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      Gain with no pain? Pain management in dermatological photodynamic therapy.

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          Abstract

          Pain during photodynamic therapy (PDT) is the main limiting adverse effect in its use in dermatology. Given its multifactorial nature, we reviewed both intrinsic and extrinsic factors that are involved in PDT pain. We propose a threshold theory for pain experience in PDT: it correlates positively with fluence rate and dose below a certain threshold (rate of ~60 mW cm-2, dose of ~50 J cm-2); when the threshold is surpassed, pain intensity saturates. Additionally, we carefully compared recent updates on pain management strategies and we suggest that cold-air analgesia and low-irradiance light sources (such as variable pulsed light and daylight PDT) represent the current best analgesic options. Finally, we discuss the possible mechanisms of pain experience during PDT. Reactive oxygen species, transient receptor potential channels and inflammatory responses are key mediators in pain. Further investigation into these pathways should help with the development of more effective analgesic strategies. Taking these points together, for pain management in PDT, an individualized plan of analgesia is possible.

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          Author and article information

          Journal
          Br. J. Dermatol.
          The British journal of dermatology
          Wiley-Blackwell
          1365-2133
          0007-0963
          Sep 2017
          : 177
          : 3
          Affiliations
          [1 ] Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
          [2 ] Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Shanghai, 200443, China.
          [3 ] Department of Dermatology and Allergology, Vest Clinic, Recklinghausen, Germany.
          Article
          10.1111/bjd.15344
          28122416
          169cfb20-6c9d-41dc-9e14-99a9e579eb81
          History

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