L E Rhodes

The University of Manchester, Manchester, England, United Kingdom

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Publications (67)231.28 Total impact

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    ABSTRACT: Background Photoprotection including sunscreen use in children is encouraged by health campaigns. While sunscreen chemicals are common causes of photoallergic (PA) contact reactions in adults, limited data is available in children.Objectives To assess the frequency of PA and contact allergy (CA) to sunscreens in children <18 years undergoing investigation for suspected photosensitivity.Methods Retrospective analysis of data on children who underwent photopatch testing to a standard series of 9 ultraviolet (UV)-filters and to sunscreen-products in a single photoinvestigation centre (2000-2011). Duplicate series of UV-filters and the children's own sunscreen-products were applied to the back, with readings taken at sample removal, and at 24 and 48h post 5J/cm2 UVA exposure of one set.ResultsThe analysis comprised 157 children (3-17 yrs, 69 males and 88 females). A total of 10 (6.4%) children showed positive photopatch responses to UV-filters and/or their sunscreen-products (4.5% to UV-filters, 5.7% to their sunscreen-products). The responsible UV-filters most often identified were benzophenone-3 and ethylhexyl methoxycinnamate. Additionally, CA reactions were observed in 9 (5.7%) children, with overall 16 (10.2%) children showing PA and/or CA to UV-filters and/or sunscreen-products.Conclusion This is the largest series of photopatch testing reported in children, and shows that sunscreen PA and also CA are quite frequent in those undergoing photoinvestigation. Photopatch testing should be considered in children presenting with features of photosensitivity.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 03/2014; · 3.76 Impact Factor
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    ABSTRACT: Animal studies report photodynamic therapy (PDT) to improve healing of excisional wounds but the mechanism is uncertain and equivalent human studies are lacking. To explore the impact of methyl aminolaevulinate (MAL)-PDT on clinical and microscopic parameters of human cutaneous excisional wound healing, examining for potential modulation through production of transforming growth factor (TGF)-β isoforms. In healthy older men (60-77 years; n=27), a 4 mm punch biopsy wound was created in skin of the upper inner arm and treated with MAL-PDT three times over five days. An identical control wound to the contralateral arm was untreated and both wounds left to heal by secondary intention. Wounds were re-excised at time points examining the inflammatory phase (7 days, n=10), matrix remodelling (3 weeks, n=8) and cosmetic outcome/dermal structure (9 months, n=9). Production of TGF-β1, TGF-β3 and matrix metalloproteinases (MMPs), key mediators of matrix deposition and remodelling, was assessed by immunohistochemistry alongside microscopic measurement of wound size/area and clinical assessment of wound appearance. MAL-PDT delayed re-epithelialisation at 7 days, associated with increased inflammation. However, 3 weeks post-wounding, treated wounds were smaller with higher production of MMP-1 (P=0.01), MMP-9 (P=0.04) and the anti-scarring cytokine, TGF-β3 (P=0.03). TGF-β1 was lower than control at 7 days and higher at 3 weeks (both P=0.03). At 9 months MAL-PDT treated wounds showed greater, more ordered deposition of collagen I, collagen III and elastin (all P<0.05). MAL-PDT increases MMP-1, MMP-9, and TGF-β3 production during matrix remodelling, ultimately producing scars with improved dermal matrix architecture. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 01/2014; · 3.76 Impact Factor
