Photodynamic Therapy in Dermatology

Dear Colleagues,

As many of you already know, photodynamic therapy (PDT) relies on the interaction between a photosensitizer, the appropriate activating wavelength of light, and oxygen. This reaction generates reactive oxygen species (ROS) in cells that either take up an exogenous photosensitizer or produce their own endogenously and causes cell death by necrosis or apoptosis, while minimally affecting the surrounding tissue. Initially, PDT relied on the systemic administration of a photosensitizer; more recently, the possibility of its topical application has revolutionized the field. The main types of topical photosensitizer prodrugs used for PDT are 5-aminolevulinic acid (5-ALA) and its derivatives. The most used derivative is methyl aminolevulinate (MAL), which is demethylated by the target tissue to produce ALA. Exogenously applied ALA and MAL bypass the intracellular rate-limiting step in the heme synthesis pathway to produce the actual photosensitizers, i.e., protoporphyrin IX and other porphyrins. Over the past 100 years, PDT has evolved into a safe and effective dermatologic treatment option for actinic keratosis/cheilitis, superficial nonmelanoma skin cancer (NMSC), and more recently, photoaging, acne, rosacea, sebaceous hyperplasia, and verrucae. When compared with other destructive treatment modalities, topical PDT offers the advantage of selectively and effectively targeting and simultaneously treating lesions over large surface areas, with little or no risk of scarring. One of the drawbacks of conventional PDT is the pain patients experience during treatment. For some time now, daylight PDT, with a shorter incubation time without occlusion (30 min) and a longer light phase (2h), has been used as an effective, safe, and much less painful alternative to conventional PDT. Recently, the joint application of new procedures, such as treatment with fractionated CO₂ laser as a drug-assisted delivery system, have been shown to increase PDT effectiveness. 

With this Special Issue, we hope to encourage submissions that discuss the current state of the art of conventional PDT and address new approaches to improve its efficacy.

Dr. Paula Aguilera
Guest Editor

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• Photodynamic Therapy
• ALA
• MAL
• Skin cancer
• Daylight PDT
• Fractionated CO2 laser