Presidential Greeting - American Society for Laser Medicine and ...

52 American Society for Laser Medicine and Surgery Abstracts
unblinded evaluation PDT reactions were enhanced and clearance
rates increased on the treated extremity compared to the nontreated
extremity. The treatment was generally tolerated well.
Conclusion: Warm-skin PDT appears to improve the efficacy of
the treatment of actinic keratoses on the extremities with
reasonable tolerability and may be a useful adjunct in the setting
of field cancerization.
#177
FRACTIONAL CO2 LASER IMPROVES
TREATMENT OF NBCC WITH ALA-PDT
Roman Smucler, Jan Lippert, Marek Vlk
Charles University, Prague, Czech Republic
Background: Photodynamic therapy with aminolevulic acid
(ALA-PDT) is well-established treatment method for superficial
form of basal cell carcinoma (BCC) and actinic keratosis mostly.
Nodular form of BCC is perceived as contraindication due to
tumor layer bigger then 2 mm. Proper penetration of
photosensitizer is crucial. Classical approach is curettage.
Authors previously improved results with ablative laser. Another
possibility offers ablative fractional laser which produce skin
microtubules. This principle can enhance penetration of ALA but
necrotic tissue surrounding tubules can decrease effectiveness.
Aim of our study is to evaluate fractional laser as pre-treatment
before ALA-PDT in nodular BCC.
Study: Twenty-five histologically verified nBCC were under
control of ultrasound ablated with 980 nm diode laser up depth
between 1 and 3 mm. Three weeks later half of tumor was treated
with curettage and second with fractional CO2 laser—density
40%. Study was blinded with different side treatment.
Immediately after we applied mALA, 3 hours occlusion, Aklilite
irradiation 40 J cm 2 . Checkups every months with fluorescence
(ALA based) and defined photography. Single-blinded. Evaluator
compared fluorescence with use of scale. After 12 months biopsy
from both sides.
Results: Twenty-five nBCC treated compare 22 in control
group. Fluorescence significantly lower in treatment group. More
adverse effects and longer down time in treatment group.
Conclusion: Fractional laser pre-treatment can enhance ALA-
PDT but we do not know proper parameters, optimal laser, protocol.
Many studies will be necessary before finalclinicaloutcomes.
#178
NEW TOPICAL PHOTODYNAMIC THERAPY FOR
MANAGEMENT OF PRIMARY AXILLARY
HYPERHIDROSIS
Abeer Attia, Manal Salah
National Institute of Enhanced Laser Sciences, Cairo, Egypt
Background: A variety of treatment modalities have been used
in the management of primary axillary hyperhidrosis but no ideal
treatment yet. Recurrence and side effects of these modalities
suggested the need for a long acting treatment with a strong
safety profile. To study the efficacy and safety of photodynamic
therapy in management of primary axillary hyperhidrosis using
topical Eosin gel and intense pulsed light.
Study: Twenty patients were treated using intense pulsed light
with a 400 nm filter, 20 milliseconds pulse duration and 25 J/cm 2
fluence, once weekly, for four sessions after applying Eosin gel to
the right axilla for 1 hour and placebo gel to the left. Efficacy was
measured by hyperhidrosis disease severity scale (HDSS), and
assessment of sweating area reduction using the minor iodine
starch test. Liposomal eosin hydrogel has been prepared and
applied on 24 rats to test for sensitivity reaction, and autopsies
were examined histologically after irradiation of liposomal Eosin
hydrogel with light emitting diode (LED).
Results: A highly significant reduction of the mean hyperhidrotic
area from 65 28.2 cm 2 before treatment to 5.7 5.2 cm 2 at the
end of treatment (P < 0.01). A 90.1% reduction in the area of
hyperhidrosis of the right axilla was obtained versus 2.2%
reduction in the placebo site. A 3-point improvement on the 4point
(HDSS) was reported in seven patients (35%), a 2-point
improvement was reported in nine patients (45%) and 1-point
improvement was elicited in four patients (20%). Three patients
(15%) reported a 1-point improvement from HDSS score 4 to score
3 at the placebo site. No recurrence occurred during the 8-month
follow-up period.
Conclusion: Photodynamic therapy using Eosin gel, which is
photoactivated by IPL, is a non-invasive, safe and effective
method for management of primary axillary hyperhidrosis with
no risk of multiple frequent injections and is not time consuming.
Further studies and long-term follow-up are needed.
#179
INVESTIGATION OF THE EFFECTIVENESS OF
NON-COHERENT BLUE LIGHT IN
INTRALESIONAL PHOTODYNAMIC THERAPY OF
BASAL CELL CARCINOMA
Robert Anolik, Lori Brightman, Anne Chapas,
Elliot Weiss, Leonard Bernstein, Roy G. Geronemus,
Elizabeth K. Hale, Julie K. Karen
Laser and Skin Surgery Center of New York, New York, NY
Background: Innovative treatments are urgently needed for the
more than 1 million non-melanoma skin cancers (NMSCs) that
arise in the US annually, particularly for those prone to numerous
NMSCs or poor surgical candidates. Topical photodynamic
therapy (PDT) offers a novel strategy. Injection of
photosensitizing agents may enhance PDT efficacy by increasing
depth of activity around localized tumors. The purpose of this
study is to determine the effectiveness of non-coherent blue light
in the intralesional PDT of BCC.
Study: This is a prospective, IRB-approved study of 20 BCCs in a
private dermatology center. Each BCC was injected with 20%
aminolevulinic acid, incubated for one hour, and exposed to noncoherent
blue light. If without clinical clearance at 8 weeks, a
second treatment was performed. Clinical evaluations were
performed at each treatment and repeated at 16 weeks, 1 year,
and 2 years after PDT. These follow-up visits included subjective
patient assessments and punch biopsies of the treatment sites.
Results: To date, no patient has been lost to follow-up. All 20
BCCs were evaluated at 16 weeks, showing recurrence at two sites
on histology. For those 18 sites still negative at 16 weeks, 13 have
been re-evaluated at 1 year, with an additional 4 sites of
recurrence. Five have returned for their 2-year exam and showed
recurrence at 1 more site. Although the number may increase with
the remaining 1- and 2-year follow-up visits, the overall
recurrence rate to date is 35% (7 of 20 sites) at 2 years. Notably,
physicians graded cosmetic outcome as good-to-excellent in 2/3 or
more of the treatment sites at all follow-up exams. No unusual
adverse event was appreciated.
Conclusion: Intralesional PDT offers a potential alternative for
effective and cosmetically acceptable treatment of BCC, although
recurrence rates are higher than some other options.