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    ABSTRACT: Topical 5-aminolevulinic acid-photodynamic therapy (5-ALA-PDT) causes a clinical inflammatory response in human skin. While histamine mediates the immediate reaction, the mediators of the prolonged erythema are unknown OBJECTIVE: To examine for involvement of pro-inflammatory mediators prostaglandin E2 (PGE2 ) and nitric oxide (NO) in topical PDT-induced erythema in human skin. A series of studies were performed in forearm skin of healthy volunteers (n=35). Following definition of the erythemal time-course and dose-response to 5-ALA-PDT, duplicate 5-ALA dose-series were iontophoresed into the skin of each ventral forearm and exposed to 100J/cm(2) broadband red light. Within subject, arms were randomised to control or treatment with cyclooxygenase and nitric oxide synthase inhibitors, indomethacin and N(ω)-nitro-L-arginine methyl ester (L-NAME), respectively, and impact on 5-ALA-PDT induced erythema quantified. Additionally, release of PGE2 and NO was directly assessed by sampling dermal microdialysate at intervals following 5-ALA-PDT. A 5-ALA dose-related delayed erythema occurred by 3h (r= 0.97, P<0.01), with erythema persisting to 48h post-PDT. Topical indomethacin applied immediately post-PDT reduced the slope of erythemal response at 3 and 24h (P<0.05). Intradermal injection of L-NAME into 5-ALA-PDT treated sites reduced the slope of response at 24h post-PDT (p<0.001) whilst significantly inhibiting erythema from 3-48h post-PDT (P<0.01). Analysis of dermal microdialysate showed release of NO and PGE2 following topical 5-ALA-PDT. Topical 5-ALA-PDT upregulates PGE2 and NO in human skin, where they play a significant role in the clinical inflammatory response. The potential relevance of these mediators to PDT of human cutaneous pathology warrants study. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 08/2013; · 3.76 Impact Factor
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    ABSTRACT: Long-standing concerns over vitamin D status of South Asian adults in the UK require studies using statistically valid sample sizes to measure annual variation and contributory lifestyle factors. Measure annual variation in vitamin D status and determine associated lifestyle influences. Evaluate with respect to a similar study of white Caucasian adults. A single-centre, prospective cohort study measuring circulating 25(OH)D, sunlight exposure levels and lifestyle factors for one year in 125 ambulant South Asian adults with sun-reactive skin type V, aged 20-60 years, in Greater-Manchester, UK (53.5°N). The 25(OH)D levels of South Asians were alarmingly low. In summer, their median (IQR) 25(OH)D was 9.0(6·7-13·1)ng/mL (22·5nmol/L) falling to 5·8(4·0-8·1) ng/mL (14·5nmol/L) in winter. This compared to white Caucasian values of 26·2(19·9-31·5) ng/mL (65·5nmol/L) in summer and 18·9(11·6-23·8) ng/mL (47·2nmol/L) in winter. Median daily dietary vitamin D was lower in South Asians (1·32μg versus 3·26μg for white Caucasians) and compounded by low supplement use. Despite similar times spent outdoors, UV-dosimeters recorded lower personal UV exposure amongst South Asians, indicating sun avoidance when outside, while sun exposure diaries recorded lower amounts of skin surface exposure. The majority of South Asians never reached sufficiency in vitamin D status. Lifestyle differences, with lower oral intake, sun exposure and rates of cutaneous production due to darker skin, indicate that standard advice on obtaining sufficient vitamin D needs modification for the South Asian community in UK. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 07/2013; · 3.76 Impact Factor
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    ABSTRACT: In order to establish a consensus recommendation for performing photopatch testing, a photopatch test taskforce group was established under the joint umbrella of the European Society for Contact Dermatitis and the European Society for Photodermatology in 2000. After proposing the most adequate methodology in 2004 and completing a European multicentre photopatch test study in 2011, this taskforce is recommending a list of photoallergens that should form part of a baseline series for photopatch testing in Europe. It contains mainly ultraviolet filters and drugs, mostly non-steroidal anti-inflammatory drugs. The choice of chemicals was based on the results of a recent multicentre study, previous published cases of photoallergy, and use of the substances in the European market. It is suggested that an extended list of photoallergens should be photopatch tested in selected cases, along with patients' own products. Two contact allergens, cinnamyl alcohol and decyl glucoside, should be simultaneously patch tested in order to clarify photopatch and patch test reactions, respectively, to ketoprofen and methylene bis-benzotriazolyl tetramethylbutylphenol (Tinosorb M™).
