Document Type : systematic review

Author

Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Although the application of Photo-Dynamic Therapy (PDT) has been increased for the treatment of cutaneous disease in adults with various skin problems, it seems that the effectiveness of the approach has been less investigated in children. Therefore, this systematic review aimed to assess the application of photodynamic therapy in children with skin disease.
Methods: The present review has followed Cochrane’s methods for conducting systematic reviews of interventions. Relevant studies were collected by searching four electronic databases, including PubMed, Scopus, Medline, and Web of Sciences using such keywords as "photodynamic therapy " and "PDT", in combination with "cutaneous disease ", "skin disease ", and "Children" or "pediatric" up to 2022.
Results: In total, 42 studies were included in this review, among which 14 were conducted on patients with acne vulgaris (treatment success rate: 26.3% to 100%) and eight articles studied plantar warts and condyloma acuminatum (treatment success rate: 30% to 100%). Other cutaneous diseases in children treated by PDT included porokeratosis, port-wine stain, basal cell carcinomas, leishmaniasis, tinea capitis, xeroderma pigmentosum, Langerhans cell histiocytosis, lymphomatoid papulosis, and Bowen’s disease, with treatment success rates between 30% and 100%.
Conclusion: It seems that PDT has a treatment potential to be used for children with cutaneous disease. However, due to the existence of non-uniform parameters for PDT treatment, optimization of the treatment protocol (distinct for each disease) is necessary to ensure a better result with long-term remission in children with cutaneous disease.

Keywords

  1. Wan MT, Lin JY. Current evidence and applications of photodynamic therapy in dermatology. Clinical, cosmetic and investigational dermatology. 2014; 7:145.
  2. Babilas P, Schreml S, Landthaler M, Szeimies RM. Photodynamic therapy in dermatology: state‐of‐the‐art. Photodermatology, photoimmunology & photomedicine. 2010; 26(3):118-32.
  3. MacFarlane DF. Skin Cancer Management: Springer; 2009.
  4. Stapleton M, Rhodes L. Photosensitizers for photodynamic therapy of cutaneous disease. Journal of dermatological treatment. 2003; 14(2):107-12.

5. Hongcharu W, Taylor CR, Aghassi D, Suthamjariya K, Anderson RR, Chang Y. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. Journal of 

Investigative Dermatology. 2000; 115(2):183-92.

