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Treatment with drugs that become active when exposed to light.

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Photodynamic therapy for treating age‐related macular degeneration

Photodynamic therapy involves injecting a photosensitive chemical (verteporfin) into the blood stream then radiating light onto the affected area of the retina as the chemical flows through the eye. The chemical is activated enough to treat neovascular or "wet" age‐related macular degeneration by sealing the new blood vessels at the back of the eye. This review includes four randomised trials involving 1429 participants. All four trials compared verteporfin therapy to 5% dextrose water (placebo treatment). Photodynamic therapy reduces the risk of vision loss caused by "wet" age‐related macular degeneration. More people treated with verteporfin also experienced improvements in vision compared to the placebo group, however, the absolute numbers experiencing vision improvement after this treatment was low (80 per 1000). A small number of people may experience acute vision loss within one week after treatment (in approximately 1 in 100 people) and infusion related back pain can occur (in approximately 1 in 50 people).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Photodynamic therapy for Barrett's esophagus: a systematic review

Bibliographic details: He JD, Wang YP, Ouyang XB.  Photodynamic therapy for Barrett's esophagus: a systematic review. World Chinese Journal of Digestology 2010; 18(17): 1815-1819 Available from: http://d.wanfangdata.com.cn/periodical_hrxhzz201017013.aspx

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Efficacy and safety of photodynamic therapy on cutaneous Bowen disease: a systematic review

Bibliographic details: Chen J, Wu Y, Liu M, Qu L, Yang ZH, Chen HD, He CD.  Efficacy and safety of photodynamic therapy on cutaneous Bowen disease: a systematic review. Chinese Journal of Evidence-Based Medicine 2010; 10(11): 1302-1307

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Narrow‐band ultraviolet B phototherapy versus broad‐band ultraviolet B or psoralen ultraviolet A photochemotherapy for treating psoriasis

Psoriasis is a common, chronic inflammatory skin disease, with an estimated global prevalence ranging from 0.5% to 4.6%. Based on clinical features, psoriasis is generally divided into the following: chronic plaque psoriasis (CPP); psoriasis associated with psoriatic arthritis; and pustular, erythrodermic, or guttate psoriasis. We also considered psoriasis affecting the palms and soles (palmoplantar psoriasis, or PPP). Although psoriasis is rarely life‐threatening, it can affect a person's quality of life significantly.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Clinical effectiveness and cost-utility of photodynamic therapy for wet age-related macular degeneration: a systematic review and economic evaluation

Age-related macular degeneration (AMD) is a major cause of blindness affecting the central portion of the retina (the macula). Wet AMD is one form of the condition and involves the formation of neovascular membranes. It is through the leakage and bleeding of these blood vessels that vision loss, which is usually irreversible, occurs. Wet AMD can be further subdivided into classic and occult and it is the classic form that is more threatening to sight. The prevalence of wet AMD has been estimated at 3 per 1000 at age 60-64 years and 117 per 1000 at 90 years and over. There are approximately 50 new cases of classic neovascular membranes per year in a typical health authority of population 500,000.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2003

Photodynamic therapy for recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis is a condition of the mucosal lining of the upper airway, which leads to multiple benign, wart‐like growths (papilloma). Although not cancerous, it can lead to serious problems, including hoarseness and airway obstruction. The main treatment is repeated surgical removal of the papilloma using a laser or cutting instrument. However, multiple surgical procedures carry the risk of complications and can also result in long‐term scarring. Photodynamic therapy works through the application of a light‐sensitising substance, which is then activated by light of a specific wavelength. A chemical reaction creates powerful active molecules that destroy the papilloma locally. It can be used on its own or as an additional treatment together with surgical removal. It has been proposed that photodynamic therapy slows the growth of the papilloma and results in fewer recurrences and therefore fewer surgical procedures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Meta-analysis of anti-vascular endothelial growth factor combined with photodynamic therapy in treatment of age-related macular degeneration

Bibliographic details: Zhou J, Lu Q.  Meta-analysis of anti-vascular endothelial growth factor combined with photodynamic therapy in treatment of age-related macular degeneration. Journal of Shanghai Jiaotong University (Medical Science) 2012; 32(12): 1621-1627

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

What are the treatment options for non-melanoma skin cancer?

