Clinical Study Of ALA-PDT In The Treatment Of Neoplastic And Inflammatory Skin Diseases

Objective To observe the clinical efficacy and adverse reactions of 5-aminolevulinic acid photodynamic therapy(ALA-PDT)in the treatment of neoplastic skin diseases and inflammatory skin diseases.Evaluate the cons and prons of ALA-PDT option from the aspects of curative effect,adverse reaction,recurrence rate,trauma,cosmetology,and patient satisfaction,to guide dermatologists to choose and implement the optimal treatment plan.Methods 1.In this study,50 patients were daignosied clinically or pathologicaly with skin tumors,genital warts,moderate-to-severe acne,and folliculitis decalvans.They have treated with ALA-PDT in our clinic department from April 2020 to January 2021.2.All patients were treated with 2~6 sessions of ALA-PDT treatment.The clinical efficacy,side-effects,recurrence rate,cosmetic outcome,skin damage,and patient satisfaction were recorded and evaluated.Results i.Treatment outcomes:(1)8 cases of non-melanic skin cancers,among them,4 cases of SCC,two cases were cured,2 cases were markedly effective,the therapeutic effect rate was 100%;one case of BCC was completely cured;one case of multifocal AK was completely cured;one case of Bowen’s disease was markedly effective;one case of extramammary of Paget’s disease was effectual.(2)38 patients with Condyloma acuminatum,29 cases were completely cured,6 cases were markedly effective;in total,the curative effect rate of genital warts in this study was 92%.(3)4 cases with acne and folliculitis,3 cases of severe cystic and inflammatory acne all were markedly effective,and the therapeutic effect rate was 100%;one case of folliculitis decalvans was cured.There was no significant difference in the total effective rate of all different types of diseases.ii.Adverse reactions: 13 patients had adverse reactions during treatment sessions,and the total incidence rate was 26%.The main manifestations were a mild burning sensation,erythema,erosions,sickness and vomiting,local area swelling,peripheral pigment changes.Among them,mild burning sensation occurred in 6 cases,with an incidence of 12%;burning pain accompanied by erosion and localized and peripheral pigment changes occurred in 3 cases,with an incidence of 6%;erythema occurred in 3 cases,with an incidence of 6%;sickness and vomiting occurred in one case only,with an incidence of 2%.iii.Traumatic assessment and management:(1)Pain assessment and management :two out of fifty patients had a pain score of 2 points(slightly aware of pain,when paying attention to it),both of them need no management.The other remaining 48 patients had 0 scores(painless).(2)Functional assessment:the evaluation results of 50 patients were grade III(satisfied,unrestricted function,no impact on everyday life activities,no local abnormality).iv.Cosmetic outcomes assessment: In 50 patients,two cases of grade 1(4 %)had localized erythema or prominent brown pigmentation spots on the surface and edges of the treatment site;2 cases of grade 2(4%)had very thin scars or no scars;the other remaining cases of grade 3(92%)had no scars and pigment changes.v.Recurrence rate(RR): In total,there were 9 cases of recurrence in this study.In the skin neoplasm group,Bowen’s disease(1 case,RR: 4%),Paget’s disease(1 case,RR: 4%),Actinic keratosis(AK),basal cell carcinoma(BCC),squamous cell carcinoma(SCC)had no recurrence.In the genital warts group,6 out 38 cases have recurred(RR: 15.79%);including 3 cases of urethral orifice condyloma acuminatum,with a recurrence rate of(7.9%),one case of anal canal condyloma acuminatum(2.6%),one case of cervical condyloma acuminatum(2.6%),one case of condyloma acuminatum of the penile shaft(2.6%),there was no recurrence of vulvar condyloma acuminatum;only 1 case of inflammatory cystic acne recurred(RR: 33.3%)in the acne and folliculitis groups;there was no recurrence of folliculitis decalvans(FD).vi.Patient satisfaction survey: 32 cases were 5 points(very satisfied),accounting for 64%;15 cases were 4 points(satisfied),accounting for 30%;3 cases were 3 points(neutral),accounting for 6%.The total satisfaction rate in this study was 94%.Conclusion 1.ALA-PDT is a non-invasive emerging modality of photochemical therapy,which can be widely used to treat various skin disorders.2.Combined treatment methods can achieve better clinical response and reduce recurrence rate in neoplastic and inflammatory skin lesions,especially large-size lesions;thus,it is recommended first to apply one or more of other modalities(surgery,cryotherapy,electrocautery,topical chemotherapy agents),followed by ALA-PDT treatment.3.ALA-PDT has a low incidence rate of side effects,including mild pain,burning sensation,erosion,peripheral pigment changes,and other adverse reactions.4.ALA-PDT treatment is a non-invasive procedure,has excellent cosmetic outcomes,high patient satisfaction,less adverse reactions.PDT modality is also suitable for specialized patients groups,for example,organs transplant recipients,immunocompromised individuals,neoplastic and inflammatory lesions in sites with high cosmetic concerns(scalp,face,genitalia),and elderly patients,especially those with multiple chronic diseases,and can not tolerate other traumatic treatment.