  1. Abdel-Kader MH, Eltayeb TA. Photodynamic control of malaria vector, noxious insects and parasites. Photodynamic Therapy: Springer; 2014. p. 269-91.
  2. Morton C, McKenna K, Rhodes L, Guidelines BAoDT, Subcommittee A, Group tBP. Guidelines for topical photodynamic therapy: update. British Journal of Dermatology. 2008; 159(6):1245-66.
  3. MacCormack MA, editor Photodynamic therapy in dermatology: an update on applications and outcomes. Seminars in cutaneous medicine and surgery; 2008: WB Saunders.
  4. Fernández-Guarino M, García-Morales I, Harto A, Montull C, Pérez-García B, Jaén P. Photodynamic therapy: new indications. Actas Dermo-Sifiliográficas (English Edition). 2007; 98(6):377-95.
  5. Van der Snoek E, Robinson D, Van Hellemond J, Neumann H. A review of photodynamic therapy in cutaneous leishmaniasis. Journal of the European Academy of Dermatology and Venereology. 2008; 22(8):918-22.
  6. Green S, Higgins J. Cochrane handbook for systematic reviews of interventions. Version; 2005.
  7. Higgins J. Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 (updated March 2011). The Cochrane Collaboration. www. cochrane-handbook org. 2011.
  8. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: John Wiley & Sons; 2011.
  9. Pollock B, Turner D, Stringer M, Bojar R, Goulden V, Stables G, Cunliffe WJ. Topical aminolevulinic acid‐photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. British Journal of Dermatology. 2004; 151(3):616-22.
  10. Ma Y, Liu Y, Wang Q, Ren J, Xiang L. Prospective study of topical 5‐aminolevulinic acid photodynamic therapy for the treatment of severe adolescent acne in Chinese patients. The Journal of Dermatology. 2015; 42(5):504-7.
  11. Ahmed Abdul Latif A, Mohammad Abd El-Kareem I. Methylene Blue Photodynamic Therapy Versus Tuberculin Purified Protein Derivative (PPD) Immunotherapy in Plane Warts in Children. Al-Azhar Medical Journal. 2020; 49(2):639-50.
  12. Nassar A, Mostafa M, Khashaba S. Photodynamic therapy versus candida antigen immunotherapy in plane wart treatment: a comparative controlled study. Photodiagnosis and Photodynamic Therapy. 2020; 32:101973.
  13. Borgia F, Giuffrida R, Coppola M, Princiotta R, Vaccaro M, Guarneri F, Cannavò SP. Efficacy and safety of conventional versus daylight photodynamic therapy in children affected by multiple facial flat warts. Photodiagnosis and Photodynamic Therapy. 2020; 31:101819.
  14. Schroeter CA, Pleunis J, van Nispen tot Pannerden C, Reineke T, Neumann HA. Photodynamic therapy: new treatment for therapy‐resistant plantar warts. Dermatologic surgery. 2005; 31(1):71-5.
  15. Yin G, Zhang Y, Liu J, Wang P, Li X. Successful application of aminolevulinic acid/photodynamic therapy in the treatment of condyloma acuminatum in a young child. Photodiagnosis and Photodynamic Therapy. 2022; 38:102746.
  16. Borgia F, Coppola M, Giuffrida R, Cannavò SP. Excellent cosmetic result of daylight photodynamic therapy for facial flat warts in a child. Photodiagnosis and Photodynamic Therapy. 2019; 26:27-8.
  17. Chen M, Xie J, Han J. Photodynamic therapy of condyloma acuminatum in a child. Pediatric dermatology. 2010; 27(5):542-4.
  18. LIN MY, XIANG LH. Topical 5‐aminolevulinic acid photodynamic therapy for recalcitrant facial flat wart in Chinese subjects. The Journal of dermatology. 2008; 35(10):658-61.
  19. Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. British Journal of Dermatology. 2000; 142(5):973-8.
  20. Tzung TY, Wu KH, Huang ML. Blue light phototherapy in the treatment of acne. Photodermatology, photoimmunology & photomedicine. 2004; 20(5):266-9.
  21. Oseroff AR, Shieh S, Frawley NP, Cheney R, Blumenson LE, Pivnick EK, Bellnier DA. Treatment of diffuse basal cell carcinomas and basaloid follicular hamartomas in nevoid basal cell carcinoma syndrome by wide-area 5-aminolevulinic acid photodynamic therapy. Archives of dermatology. 2005; 141(1):60-7.
  22. Morton C, Scholefield R, Whitehurst C, Birch J. An open study to determine the efficacy of blue light in the treatment of mild to moderate acne. Journal of dermatological treatment. 2005; 16(4):219-23.
  23. Rojanamatin J, Choawawanich P. Treatment of inflammatory facial acne vulgaris with intense pulsed light and short contact of topical 5‐aminolevulinic acid: a pilot study. Dermatologic surgery. 2006; 32(8):991-7.
