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Esperienze Dermatologiche 2019 December;21(2-4):58-61

DOI: 10.23736/S1128-9155.19.00490-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

A biological therapeutic challenge for chronic ulcers: results of a clinical pilot study

Alessandra SCARABELLO 1 , Mauro BERTA 2, Mara LOTTI 3, Pier L. SARACENI 3

1 Dermatologic Unit, L. Spallanzani National Institute for Infectious Diseases, IRCCS, Rome, Italy; 2 Private practitioner, Rome, Italy; 3 San Gallicano Dermatological Institute, IRCCS, Rome, Italy


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BACKGROUND: Chronic ulcers, including diabetic ulcers, pressure ulcers, venous ulcers, and arterial insufficiency ulcers, are both difficult and expensive to treat and are an increasingly important challenge for the dermatologist, especially in relation to the growing problem of antibiotic resistance as very often the skin ulcers are optimal sites for bacterial proliferation and the poorly controlled use of antibiotics, even topically and not only systemically, has led to the development of multidrug-resistance that limits its effectiveness. Photodynamic therapy seems to have antimicrobial activity in skin infections. It also appears to be effective in stimulating fibroblasts and consequently in the reparative processes involved in wound healing. The objective of this pilot study is to evaluate clinically the therapeutic efficacy, both antimicrobial activity and promoting wound healing, of photodynamic therapy in skin ulcers of various etiology, which have shown difficulty in healing, with failure for over 1 year of conventional therapies used.
METHODS: Ten patients, 3 males and 7 females, mean age of 72.5 years, range 56-86 years, who had chronic ulcers with overlapping bacterial infections, sometimes multiple, from the beginning, were enrolled. The skin ulcers were treated with 5-aminolevulinic acid gel, in occlusion for 45-60 minutes; then the surfaces was exposed to 630 nm red light for 10 minutes, The single patient was treated once a week, for 4-16 weeks, depending on the therapeutic response and healing rapidity.
RESULTS: All patients achieved ulcer resolution, with excellent treatment tolerability and easy daily home medication between sessions, without the need for antibiotic therapy, despite the presence of bacteria in the lesion.
CONCLUSIONS: These results indicated the PDT is valid therapeutic option for the resolution of difficult ulcers of different etiologies, it avoids the use of antibiotics and it is well tolerated and effective even for those cases of ulcers infected with multi-resistant germs.


KEY WORDS: Photochemotherapy; Skin ulcer; Drug resistance, multiple

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