind, placebo-controlled prospective study of the efficacy of topical anaesthesia with a eutetic mixture of lignocaine 2.5% and prilocaine 2.5% for topical 5-aminolaevulinic acid-photodynamic therapy for extensive scalp actinic keratoses, Br. J. Dermatol., 2006, 154, 146–149.

    Article  CAS  Google Scholar 

  15. C. Sandberg, B. Stenquist, I. Rosdahl, A. M. Ros, I. Synnerstad, M. Karlsson, F. Gudmundson, M. B. Ericson, O. Larkö, A. M. Wennberg, Important factors for pain during photodynamic therapy for actinic keratosis, Acta Derm. Venereol., 2006, 86, 404–408.

    Article  Google Scholar 

  16. J. Skiveren, M. Haedersdal, P. A. Philipsen, S. R. Wiegell, H. C. Wulf, Morphine gel 0.3% does not relieve pain during topical photodynamic therapy: a randomized, double-blind, placebo-controlled study, Acta Derm. Venereol., 2006, 86, 409–411.

    Article  Google Scholar 

  17. P. Babilas, M. Landthaler, R. M. Szeimies, Actinic keratoses, Hautarzt, 2003, 54, 551–560.

    Article  CAS  Google Scholar 

  18. A. M. Wennberg, O. Larko, P. Lennroth, G. Larson, A. L. Krogstad, Delta-aminolevulinic acid in superficial basal cell carcinomas and normal skin–a microdialysis and perfusion study, Clin. Exp. Dermatol., 2000, 25, 317–22.

    Article  CAS  Google Scholar 

  19. S. Grapengiesser, M. Ericson, F. Gudmundsson, O. Larkö, A. Rosén, A. M. Wennberg, Pain caused by photodynamic therapy of skin cancer, Clin. Exp. Dermatol., 2002, 27, 493–497.

    Article  CAS  Google Scholar 

  20. I. Wang, Photodynamic Therapy and Laser-Based Diagnostic Studies of Malignant Tumours, Dissertation, Lund University, Lund, Sweden, 1999.

    Google Scholar 

  21. R. Agostino, G. Cruccu, G. Iannetti, A. Romaniello, A. Truini, M. Manfredi, Topographical distribution of pinprick and warmth thresholds to CO2 laser stimulation on the human skin, Neurosci. Lett., 2000, 285, 115–118.

    Article  CAS  Google Scholar 

  22. E. Rud, O. Gederaas, A. Høgset, K. Berg, 5-aminolevulinic acid, but not 5-aminolevulinic acid esters, is transported into adenocarcinoma cells by system BETA transporters, Photochem. Photobiol., 2000, 71, 640–647.

    Article  CAS  Google Scholar 

  23. R. R. Edwards, N. B. Fillingim, T. J. Ness, Age-related differences in endogenous pain modulation: a comparison of diffuse noxious inhibitory controls in healthy older and younger adults, Pain, 2003, 101, 155–165.

    Article  Google Scholar 

  24. M. W. Heft, B. Y. Cooper, K. K. O’Brien, E. Hemp, R. O’Brien, Aging effects on the perception of noxious and non-noxious thermal stimuli applied to the face, Aging (Milano), 1996, 8, 35–41.

    CAS  Google Scholar 

  25. R. R. Edwards, R. B. Fillingim, Age-associated differences in responses to noxious stimuli, J. Gerontol. A: Biol. Sci. Med. Sci., 2001, 56, M180–M185.

    Article  CAS  Google Scholar 

  26. R. R. Edwards, R. B. Fillingim, T. J. Ness, Age-related differences in endogenous pain modulation: a comparison of diffuse noxious inhibitory controls in healthy older and younger adults, Pain, 2003, 101, 155–165.

    Article  Google Scholar 

  27. R. R. Edwards, D. M. Doleys, D. Lowery, R. B. Filligim, Pain tolerance as a predictor of outcome following multidisciplinary treatment for chronic pain: differential effects as a function of sex, Pain, 2003, 106, 419–426.

    Article  Google Scholar 

  28. D. Lowery, R. B. Fillingim, R. A. Wright, Sex differences and incentive effects on perceptual and cardiovascular responses to cold pressor pain, Psychosom. Med., 2003, 65, 284–291.

    Article  Google Scholar 

  29. D. L. Mahony, W. J. Burroughs, A. C. Hieatt, The effects of laughter on discomfort thresholds: does expectation become reality?, J. Gen. Psychol., 2001, 128, 217–226.

    Article  CAS  Google Scholar 

  30. Y. Sharav, M. Tal, Focussed analgesia and generalized relaxation produce differential hypnotic analgesia in response to ascending stimulus intensity, Int. J. Psychophysiol., 2004, 52, 187–196.

    Article  Google Scholar 

  31. M. P. Goldman, C. Merial-Kieny, T. Nocera, S. Mery, Comparative benefit of two thermal spring waters after photodynamic therapy procedure, J. Cosmet. Dermatol., 2007, 6, 31–35.

    Article  Google Scholar 

  32. H. J. McQuay, M. Tramèr, B. A. Nye, D. Carroll, P. J. Wiffen, R. A. Moore, A systematic review of antidepressants in neuropathic pain, Pain, 1996, 68, 217–227.

    Article  CAS  Google Scholar 

  33. K. H. Todd, K. G. Funk, J. P. Funk, R. Bonacci, Clinical significance of reported changes in pain severity, Ann. Emerg. Med., 1996, 27, 485–489.

    Article  CAS  Google Scholar 

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Author notes

  1. Both authors contributed equally to this paper.

Authors and Affiliations

  1. Department of Dermatology, Regensburg University Hospital, D-93042, Regensburg, Germany

    Julia Maria Steinbauer, Stephan Schreml, Philipp Babilas, Sigrid Karrer, Michael Landthaler & Rolf-Markus Szeimies

  2. Center for Clinical Studies, Regensburg University Hospital, D-93042, Regensburg, Germany

    Florian Zeman

Authors
  1. Julia Maria Steinbauer
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  2. Stephan Schreml
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  3. Philipp Babilas
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  4. Florian Zeman
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  5. Sigrid Karrer
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  6. Michael Landthaler
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  7. Rolf-Markus Szeimies
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Correspondence to Rolf-Markus Szeimies.

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Steinbauer, J.M., Schreml, S., Babilas, P. et al. Topical photodynamic therapy with porphyrin precursors—assessment of treatment-associated pain in a retrospective study. Photochem Photobiol Sci 8, 1111–1116 (2009). https://doi.org/10.1039/b823378k

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  • DOI: https://doi.org/10.1039/b823378k

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