    Contact Dermatitis 04/2013; 68(4):239-243. · 2.93 Impact Factor
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    Proceedings of The Nutrition Society 01/2013; 72(OCE4). · 3.67 Impact Factor
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    ABSTRACT: Background  Voriconazole, a broad-spectrum triazole antifungal agent increasingly used to treat aspergillosis, has been linked with acute photosensitivity and skin carcinogenesis. The action spectrum of the photosensitivity is unknown, whilst an indirect retinol effect secondary to the anti-fungal's impact on CYP450 enzymes has been proposed to contribute to the underlying mechanism. Objectives  To perform a detailed photobiological assessment of the photosensitivity presenting in a series of 12 voriconazole treated patients. Results  Patients (8 male, 4 female; median age 54y, range 40-63y) experienced moderate-severe cutaneous erythema (n=12), burning pain (n=5), itching (n=3), scaling (n=5), vesiculation (n=5) and oedema (n=1) following sunlight exposure; increased lentigines (n=5) and actinic cheilitis (n=3) were also observed. While the majority (n=8) of patients showed normal minimal erythemal (MED) thresholds to monochromator phototesting to UVB, UVA and visible light, a low MED to UVA was observed in 4 patients. Repeated provocation testing with broadband UVA and solar simulated radiation (SSR) provoked an abnormal erythema in 8 and 10 patients, respectively. Serum retinol levels were mildly elevated in 2 patients but normal in the majority Conclusion  UVA sensitivity is the predominant finding in acute voriconazole induced photosensitivity. We found little evidence of elevated circulating retinol as the causal factor. Patients with voriconazole-induced photosensitivity require education in appropriate UVA protective measures in addition to consideration of skin surveillance for malignant sequelae.
    British Journal of Dermatology 08/2012; · 3.76 Impact Factor
  • L E Rhodes
    British Journal of Dermatology 02/2012; 166(2):238-9. · 3.76 Impact Factor
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    ABSTRACT: Background:  The two most common agent groups currently responsible for photoallergic contact dermatitis (PACD) are organic ultraviolet (UV) absorbers in sunscreens and topical nonsteroidal anti-inflammatory drugs (NSAIDs). However, availability of information on the photoallergenic potential of these agents is scarce. Objectives:  To obtain current information on the frequency of PACD to 19 organic UV absorbers and 5 topical NSAIDs, including newer agents, in common usage in Europe. Methods:  A prospective, multi-centre photopatch test study of 1,031 patients attending for investigation of suspected PACD in 30 centres across 12 European countries. Results:  A total of 346 PACD reactions in 200 (19.4%) subjects occurred. PACD was most commonly caused by the topical NSAIDs ketoprofen (128 subjects) and etofenamate (59 subjects). Of the organic UV absorbers, octocrylene, benzophenone-3 and butyl methoxydibenzoylmethane most frequently elicited PACD. The "newer" organic sunscreen absorbers rarely led to PACD. There appeared to be an association between the agents ketoprofen, octocrylene and benzophenone-3, with several subjects developing PACD to two or all three agents concomitantly. Allergic contact dermatitis (ACD) was less commonly observed than PACD, comprising 55 reactions in 47 (4.6%) subjects. Irritant reactions and photoaugmentation and photoinhibition of ACD occurred infrequently. Conclusions:  The EMCPPTS has provided current information on the relative frequency of PACD to common photoallergens. Such data will be of value when deciding on which agents to include in future European "baseline" photopatch test series.
