Hautphysiologische Veränderungen unter der Kombination einer Tageslicht-photodynamischen Therapie mit einer fraktionierten Lasertherapie
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Currently, for the treatment of actinic keratoses, photodynamic therapy with daylight is preferred by physicians and patients due to its greater effectiveness and lower pain compared to conventional photodynamic therapy. To enhance the effectiveness of the therapy, particularly in hyperkeratotic forms of actinic keratoses, various pre-treatments, especially
fractional laser therapy, are currently available. To date, only a few studies have investigated skin physiology after photodynamic therapy and fractional laser treatment.
The aim of the study was to investigate the physiological changes in the skin with photodynamic therapy using daylight, with and without pre-treatment with a fractional laser. For this purpose, 30 patients with actinic keratoses, 23 men and 7 women with an average age of 77.3 ± 7.0 years, were recruited at the Clinic for Dermatology, Allergology, and Phlebology at the Gesundbrunnen Clinic (SLK-Clinic Heilbronn).
On the ventral right or left forearm of the patients, four fields of three by three centimetre each were marked and randomly assigned to the application of 10% 5-aminolevulinic acid hydrochloride gel followed by daylight exposure, fractional laser therapy followed by daylight exposure, fractional laser therapy followed by application of 10% 5-aminolevulinic acid
hydrochloride gel and daylight exposure, as well as daylight exposure only. Skin physiological characteristics (skin moisture, redness, and transepidermal water loss) were measured before treatment, 30 minutes, 24 hours, seven, and 14 days after daylight exposure.
Thirty minutes after application of daylight photodynamic therapy, an increase in transepidermal water loss values and a decrease in skin moisture were observed, indicating acute damage to the skin barrier. On the next observation day, increased skin redness with a corresponding increase in colorimetric values and simultaneous normalization of corneometry and transepidermal water loss values were seen. This observation indicated further development of the inflammatory reaction due to the effect of the photosensitizer. Seven and fourteen days after treatment, normalization of skin physiological parameters was observed, indicating complete healing and reepithelialisation of the skin.
Following the combination therapy with fractional laser, more pronounced changes in skin physiology were found. Immediately after treatment, a significant skin redness was seen clinically. Measurements showed a exploratively highly significant increase in colorimetric and transepidermal water loss values and a significant decline in skin moisture. This observation can be explained by the laser-induced disruption of the skin barrier. These changes in skin physiology were still seen after 24 hours.
After seven days, another phase of skin inflammation was observed: normalization of the transepidermal water loss value due to the closure of the laser-perforated epidermis, persistent skin redness, and a maximum decline in skin moisture with skin drying and flake formation. Fourteen days after treatment, significant redness, drying, and flaking of the skin were less
but still clinically observed. The clinical reaction correlated with a persistent increase in colorimetric values and a decline in skin moisture. This observation suggested a persistently ongoing inflammation of the skin and elimination of epithelial cells.
Compared to the effect of photodynamic therapy with daylight alone, combination therapy of fractional laser with daylight photodynamic therapy caused a more noticeable increase in colorimetric, corneometric, and transepidermal water loss values after treatment, with the persistence of these increases up to 24 hours for transepidermal water loss values and up
to 14 days for skin redness and moisture. These changes corresponded with the clinical reaction and pathogenically indicated significant damage to the skin barrier.
This study investigated and described in detail the timeline of skin physiological changes under photodynamic therapy with and without pretreatment with a fractional laser. The study showed that photodynamic therapy significantly alters skin physiology: the skin barrier is damaged, inflammatory redness increases, and during the healing phase, skin dryness
occurs. Fractional laser therapy intensifies these parameter changes, indicating an intensification of inflammatory processes and skin barrier damage. This enhanced biological effect could also lead to a stronger clinical effect on actinic keratoses. This knowledge enhances the understanding of the healing process and can be used in daily practice for patient education and therapy planning as well as skin care after treatment to improve therapy adherence and patient satisfaction.
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