光动力疗法(PDT)是一种非常有效和广泛采用的治疗方法,用于许多皮肤病,特别是对于多发性光化性角化病(AKs)。然而,PDT在某些情况下是无效的,特别是如果AKs发生在身体的肢端部分。已经提出了几种提高PDT疗效而不显著增加副作用风险的方法。在这项研究中,我们回顾了文献中描述的用于治疗AKs的基于组合的PDT治疗;治疗后和预处理都被认为包括局部(即,双氯芬酸,咪喹莫特,阿达帕林,5-氟尿嘧啶,和骨化三醇),系统性(即,阿维酮,甲氨蝶呤,和polypodiumleuotomos),和机械物理(即,射频,热机械分数损伤,微针,微晶换肤术,和激光)治疗策略。用咪喹莫特进行局部预处理,阿达帕林,5-氟尿嘧啶,卡泊三醇在治疗AKs方面比单独的PDT更成功,而双氯芬酸凝胶的效果不明显。用CO2和Er:YAG(铒:钇-铝-石榴石)进行机械激光治疗以及用波形藻进行全身治疗也是有效的。不同的方法在特定情况下相对更有效,例如在免疫抑制患者中,四肢的AK,或较厚的AKs。结论:一些研究表明,基于组合的方法可以提高PDT的有效性。然而,需要更多的研究来进一步了解联合治疗在临床实践中的有效性,并研究阿维A的作用,甲氨蝶呤,维生素D,热机械分数损伤,和人类的微晶换肤术。
Photodynamic therapy (PDT) is a highly effective and widely adopted treatment strategy for many skin diseases, particularly for multiple actinic keratoses (AKs). However, PDT is ineffective in some cases, especially if AKs occur in the acral part of the body. Several methods to improve the efficacy of PDT without significantly increasing the risks of side effects have been proposed. In this study, we reviewed the combination-based PDT treatments described in the literature for treating AKs; both post-treatment and pretreatment were considered including topical (i.e., diclofenac, imiquimod, adapalene, 5-fluorouracil, and calcitriol), systemic (i.e., acitretin, methotrexate, and polypodium leucotomos), and mechanical-physical (i.e., radiofrequency, thermomechanical fractional injury, microneedling, microdermabrasion, and laser) treatment strategies. Topical pretreatments with imiquimod, adapalene, 5-fluorouracil, and calcipotriol were more successful than PDT alone in treating AKs, while the effect of diclofenac gel was less clear. Both mechanical laser treatment with CO2 and Er:YAG (Erbium:Yttrium-Aluminum-Garnet) as well as systemic treatment with Polypodium leucotomos were also effective. Different approaches were relatively more effective in particular situations such as in immunosuppressed patients, AKs in the extremities, or thicker AKs. Conclusions: Several studies showed that a combination-based approach enhanced the effectiveness of PDT. However, more studies are needed to further understand the effectiveness of combination therapy in clinical practice and to investigate the role of acitretin, methotrexate, vitamin D, thermomechanical fractional injury, and microdermabrasion in humans.