    British Journal of Dermatology 01/2012; · 3.76 Impact Factor
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    ABSTRACT: Topical photodynamic therapy (PDT) is a widely applied treatment for basal cell carcinoma (BCC). PDT-induced immunosuppression leading to reduced antitumour immune responses may be a factor in treatment failure. To examine the impact of topical PDT on leucocyte trafficking following clinical treatment of BCC. Superficial BCCs in eight white caucasian patients were treated with methyl aminolaevulinate (MAL)-PDT. Biopsies for immunohistochemical assessment were taken from BCCs pre-PDT, 1 h and 24 h post-PDT and from untreated healthy skin. Treatment of BCC with MAL-PDT produced a rapid neutrophil infiltration, commencing by 1 h and significantly increased at 24 h post-PDT (P < 0·05 compared with baseline). An associated increase in the number of blood vessels expressing E-selectin was observed at 1 h and 24 h post-PDT (both P < 0·05 compared with baseline). In contrast, the number of epidermal Langerhans cells fell sharply by 1 h post-PDT, and remained significantly reduced at 24 h post-PDT (both P < 0·05 compared with baseline). Reduction of Langerhans cells during clinical treatment of BCC might potentially impact negatively on antitumour responses through reduced activation of tumour-specific effector cells. Investigation of modified PDT protocols with the aim to minimize immunosuppressive effects while maintaining antitumour efficacy is warranted.
    British Journal of Dermatology 01/2012; 166(5):1112-5. · 3.76 Impact Factor
  • American Journal of Clinical Nutrition 01/2012; 95:1504-1505. · 6.50 Impact Factor
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    ABSTRACT: Topical photodynamic therapy (PDT) elicits a therapeutic response in both skin cancer and immune-mediated skin disorders. While PDT induces direct cell death, host inflammatory and immune responses to PDT may contribute to the therapeutic effects. To examine the impact of topical PDT on leucocyte trafficking and mediators of chemotaxis in healthy human skin. Aminolaevulinic acid (ALA)-PDT was performed on the buttock skin of seven healthy volunteers. Biopsies for immunohistochemical assessment were taken 1, 4 and 24 h post-PDT and from untreated contralateral buttock skin (baseline). A significant dermal neutrophilic infiltrate appeared early, peaking at 4 h (P < 0·01) and returning to near baseline by 24 h. Expression of E-selectin was significantly higher at 4 h (P < 0·05) and correlated strongly with neutrophil numbers (r = 0·93). Expression of intercellular adhesion molecule 1 was significantly elevated after 24 h (P < 0·05) with an apparent gradual increase in CD4+ T cells up to this time point. Notably, epidermal Langerhans cells were significantly reduced 24 h post-PDT compared with baseline (P < 0·01) and comprised a significantly larger proportion of cells with migratory rather than dendritic morphology (P < 0·05). The number of epidermal cells expressing tumour necrosis factor-α significantly increased at 4 h (P < 0·05) and remained elevated 24 h post-PDT, whereas no significant change in expression of interleukin (IL)-1β or IL-8 was seen. Reduction of Langerhans cells by topical PDT of human skin may play a significant role in PDT-induced local immunosuppression, potentially benefiting the treatment of immune-mediated skin disorders but negatively impacting on antitumour responses. Further exploration according to disease indication/treatment protocol is warranted.
