https://orcid.org/0000-0002-4732-071X
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R.S. Dawe, Interventions for the pain of topical photodynamic therapy, British Journal of Dermatology, Volume 173, Issue 1, 1 July 2015, Pages 15–16, https://doi.org/10.1111/bjd.13912
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ORIGINAL ARTICLE, p 192
Pain during the illumination phase of cutaneous topical photodynamic therapy (PDT) can be a problem. Most dermatologists occasionally see patients with lesions that would ideally be treated with PDT who decline because they have had PDT before and are unwilling to risk experiencing this type of pain again.
PDT‐induced pain is only loosely associated with the amount of fluorescence. There must be factors other than variation in the amount of protoporphrin IX formed from the pro‐drug to explain why pain is a major problem for some and not for others. Although some factors, including skin area to be treated, diagnosis and site,1 2 are associated with amount of pain we still cannot predict for the individual whether pain will be an important problem or not.
Various measures are often used to try to help with PDT‐induced pain, including distraction methods and forced cold air devices. Topical anaesthetics have not been shown to be helpful,3 4 nor has topical morphine helped.5 Large volumes of infiltrative local anaesthetic can be useful;6 7 ‘ordinary’ subcutaneous infiltrative anaesthetics have not been well studied. The rate of illumination is a factor, with portable illumination devices that allow doses to be given over longer times and the use of daylight, as a relatively low output source, causing less pain than conventional PDT.8 9