  24. Hörfelt C, Funk J, Frohm‐Nilsson M, Wiegleb Edström D, Wennberg AM. Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study. British Journal of Dermatology. 2006; 155(3):608-13.
  25. Asilian A, Davami M. Comparison between the efficacy of photodynamic therapy and topical paromomycin in the treatment of Old World cutaneous leishmaniasis: a placebo‐controlled, randomized clinical trial. Clinical and Experimental Dermatology: Clinical dermatology. 2006; 31(5):634-7.
  26. Hörfelt C, Stenquist B, Larkö O, Faergemann J, Wennberg A-M. Photodynamic therapy for acne vulgaris: a pilot study of the dose-response and mechanism of action. Acta dermato-venereologica. 2007; 87(4).
  27. Loncaster J, Swindell R, Slevin F, Sheridan L, Allan D, Allan E. Efficacy of photodynamic therapy as a treatment for Gorlin syndrome-related basal cell carcinomas. Clinical Oncology. 2009; 21(6):502-8.
  28. García-Navarro X, Garcés JR, Baselga E, Alomar A. Linear porokeratosis: excellent response to photodynamic therapy. Archives of dermatology. 2009; 145(5):526-7.
  29. Barolet D, Boucher A. Radiant near infrared light emitting Diode exposure as skin preparation to enhance photodynamic therapy inflammatory type acne treatment outcome. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery. 2010; 42(2):171-8.
  30. Failla V, Wauters O, Caucanas M, Nikkels-Tassoudji N, Nikkels AF. Photodynamic therapy for multi-resistant cutaneous Langerhans cell histiocytosis. Rare Tumors. 2010; 2(2):94-6.
  31. Larson DM, Cunningham BB. Photodynamic therapy in a teenage girl with xeroderma pigmentosum type C. Pediatric Dermatology. 2012; 29(3):373-4.
  32. Yeung CK, Shek SY, Bjerring P, Yu CS, Kono T, Chan HH. A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery. 2007; 39(1):1-6.
  33. Girard C, Debu A, Bessis D, Blatière V, Dereure O, Guillot B. Treatment of Gorlin syndrome (nevoid basal cell carcinoma syndrome) with methyl aminolevulinate photodynamic therapy in seven patients, including two children: interest in tumescent anesthesia for pain control in children. Journal of the European Academy of Dermatology and Venereology. 2013; 27(2):e171-e5.
  34. Curkova AK, Hegyi J, Kozub P, Szep Z, D'Erme AM, Simaljakova M. A case of linear porokeratosis treated with photodynamic therapy with confocal microscopy surveillance. Dermatologic Therapy. 2014; 27(3):144-7.
  35. Gracia‐Cazaña T, Vera‐Álvarez J, García‐Patos V, Gilaberte Y. Imiquimod and photodynamic therapy are useful in the treatment of porokeratosis in children with bone marrow transplantation. Pediatric dermatology. 2015; 32(6):e291-e3.
  36. Garrido-Colmenero C, Ruiz-Villaverde R, Martínez-García E, Aneiros-Fernández J, Tercedor-Sánchez J. Photoletter to the editor: response of linear porokeratosis to photodynamic therapy in an 11-year-old girl. Journal of Dermatological Case Reports. 2015;9(4):118.
  37. Tao S-q, Li F, Cao L, Xia R-s, Fan H, Fan Y, Sun H, Jing C, Yang LJ. Low-dose topical 5-aminolevulinic acid photodynamic therapy in the treatment of different severity of acne vulgaris. Cell biochemistry and biophysics. 2015; 73(3):701-6.
  38. Tao S, Xia R, Li F, Cao L, Fan H, Fan Y, Tao S-Q, Xia R-S, Li F, Cao L, Fan H, Fan Y, Yang L-J. Efficacy of 3.6% topical ALA-PDT for the treatment of severe acne vulgaris. Eur Rev Med Pharmacol Sci. 2016; 20(2):225-31.
  39. Hyun DJ, Seo SR, Kim DH, Yoon MS, Lee HJ. Periungual Bowen's disease in a 12‐year‐old boy treated with photodynamic therapy. Pediatric Dermatology. 2016; 33(2):e82-e3.
  40. Pariser D M, Eichenfield LF, Bukhalo M, Waterman G, Jarratt M; PDT Study Group. Photodynamic therapy with methyl aminolaevulinate 80 mg g− 1 for severe facial acne vulgaris: a randomized vehicle‐controlled study. British Journal of Dermatology. 2016; 174(4):770-7.
  41. Zhang Y, Jiang S, Chen H, Zou X. Hemoporfin-mediated photodynamic therapy for the treatment of port-wine stain birthmarks in pediatric patients. Anais Brasileiros de Dermatologia. 2017; 92:559-61.
  42. Li-Qiang G, Hua W, Si-Li N, Chun-Hua T. A clinical study of HMME-PDT therapy in Chinese pediatric patients with port-wine stain. Photodiagnosis and Photodynamic Therapy. 2018; 23:102-5.
  43. Therapy. 2020; 30:101745.