    British Journal of Dermatology 05/2011; 165(3):513-9. · 3.76 Impact Factor
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    ABSTRACT: Previous epidemiological, animal and human data report that lycopene has a protective effect against ultraviolet radiation (UVR)-induced erythema. We examined whether tomato paste--rich in lycopene, a powerful antioxidant--can protect human skin against UVR-induced effects partially mediated by oxidative stress, i.e. erythema, matrix changes and mitochondrial DNA (mtDNA) damage. In a randomized controlled study, 20 healthy women (median age 33 years, range 21-47; phototype I/II) ingested 55 g tomato paste (16 mg lycopene) in olive oil, or olive oil alone, daily for 12 weeks. Pre- and postsupplementation, UVR erythemal sensitivity was assessed visually as the minimal erythema dose (MED) and quantified with a reflectance instrument. Biopsies were taken from unexposed and UVR-exposed (3 × MED 24 h earlier) buttock skin pre- and postsupplementation, and analysed immunohistochemically for procollagen (pC) I, fibrillin-1 and matrix metalloproteinase (MMP)-1, and by quantitative polymerase chain reaction for mtDNA 3895-bp deletion. Mean ± SD erythemal D(30) was significantly higher following tomato paste vs. control (baseline, 26·5 ± 7·5 mJ cm(-2); control, 23 ± 6·6 mJ cm(-2); tomato paste, 36·6 ± 14·7 mJ cm(-2); P = 0·03), while the MED was not significantly different between groups (baseline, 35·1 ± 9·9 mJ cm(-2); control, 32·6 ± 9·6 mJ cm(-2); tomato paste, 42·2 ± 11·3 mJ cm(-2)). Presupplementation, UVR induced an increase in MMP-1 (P = 0·01) and a reduction in fibrillin-1 (P = 0·03). Postsupplementation, UVR-induced MMP-1 was reduced in the tomato paste vs. control group (P = 0·04), while the UVR-induced reduction in fibrillin-1 was similarly abrogated in both groups, and an increase in pCI deposition was seen following tomato paste (P = 0·05). mtDNA 3895-bp deletion following 3 × MED UVR was significantly reduced postsupplementation with tomato paste (P = 0·01). Tomato paste containing lycopene provides protection against acute and potentially longer-term aspects of photodamage.
    British Journal of Dermatology 01/2011; 164(1):154-62. · 3.76 Impact Factor
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    ABSTRACT: Vitamin D is necessary for bone health and is potentially protective against a range of malignancies. Opinions are divided on whether the proposed optimal circulating 25-hydroxyvitamin D [25(OH)D] level (≥ 32 ng mL⁻¹) is an appropriate and feasible target at population level. We examined whether personal sunlight exposure levels can provide vitamin D sufficient (≥ 20 ng mL⁻¹) and optimal status in the U.K. public. This prospective cohort study measured circulating 25(OH)D monthly for 12 months in 125 white adults aged 20-60 years in Greater Manchester. Dietary vitamin D and personal ultraviolet radiation (UVR) exposure were assessed over 1-2 weeks in each season. The primary analysis determined the post-summer peak 25(OH)D required to maintain sufficiency in wintertime. Dietary vitamin D remained low in all seasons (median 3·27 μg daily, range 2·76-4·15) while personal UVR exposure levels were high in spring and summer, low in autumn and negligible in winter. Mean 25(OH)D levels were highest in September [28·4 ng mL⁻¹; 28% optimal, zero deficient (<5 ng mL⁻¹)], and lowest in February (18·3 ng mL⁻¹; 7% optimal, 5% deficient). A February 25(OH)D level of 20 ng mL⁻¹ was achieved following a mean (95% confidence interval) late summer level of 30·4 (25·6-35·2) and 34·9 (27·9-41·9) ng mL⁻¹ in women and men, respectively, with 62% of variance explained by gender and September levels. Late summer 25(OH)D levels approximating the optimal range are required to retain sufficiency throughout the U.K. winter. Currently the majority of the population fails to reach this post-summer level and becomes vitamin D insufficient during the winter.