If someone is diagnosed with non-melanoma skin cancer, the first treatment doctors usually suggest is surgery to try to remove it. Skin cancer can also be treated using medication or radiotherapy. The treatment options will depend on various factors such as the type of cancer, how big the tumor is, and how aggressive it is.Non-melanoma skin cancers like squamous cell cancer and basal cell cancer usually develop on parts of the body that are exposed to the sun a lot and easy to see. Basal cell cancer typically grows slowly and stays in one place. But if it is only treated after a long time, or not treated at all, it can enter deeper layers of tissue. This may end up damaging and deforming the face, bones, spinal cord or brain, making treatment more difficult.Like basal cell cancer, squamous cell cancer grows in the area where it first develops, and destroys tissue around it. But it is more aggressive than basal cell cancer. If left untreated, the cancer might spread to other parts of the body, causing metastatic tumors to arise in other organs. Most squamous cell cancer tumors are discovered beforehand, though.The treatment options will depend on many factors. These include the type of tumor, how big and aggressive it is, whether it has spread to other parts of the body and, if so, where. Cosmetic aspects and the patient’s preferences may play a role too.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 10, 2015

A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett’s oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin

Photodynamic therapy (PDT) is the use of a light-sensitive drug (a photosensitiser), in combination with light of a visible wavelength, to destroy target cells (e.g. cancerous or pre-cancerous cells). PDT is generally used either as a primary treatment (usually in skin conditions) or as an adjunctive treatment alongside surgery, radiotherapy or chemotherapy. Although PDT is a fairly well-accepted treatment in clinical practice for some types of skin lesion, as a treatment for other forms of cancer it has yet to be fully explored.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2010

Interventions for actinic keratoses

Actinic keratoses are a skin disease caused by long‐term sun exposure. Damaged skin shows small, red, rough, scaly, flat spots called actinic keratoses or lesions, which feel like patches of dry skin. Symptoms such as bleeding and pain can be associated with actinic keratoses. Moreover, actinic keratoses have the potential to develop into skin cancer if left untreated. The reasons for treatment may include cosmetic appearance, relief of symptoms, or prevention of skin cancer. Treatment can be directed either at individual lesions or to larger areas of the skin where several visible and less visible lesions occur (field‐directed treatment).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Steroids with antiangiogenic properties for treating neovascular age‐related macular degeneration

Neovascular age‐related macular degeneration (AMD) is associated with rapid loss of vision due to abnormal growth of blood vessels in the macula. Corticosteroids that reduce this growth of blood vessels have been tested for treatment of such vision loss. This review included three trials evaluating two different types of steroids, triamcinolone acetonide and anecortave acetate, for the treatment of neovascular AMD. The findings across the three trials, which included a total of 809 participants, were consistent with no evidence of benefit, in terms of preventing vision loss, with antiangiogenic steroids compared with placebo or photodynamic therapy. Based on available evidence, there is little benefit of steroids with anti‐angiogenic properties in the treatment of neovascular age‐related macular degeneration.".

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Macular translocation for age‐related macular degeneration

It is unclear if macular translocation can improve vision in patients with wet AMD, the form of age‐related macular degeneration (AMD) caused by the abnormal growth of new blood vessels in the region of the central retina called macula. Age‐related macular degeneration leads to the development of a blind spot in the centre of the visual field and is the most common cause of legal blindness among the elderly in the western world. Macular translocation is a surgical procedure that involves the detachment of the retina which includes the macula into a less‐damaged area. Some ophthalmologists have suggested that this surgery can help patients improve vision. We found a small study suggesting that vision might improve, but severe complications can arise during the process of retinal displacement. Thus, macular translocation might not be considered for most patients with wet AMD given the treatment options already available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Treatment of Barrett's oesophagus

One of the two main types of oesophageal (gullet) cancer, oesophageal adenocarcinoma, is rapidly increasing in incidence in the western world. The prognosis for patients treated for oesophageal adenocarcinoma is appalling with fewer than 15% of individuals surviving beyond five years. Barrett’s oesophagus has been identified as the pre‐cancerous stage of adenocarcinoma. It is recognised that Barrett's oesophagus develops as a complication of acid and bile reflux which commonly, but not inevitably, leads to heartburn symptoms. In response to these injurious agents, the normal squamous lining of the oesophagus is replaced by a columnar lining resembling the lining of the intestine. This intestinal subtype has the highest risk of malignancy and the term Barrett's oesophagus is used only for this subtype in many areas of the world, and in most research publications. Barrett's oesophagus can gradually progress to adenocarcinoma through a series of stages called dysplasia which can be identified in biopsies examined under the microscope.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatments for strawberry birthmarks of the skin in infants and children

