Do pulsed lasers produce an effective photodynamic therapy response?

Abstract

Background: Photodynamic therapy (PDT) in dermatology is traditionally performed with topical aminolevulinic acid (ALA) and continuous-wave (CW) illumination with blue or red light. Recently, several authors have reported success with laser and other pulsed-light sources for PDT. While the clinical benefits on sun-exposed skin are apparent, no study has demonstrated that the pulsed light sources are responsible for the observed response. Study Design: A placebo-controlled study of two pulsed light sources previously reported for PDT: the pulsed dye laser (PDL) or broadband flashlamp filtered intense pulsed light (IPL). Sun-hidden skin was prepared with micro-dermabrasion and acetone scrub followed by ALA under occlusion. Laser or IPL was delivered under conditions previously reported to produce a clinical response. Control areas were exposed to standardized CW blue light or to no light. A second control area was prepared and received light and the ALA vehicle. Results: IPL and PDL demonstrated a faint dose-response effect on PDT activation, but were less potent than a smaller fluence of CW blue light. Ambient light activated ALA-treated skin. Conclusion: Both IPL and PDL are capable of activation of PDT but produce dramatically less PDT reaction than the standard CW blue-light broadband source. Physicians desiring a robust PDT response might select CW sources over pulsed sources. Ambient light may activate a PDT reaction. © 2006 Wiley-Liss, Inc.