    British Journal of Dermatology 11/2010; 163(5):1050-5. · 3.76 Impact Factor
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    ABSTRACT: Solar urticaria is a rare photosensitivity disorder demonstrating a range of action spectra, which can inflict a very large impact on life quality despite available treatments. Melanin broadly reduces skin penetration by ultraviolet-visible wavelengths, thus increased melanization may protect in solar urticaria. To examine quantitatively for impact of the potent α-melanocyte stimulating hormone analogue afamelanotide ([Nle(4)-D-Phe(7)]-α-MSH, Scenesse(®); Clinuvel Pharmaceuticals Ltd, Melbourne, Vic., Australia) on the solar urticaria response and skin melanization. Five patients with solar urticaria received a single dose of 16 mg subcutaneous afamelanotide implant in winter time. Melanin density was assessed spectrophotometrically from day 0 to day 60. Detailed monochromated light testing to geometric dose series (increment ) of wavelengths 300-600 nm was performed at 0, 30 and 60 days, with assessment of weal and flare area and minimum urticarial dose (MUD). Data were analysed by repeated-measures anova. Mean melanin density increased by day 7, peaked at day 15 and remained elevated at day 60 (P=0·03, 0·01, 0·02 vs. baseline, respectively). Baseline phototesting revealed action spectra of 320-400 (n=1), 320-500 (n=2), 300-600 (n=1) and 370-500 nm (n=1), and on afamelanotide mean rises in MUD of 1-12 and 1-3 dose increments were seen at the individual wavelengths tested, at 30 and 60 days, respectively. A significant fall in weal area occurred across responding wavelengths from 300 to 600 nm at 60 days postimplant (P=0·049 vs. baseline), accompanied by greater than twofold overall increase in MUD (P=0·058 vs. baseline). Melanization following afamelanotide is accompanied by reduction in solar urticaria response across a broad spectrum of wavelengths. Further study is warranted to assess clinical benefit under ambient conditions in summer.
    British Journal of Dermatology 10/2010; 164(2):407-14. · 3.76 Impact Factor
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    ABSTRACT: Photosensitivity disorders involve an abnormal skin reaction to sunlight exposure and affect a substantial percentage of the population. No previous studies have directly compared lifestyle attributes between photosensitive and healthy individuals. To assess the impact of photosensitivity on time spent outdoors in the U.K., holiday behaviour, use of sunscreens and vitamin D supplements, and employment status. Questionnaires were completed by ambulant photosensitive and healthy adults aged 18-60 years residing in Greater Manchester. Forty-five adults with moderate-severe photosensitivity and 124 healthy adults completed the questionnaire. This revealed that photosensitive subjects spent significantly less time outdoors in the U.K. on both summer weekdays (P < 0·01) and summer weekends (P < 0·0001) than healthy subjects, took fewer holidays per year (P < 0·05), and spent less time outdoors on a sunny holiday (P < 0·0001). They wore clothing that covered a wider skin area (P < 0·0001), and use of sunscreen was greater (both frequency of application and area covered) in the photosensitive group outside of holiday time (P < 0·0001), but not when on a sunny holiday, as healthy people increased their sunscreen use at this time. Despite the reduced sun exposure, photosensitive subjects were no more likely to take vitamin D supplements than healthy subjects were; they also exhibited a significantly higher rate of unemployment (P < 0·05). Photosensitivity disorders negatively influence lifestyle including employment status; more attention is required to the socioeconomic impact of these conditions.
    British Journal of Dermatology 10/2010; 163(4):817-22. · 3.76 Impact Factor
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    E A Langan, Z Nie, L E Rhodes
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    ABSTRACT: While ultraviolet radiation (UVR) is a major cause of skin ageing and carcinogenesis, public pursuit of a novel tanning strategy circumventing the need for UVR is increasingly reported in the media and scientific press. This involves the subcutaneous self-administration of unregulated products labelled as melanotan I and/or II, synthetic analogues of α-melanocyte stimulating hormone (α-MSH), as obtained via the internet, tanning salons and gyms. The Medicines and Healthcare products Regulatory Authority has recently raised awareness of the public health risk of transmission of blood-borne viruses from the needle sharing that may occur, and of the potential impurity of these products. Dermatologists should also be aware that these agents can complicate the clinical presentation of patients with pigmented lesions; their use may be suspected in unexpectedly tanned individuals with rapidly pigmenting naevi. Meanwhile, the regulated α-MSH analogue afamelanotide (Clinuvel Pharmaceuticals Ltd, Melbourne, Australia) is showing promise for its photoprotective potential, and is undergoing phase II and III clinical trials in people with photosensitivity disorders and those prone to nonmelanoma skin cancer. The photoprotective and other biological effects of α-MSH analogues await full determination.