Infantile haemangiomas are soft, raised swellings on the skin, often with a bright, red surface. They are a non‐cancerous overgrowth of blood vessels in the skin. They are commonly known as 'strawberry birthmarks', 'strawberry naevi', or 'capillary haemangiomas'. They occur in five per cent of babies, with the majority appearing within the first few weeks of life, and reach their full size at about three to six months of age. The vast majority are uncomplicated and will shrink on their own by five to seven years of age and require no further treatment. However, some infantile haemangiomas may occur in high‐risk areas (such as near the eyes and nose which can result in impairment to vision and airway obstruction, respectively) and some of them are disfiguring and psychologically distressing to the children and their parents. Some may also develop complications so early medical treatment may be necessary. Corticosteroids are currently the standard treatment; however, it is not known which of a variety of treatments is best.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Interventions for cough in patients with cancer

Cough is a distressing symptom in patients with cancer and is difficult to manage in practice. Hence, the aim of this review was to assess and synthesise the available literature on the management of cough in cancer patients in order to improve practice recommendations. Studies with chemotherapy or radiotherapy were excluded. An extensive literature search yielded 17 studies for evaluation. For this update, we did not identify any additional studies for inclusion. Eight of the studies were about the use of brachytherapy (a technique where a radiation source is placed inside the bronchus in the lung for lung cancer or next to the area requiring treatment), use of laser resection or photodynamic therapy (a treatment that uses a drug plus a special type of light to kill cancer cells). Nine studies assessed the effects of a number of different medications, including codeine and morphine. Overall, the research was of poor quality with significant methodological problems, hence no credible evidence was available in the literature to guide practice. Acknowledging these limitations, brachytherapy in a variety of radiation doses was found to be helpful in selected patients. Some pharmacological treatments were found to be helpful, in particular morphine, codeine, dihydrocodeine, levodropropizine, sodium cromoglycate and butamirate citrate linctus (a cough syrup), although all studies had significant risk of bias and some reported side effects. No practice recommendations could be drawn from this review. There is an urgent need to increase the number and quality of studies evaluating the effects of interventions for the management of cough in cancer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions for basal cell carcinoma of the skin

Basal cell carcinoma is the most common human cancer. It is usually caused by excessive exposure to ultraviolet light. Although not life threatening, basal cell carcinoma can destroy the skin and neighbouring tissues, causing significant cosmetic disfigurement, especially on the face. Treatments include surgical removal, radiotherapy, cryotherapy (freezing), phototherapy (light therapy) and creams. Surgery and radiotherapy appear to be the most effective treatments for basal cell carcinoma and Mohs' micrographic surgery (the removal of the tumour layer by layer until it has gone, as determined histologically) the most effective for high risk facial basal cell carcinoma. Photodynamic therapy appears to be useful in the short‐term, especially for people who wish to avoid scarring. However, long‐term follow‐up is needed. Cryotherapy, while convenient and less expensive, does not have a higher cure rate. Early results for imiquimod cream are promising for superficial basal cell carcinoma, and results from an ongoing study are awaited.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Interventions for Old World cutaneous leishmaniasis

Old World cutaneous leishmaniasis (OWCL) is a disfiguring and stigmatising disease occuring in areas of the Mediterranean, Middle East and Asia, caused by a parasitic infection transmitted by sandflies. Pentavalent antimonial drugs such as sodium stibogluconate (Pentostam, Stibanate) and meglumine antimoniate (Glucantime), have been used since the 1940s as the main first‐line therapeutic agents for cutaneous leishmaniasis worldwide. However, many different treatments for OWCL have been described.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Topical treatments for skin warts

Viral warts are a common skin disease, most frequently affecting the hands and feet, caused by the human papilloma virus. While warts are not harmful and usually go away in time without any treatment, they can be unsightly and painful. Warts on the soles of the feet are also called 'plantar warts' or 'verrucas'.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Treatments for mycosis fungoides (a malignant condition with blood cells initially affecting the skin)

Mycosis fungoides is a chronic, malignant disease causing blood cells responsible for the human immune system to affect the skin. People of all ages and from all ethnic backgrounds can develop this disease. Mycosis fungoides can cause physical symptoms that typically occur in a certain sequence making it possible to classify the disease in different stages. Usually this disease starts with patches on the body and extremities. After some time (often years), these patches develop into plaques, and further progress into solid tumours is possible. Lymph nodes and other organs can also be affected, but progress of the disease in most cases is slow compared to other malignant diseases. Life expectancy in the first stage of the disease is similar to people without mycosis fungoides; whereas, prognosis in the later stages of the disease gets worse.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Does photodynamic therapy enhance standard antibacterial therapy in dentistry?

OBJECTIVE: The aim of this study was to assess whether or not photodynamic therapy enhanced standard antibacterial therapy in dentistry.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

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