局部光动力疗法是一种广泛批准的用于光化性角化病和低风险非黑色素瘤皮肤癌的疗法,其其他皮肤疾病的新适应症的范围迅速增加。这篇综述总结了最佳的可用证据,为皮肤科医生提供关于光动力疗法的批准和新兴适应症的临床更新。大量证据表明,光动力疗法优于或不劣于其他可用的光化性角化病治疗方式,低风险基底细胞癌,Bowen病,皮肤区域癌变,器官移植受者角质形成细胞癌的化学预防,光老化,寻常痤疮,和皮肤感染,包括疣,甲癣,皮肤利什曼病.有新的证据表明,光动力疗法在光化性唇炎的管理中发挥作用,早期霉菌病,乳腺外Paget病,扁平苔藓硬化,和毛囊炎decalvans,但没有与其他积极治疗方式的比较研究。局部光动力疗法的常见障碍包括手术疼痛,成本,以及治疗交付所需的时间。文献报道的光动力治疗方案存在显著的异质性,包括不同的光敏剂,光源,治疗次数,治疗之间的时间,以及手术镇痛的使用。在治疗一系列炎症时,应考虑局部光动力疗法,肿瘤,和传染性皮肤病。然而,需要更多的比较研究来确定其在这些皮肤病的治疗算法中的作用,还需要更多的方法学研究来优化光动力治疗方案,以提高患者对该手术的耐受性.
Topical photodynamic therapy is a widely approved therapy for actinic keratoses and low-risk nonmelanoma skin cancers with a rapidly growing range of emerging indications for other cutaneous diseases. This review summarizes the best-available evidence to provide a clinical update for dermatologists on the approved and emerging indications of photodynamic therapy. The body of evidence suggests that photodynamic therapy is superior or noninferior to other available treatment modalities for actinic keratoses, low-risk basal cell carcinomas, Bowen\'s disease, skin field cancerization, chemoprevention of keratinocyte carcinomas in organ transplant recipients, photoaging, acne vulgaris, and cutaneous infections including verrucae, onychomycosis, and cutaneous leishmaniasis. There is emerging evidence that photodynamic therapy plays a role in the management of actinic cheilitis, early-stage mycosis fungoides, extramammary Paget disease, lichen sclerosis, and folliculitis decalvans but there are no comparative studies with other active treatment modalities. Common barriers to topical photodynamic therapy include procedural pain, costs, and the time required for treatment delivery. There is significant heterogeneity in the photodynamic therapy protocols reported in the literature, including different photosensitizers, light sources, number of treatments, time between treatments, and use of procedural analgesia. Topical photodynamic therapy should be considered in the management of a spectrum of inflammatory, neoplastic, and infectious dermatoses. However, more comparative research is required to determine its role in the treatment algorithm for these dermatologic conditions and more methodological research is required to optimize photodynamic therapy protocols to improve the tolerability of the procedure for patients.