    British Journal of Dermatology 09/2010; 163(3):451-5. · 3.76 Impact Factor
  • Bone 01/2010; 47. · 3.82 Impact Factor
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    C A Morton, K E McKenna, L E Rhodes
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    ABSTRACT: Multicentre randomized controlled studies now demonstrate high efficacy of topical photodynamic therapy (PDT) for actinic keratoses, Bowen's disease (BD) and superficial basal cell carcinoma (BCC), and efficacy in thin nodular BCC, while confirming the superiority of cosmetic outcome over standard therapies. Long-term follow-up studies are also now available, indicating that PDT has recurrence rates equivalent to other standard therapies in BD and superficial BCC, but with lower sustained efficacy than surgery in nodular BCC. In contrast, current evidence does not support the use of topical PDT for squamous cell carcinoma. PDT can reduce the number of new lesions developing in patients at high risk of skin cancer and may have a role as a preventive therapy. Case reports and small series attest to the potential of PDT in a wide range of inflammatory/infective dermatoses, although recent studies indicate insufficient evidence to support its use in psoriasis. There is an accumulating evidence base for the use of PDT in acne, while detailed study of an optimized protocol is still required. In addition to high-quality treatment site cosmesis, several studies observe improvements in aspects of photoageing. Management of treatment-related pain/discomfort is a challenge in a minority of patients, and the modality is otherwise well tolerated. Long-term studies provide reassurance over the safety of repeated use of PDT.
    British Journal of Dermatology 11/2008; 159(6):1245-66. · 3.76 Impact Factor
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    ABSTRACT: Polymorphic light eruption and erythropoietic protoporphyria (EPP) have been demonstrated to have a moderate and large impact on the quality of life (QoL) of patients, respectively. However, there is little information available about the impact of other photodermatoses on QoL. To assess and compare the impact of all forms of photodermatoses on patients' QoL using the standard 1-week Dermatology Life Quality Index (DLQI) questionnaire and a modified questionnaire to assess the impact over the previous year. All patients with photodermatoses seen between 2001 and 2005 at five U.K. photobiology centres were contacted by post on the same day during a forecasted sunny week across the U.K. and asked to complete DLQI questionnaires. A total of 1877 patients were contacted. Seven hundred and ninety-seven (42%) patients replied, with a range from 30% to 48% for the five individual centres. Nearly two-thirds of patients with actinic prurigo (AP) and more than one-third of patients with photoaggravated dermatoses (PAD), chronic actinic dermatitis, EPP and solar urticaria had a DLQI of > 10, confirming a very large effect of the disorders on QoL. Of the cutaneous porphyrias, both variegate porphyria (median DLQI 3) and porphyria cutanea tarda (median DLQI 1.5) had a much lower impact on QoL than EPP. This is the first large-scale study to attempt to measure the impact of a range of photodermatoses on QoL. Photodermatoses have a major impact on QoL. This impact is highest in AP and PAD.
    British Journal of Dermatology 07/2008; 159(1):192-7. · 3.76 Impact Factor

Publication Stats

1k Citations
231.28 Total Impact Points


  • 2002–2014
    • The University of Manchester
      • • Institute of Inflammation and Repair
      • • School of Translational Medicine
      • • Centre for Dermatology
      Manchester, England, United Kingdom
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom
  • 2011
    • Central Manchester University Hospitals NHS Foundation Trust
      Manchester, England, United Kingdom
  • 2008
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
    • National Health Service
      • Department of Dermatology
      Radditch, England, United Kingdom
  • 1995–2001
    • University of Liverpool
      • School of Medicine
      Liverpool, ENG, United Kingdom
  • 1992–2001
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      • • Department of Dermatology
      • • Department of Medicine
      Liverpool, England, United Kingdom