    1. Khalaf AT, Sun Y, Wang F, Sheng M, Li Y, Liu X. Photodynamic therapy using HMME for port-wine stains: clinical effectiveness and sonographic appearance. BioMed Research International. 2020; 2020.
    2. Snider S, Costello CM, Ederaine S, Besch‐Stokes J, Severson KJ, DiCaudo DJ, Pittelkow MR, Mangold AR. A case of pediatric lymphomatoid papulosis treated with photodynamic therapy and narrowband ultraviolet B. Pediatric Dermatology. 2020; 37(5):881-3.
    3. Chun-Hua T, Li-Qiang G, Hua W, Jian Z, Li L, Yi W, Can L, Xiao-Yan L, Guang-Hui W. Efficacy and safety of hemoporfin photodynamic therapy for port-wine stains in pediatric patients: A retrospective study of 439 cases at a single center. Photodiagnosis and Photodynamic Therapy. 2021; 36:102568.
    4. Zhang LC, Yang J, Huang YB, Bi MY. Efficacy of hemoporfin photodynamic therapy for pulsed dye laser-resistant facial port-wine stains in 107 children: A retrospective study. Indian J Dermatol Venereol Leprol. 2022; 88(2):275.
    5. Knapp III C, Vaz L, Onoday H, Small A. Dual treatment of cutaneous leishmaniasis with topical amphotericin B and photodynamic therapy in a pediatric patient. Pediatric Dermatology.
    6. Abdullah EM, Tawfik A, Fadel M, Alsharnoubi J, Fadeel DAA, Abdallah N. Photodynamic therapy of tinea capitis in children using curcumin loaded in nanospanlastics: A randomized controlled comparative clinical study. Journal of Drug Delivery Science and Technology. 2022:103496.
    7. Kjeldstad B, Johnsson A, Sandberg S. Influence of pH on porphyrin production in Propionibacterium acnes. Archives of dermatological research. 1984; 276(6):396-400.
    8. Kjeldstad B, Johnsson A. An action spectrum for blue and near ultraviolet in activation of Propionibacterium acnes; with emphasis on a possible porphyrin photosensitization. Photochemistry and photobiology. 1986; 43(1):67-70.
    9. Arakane K, Ryu A, Hayashi C, Masunaga T, Shinmoto K, Mashiko S, Nagano T, Hirobe M. Singlet Oxygen (1Δg) Generation from Coproporphyrin inPropionibacterium acneson Irradiation. Biochemical and biophysical research communications. 1996; 223(3):578-82.
    10. Futsaether C, Kjeldstad B, Johnsson A. Intracellular pH changes induced in Propionibacterium acnes by UVA radiation and blue light. Journal of Photochemistry and Photobiology B: Biology. 1995; 31(3):125-31.
    11. Karu T. Primary and secondary mechanisms of action of visible to near-IR radiation on cells. Journal of Photochemistry and photobiology B: Biology. 1999; 49(1):1-17.
    12. Nouri K, Villafradez‐Diaz LM. Light/laser therapy in the treatment of acne vulgaris. Journal of cosmetic dermatology. 2005; 4(4):318-20.
    13. Kawada A, Aragane Y, Kameyama H, Sangen Y, Tezuka T. Acne phototherapy with a high-intensity, enhanced, narrow-band, blue light source: an open study and in vitro investigation. Journal of dermatological science. 2002; 30(2):129-35.
    14. Lim J, Gattone VH, Sinders R, Miller CA, Liang Y, Harris P, Watkins JB, Henshel DS. Acceleration of the meckel syndrome by near-infrared light therapy. Nephron Extra. 2011; 1(1):224-34.
    15. Sakamoto FH, Lopes JD, Anderson RR. Photodynamic therapy for acne vulgaris: a critical review from basics to clinical practice: part I. Acne vulgaris: when and why consider photodynamic therapy? Journal of the American Academy of Dermatology. 2010; 63(2):183-93.
    16. Kyriakis K, Pagana G, Michailides C, Emmanuelides S, Palamaras I, Terzoudi S. Lifetime prevalence fluctuations of common and plane viral warts. Journal of the European Academy of Dermatology and Venereology. 2007; 21(2):260-2.
    17. Majid I, Imran S. Immunotherapy with intralesional Candida albicans antigen in resistant or recurrent warts: A study. Indian journal of dermatology. 2013; 58(5):360.
    18. Muñoz Garza FZ, Roé Crespo E, Torres Pradilla M, Aguilera Peirò P, Baltà Cruz S, Hernandez Ruiz ME, Torres BE. Intralesional Candida antigen immunotherapy for the treatment of recalcitrant and multiple warts in children. Pediatric Dermatology. 2015; 32(6):797-801.
    19. Hu Z, Liu L, Zhang W, Liu H, Li J, Jiang L, Zeng K. Dynamics of HPV viral loads reflect the treatment effect of photodynamic therapy in genital warts. Photodiagnosis and Photodynamic Therapy. 2018; 21:86-90.
    20. Wang H-W, Wang X-L, Zhang L-L, Guo M-X, Huang Z. Aminolevulinic acid (ALA)-assisted photodynamic diagnosis of subclinical and latent HPV infection of the external genital region. Photodiagnosis and Photodynamic Therapy. 2008; 5(4):251-5.
    21. Xie F, Yu HS, Wang R, Wang D, Li YM, Wen HY, Du JB, Ba W, Meng XF, Yang J, Lin BW, Li HJ, Li CX, Zhang LG, Fang XD, Zhao H. Photodynamic therapy for genital warts causes activation of local immunity. Journal of Cutaneous Medicine and Surgery. 2019; 23(4):370-9.
    22. Mizuki D, Kaneko T, Hanada K. Successful treatment of topical photodynamic therapy using 5‐aminolevulinic acid for plane warts. British Journal of Dermatology. 2003; 149(5):1087-8.
    23. Borgia F, Giuffrida R, Caradonna E, Vaccaro M, Guarneri F, Cannavò SP. Early and late onset side effects of photodynamic therapy. Biomedicines. 2018; 6(1):12.
    24. Nayeemuddin F, Wong M, Yell J, Rhodes L. Topical photodynamic therapy in disseminated superficial actinic porokeratosis. Clinical and experimental dermatology. 2002; 27(8):703-6.
    25. Journal of dermatological treatment. 2006; 17(3):190-1.

