Journal of the American Academy of Dermatology
Volume 61, Issue 6 , Pages 1033-1043, December 2009

Pain associated with aminolevulinic acid-photodynamic therapy of skin disease

  • Christine B. Warren, MD

      Affiliations

    • Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Laszlo J. Karai, MD, PhD

      Affiliations

    • Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Allison Vidimos, MD, RPh

      Affiliations

    • Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Edward V. Maytin, MD, PhD

      Affiliations

    • Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
    • Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
    • Corresponding Author InformationReprint requests: Edward V. Maytin, MD, PhD, Department of Dermatology/A61, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.

Background

Pain during topical aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) limits the use of this treatment of skin diseases.

Objective

We sought to summarize the effectiveness of interventions to reduce ALA-PDT–related pain, and to explore factors contributing to pain induction.

Methods

A PubMed search was performed to identify all clinical PDT trials (2000-2008) that used ALA or methyl-ALA, enrolled at least 10 patients per trial, and used a semiquantitative pain scale.

Results

In all, 43 articles were identified for review. Pain intensity is associated with lesion size and location and can be severe for certain diagnoses, such as plaque-type psoriasis. Results are inconsistent for the correlation of pain with light source, wavelength of light, fluence rate, and total light dose. Cooling represents the best topical intervention.

Limitations

Pain perception differs widely between patients and can contribute to variability in the reported results.

Conclusion

Gamma-aminobutyric acid receptors, cold/menthol receptors (transient receptor potential cation channel, subfamily M, member 8), and vanilloid/capsaicin receptors (transient receptor potential cation channel, subfamily V, member 1) may be involved in pain perception during ALA-PDT and are therefore worthy of further investigation.

Key words: aminolevulinic acid, anesthesia, methyl aminolevulinic acid, pain, photodynamic therapy, substance P, vanilloid receptor

 

 Supported by National Institues of Health/National Cancer Institute grant CA84203.

 Conflicts of interest: None declared.

PII: S0190-9622(09)00391-0

doi:10.1016/j.jaad.2009.03.048

Journal of the American Academy of Dermatology
Volume 61, Issue 6 , Pages 1033-1043, December 2009