Acta Dermato-Venereologica 97-10CompleteContent | страница 24

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SHORT COMMUNICATION
Photodynamic Therapy with Red Light and 5-Aminolaevulinic Acid for Herpes Simplex Recurrence:
Preliminary Results
Beata J. OSIECKA 1 , Piotr NOCKOWSKI 2 , Stanisław KWIATKOWSKI 1 and Jacek C. SZEPIETOWSKI 2 *
1
Department of Pathology, and 2 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, ul. Chalubinskiego
1, 50-368 Wroclaw, Poland. E-mail: [e-mail]
Accepted Jul 5, 2017; Epub ahead of print Jul 6, 2017
Herpes simplex viruses, HSV-1 and HSV-2, are the
most common cause of mucocutaneous infection with
a chronic and recurrent course. Approximately 20% of
people infected with HSV have clinical manifestations
that are promoted by states of weakened immunity (1).
Discomfort (itch, pain) associated with the eruption of
vesicles and emerging erosions, recurrence and aesthetic
discomfort significantly reduce their quality of life.
Conventional therapy with nucleotide analogues
inhibits viral replication by shortening the duration of
symptoms, but does not prevent recurrence. Photodyna-
mic therapy (PDT) is selective, non-invasive, and is not
harmful to the patient, and can be used in any clinical con-
dition, in parallel with other therapies, including immu-
nocompromised patients (e.g. transplantation, oncology
patients). Recent studies have shown the effectiveness
of PDT in the inactivation of different types of virus in
vitro and in vivo (2). The clinical application of PDT in
the treatment of recurrent herpes is based mainly on case
studies with the use of synthetic dyes as photosensitizers
(3–5). The most common photosensitizer used in PDT is
5-aminolevulinic acid (ALA).
The aim of this small pilot study was to evaluate the
clinical effectiveness of topical ALA-PDT in the treat-
ment and prevention of recurrences in 8 patients with
recurrent herpes simplex (RHS).
MATERIALS AND METHODS
The study was approved by the local ethics committee (KB/6-
2014). The patients gave their informed consent prior to enrolment.
Eight patients with RHS were enrolled in the study (2 men, 6
women, age range 25–67 years). Two patients had genital herpes
(on the buttock skin) and 6 patients had oral herpes (herpes labia-
lis). Duration of disease ranged from 3 to 6 years, and the number
of relapses per year was 4–7. The factors that influenced the ap-
pearance of symptoms for the first time, were streptococcal pha-
ryngitis, Hashimoto’s disease, chronic severe stress, influenza, and
stomach cancer surgery. All patients had received previous treat­
ment with topical acyclovir, 3 patients were also given oral acy-
clovir (1 patient with genital herpes for 3 months, 2 patients with
herpes labialis (1 for 2 months, another for 4 months)) (Table SI 1 ).
All previous treatments were ended at least 3 months prior to
PDT. The patients received no other treatment for HSV during
the course of this study.
All patients received one session of ALA-PDT in the early stages
of RHS (maculae/papule phase) before the eruption of vesicles. ALA
cream (20% with 2% dimethyl sulphoxide; DMSO) was applied to
https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-2744
1
the lesion with a thin border extending to the normal skin (an area
of approximately 1.5 cm 2 ). The lesions were then covered with
an occlusive, light-shielding dressing. After 4 h the dressing was
removed and the cream was washed off with a 0.9% saline solution.
The lesions were illuminated using red light from a halogen lamp
(Penta Lamps, Teclas, Switzerland) at an excitation wavelength
of 630  ±  20 nm selected with a bandpass filter with parameters of
light: 100 mW/cm 2 and the total dose 120 J/cm 2 . Irradiation was
performed in a dark room at an intermittent mode (pauses during
illumination), without the use of local anaesthetics. The irradiated
area was cooled by a fan. After irradiation, the treated sites were
covered with a protective dressing. The intensity of burning and
pain during the illumination was evaluated using a verbal rating
scale (VRS): none, mild, moderate and severe.
Follow-up into the efficacy of ALA-PDT was performed 7 days,
then 1, 3, 6 and 12 months after irradiation. The effectiveness of
the therapy was assessed according to the clinical response, as:
complete response (no recurrence of clinical lesions and prodromic
phase), partial response (relapse of prodromic phase only), or no
response (recurrence of lesions).
RESULTS
All patients with RHS achieved a good clinical response
with ALA-PDT. None of the 8 patients had a relapse of
physical evidence of disease during the 12 months of
follow-up. However, once during the first 6 months after
irradiation 4 patients (1 patient with herpes genitalis and
3 with herpes labialis) experienced prodromal symptoms
(partial response): itching and tingling appeared in the
place of former lesions, lasting up to several hours and
then subsided. Over the next 6 months prodromal symp-
toms re-appeared once in the same patient with herpes
genitalis and in 2 people with herpes labialis. Prodromic
signs occurred following occurrence of factors that could
provoke recurrent infections: common cold with fever,
severe stress, and psycho-physical fatigue (Table SI 1 ).
All patients reported pain and burning as the main
side-effe cts associated with irradiation session. Pain
as the dominant drawback was reported by 6 patients
with herpes labialis: 2 of them rated the pain intensity
as moderate, and 4 as severe. Burning sensation as the
main adverse effect during irradiation was reported by
2 patients with genital herpes and rated as severe (Table
SI 1 ). However, no patients discontinued the PDT session
due to pain or burning sensation.
Directly after the PDT session swelling and redness
was seen at the site of irradiation. The associated inflam-
mation, pain and burning decreased within several hours
and was resolved after 24 h in all patients. The use of anal-
gesic and anti-inflammatory drugs was not recommended.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2017 Acta Dermato-Venereologica.
doi: 10.2340/00015555-2744
Acta Derm Venereol 2017; 97: 1239–1240