Abstract / Summary
Background: Daylight photodynamic therapy (DL-PDT) has been combined with transepidermal drug delivery (TED) techniques to enhance photosensitizer penetration. Although studies have suggested improved clinical and histological outcomes with DL-PDT combined with ablative laser, evidence regarding carcinogenesis and dermal remodeling markers remains limited.
Objective: To evaluate changes in epidermal carcinogenesis and dermal remodeling markers after standard DL-PDT compared with DL-PDT combined with TED techniques for facial field cancerization.
Methods: Forty patients were randomized into four groups (n = 10): standard DL-PDT, DL-PDT with microneedling, DL-PDT with CO2 laser, and DL-PDT with microdermabrasion. All underwent two treatment sessions 1 month apart using methyl aminolevulinate cream followed by 2 h of daylight exposure. Skin biopsies were obtained at baseline and 3 months after the second session. Immunohistochemistry evaluated p53, Ki67, Collagens I and III, metalloproteinases (MMP-1, MMP-3, MMP-9), and TIMP-1.
Results: A reduction in the vertical extent of Ki67 expression (from two-thirds to one-third of the epidermis) was observed mainly in the microneedling and CO2 laser groups, although it was not statistically significant. No significant differences in Ki67 or p53 expression were observed within or between groups. Increased Type III collagen, MMP-3, and MMP-9 expression and decreased MMP-1 and TIMP-1 expression were observed, with only TIMP-1 reduction being statistically significant (p = 0.041) in the overall analysis.
Conclusions: A trend toward reduced vertical Ki67 expression suggests potential benefit of DL-PDT combined with microneedling and CO2 laser, and favorable changes in dermal remodeling markers were observed overall. These exploratory findings require confirmation in larger randomized studies.
Trial registration: ClinicalTrials.gov: NCT03963765.