      1. Itoh M, Nakagawa H. Successful treatment of disseminated superficial actinic porokeratosis with Q‐switched ruby laser. The Journal of Dermatology. 2007; 34(12):816-20.
      2. Ahn SJ, Lee HJ, Chang SE, Lee MW, Choi JH, Moon KC, Koh JK. Case of linear porokeratosis: successful treatment with topical 5% imiquimod cream. The Journal of Dermatology. 2007; 34(2):146-7.
      3. Gu Y, Li J, Jiang Y, Liang J, Zhou P, Cui X, et al. A clinical study of photodynamic therapy for port wine stain: a report of 40 cases. Clin J laser Med Surg. 1992; 1:6-10.
      4. Zhang B, Zhang T-H, Huang Z, Li Q, Yuan K-H, Hu Z-Q. Comparison of pulsed dye laser (PDL) and photodynamic therapy (PDT) for treatment of facial port-wine stain (PWS) birthmarks in pediatric patients. Photodiagnosis and Photodynamic Therapy. 2014; 11(4):491-7.
      5. van Drooge AM, Beek JF, van der Veen JW, van der Horst CM, Wolkerstorfer A. Hypertrophy in port-wine stains: prevalence and patient characteristics in a large patient cohort. Journal of the American Academy of Dermatology. 2012; 67(6):1214-9.
      6. Chen H, Zou X, Zhang Y. Recent Progress in Photodynamic therapy for port wine stains. Chin J Derm Venereol. 2014; 28(June (6)):631-3.
      7. Melancon JM, Dohil MA, Eichenfield LF. Facial Port‐Wine Stain: When to Worry? Pediatric Dermatology. 2012; 29(1):131-3.