| 1. |
- Bendsoe, N., et al.
(författare)
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A Non-Interventional Study on Vismodegib for Basal Cell Carcinoma in Swedish Patients
- 2023
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Ingår i: Dermatology Practical & Conceptual. - : Mattioli1885. - 2160-9381. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Real-life data on vismodegib in advanced basal cell carcinoma (aBCC) are limited. Optimal treatment duration is left to the discretion of the physician.Objectives: To assess the effectiveness, safety and treatment pattern for vismodegib in aBCC in clinical practice.Methods: In this multicenter, non-interventional, prospective study, 49 Swedish patients planned for vismodegib treatment were included. The treatment pattern observed was treatment until remission, allowing unlimited discontinuations/pauses.Results: The majority of patients (93.8%), discontinued at least once during the study. Compared to earlier studies there was a decrease of more than 2 months with actual drug intake, reducing the patients burden and costs, at the same time as a high number of responses were seen (87.8%). Median progression-free-survival was 16.7 months, and 90% of the patients were alive at 13.3 months. Ten patients were re-challenged with vismodegib at recurrence or progression, resulting in five partial remissions and three complete remissions.Conclusions: Clinical response rates with vismodegib for aBCC were comparable to those of similar trials despite a shorter and more intermittent treatment duration. The majority of re-challenges lead to partial or complete remissions.
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| 2. |
- Halldin, Christina, 1957, et al.
(författare)
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Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp
- 2009
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Ingår i: British Journal of Dermatology. - 1365-2133. ; 160:4, s. 795-800
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Topical photodynamic therapy (PDT) is an effective method when treating extensive areas of sun-damaged skin with multiple actinic keratoses (AKs) (field cancerization) on areas such as the forehead and scalp, and offers excellent cosmetic outcome. The major side-effect of PDT is the pain experienced during treatment. OBJECTIVES: To investigate whether nerve blocks could provide adequate pain relief during PDT of AKs on the forehead and scalp. METHODS: Ten men with symmetrically distributed and extensive AKs on the forehead and scalp were included in the study. Prior to PDT one side of the forehead and scalp was anaesthetized by nerve blocks while the other side served as control. RESULTS: The mean visual analogue scale (VAS) score on the anaesthetized side was 1 compared with 6.4 on the nonanaesthetized side during PDT. This difference was significant (P<0.0001), implying that nerve blocks reduce VAS scores during PDT. CONCLUSIONS: The results of the study support the use of nerve blocks as pain relief during PDT of field cancerization on the forehead and scalp, although individual considerations must be taken into account to find the most adequate pain-relieving method for each patient.
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| 3. |
- Halldin, Christina, 1957, et al.
(författare)
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Patients' Experiences of Pain and Pain Relief During Photodynamic Therapy on Actinic Keratoses: An Interview Study.
- 2013
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Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555. ; 93:4, s. 433-437
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Tidskriftsartikel (refereegranskat)abstract
- Photodynamic therapy (PDT) is a well-known, effective method for treating extensive areas of multiple actinic keratoses in the face and scalp. The main side-effect of PDT is the pain experienced during treatment. The objective of this study was to explore and describe patients' experiences of PDT. The study used individual interviews, and analysis was carried out using phenomenography. The patients had all been treated with PDT for actinic keratoses on the face and scalp, and experienced PDT with and without nerve blocks. The results are presented in 3 themes and 10 categories. Most patients reported that the nerve blocks given prior to PDT altered their experience of pain. Alternative options are needed to reduce pain during PDT based on patients' needs and body site. This study adds a patient perspective highlight-ing patients' own voices as a qualitative complement to statistical analysis using the visual analogue scale.
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| 4. |
- Halldin, Christina, 1957
(författare)
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Photodynamic therapy- pain and aspects of pain relief
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Photodynamic therapy – pain and aspects of pain relief Christina Halldin Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ABSTRACT Photodynamic therapy (PDT) is a non-invasive treatment option for superficial basal cell carcinoma (BCC), squamous cell carcinoma (SCC) in situ or Bowen’s disease (BD), and actinic keratoses (AK). One of the advantages of PDT is the possibility to treat field cancerization. PDT is also suitable to use when treating poor healing areas such as the lower extremities. Furthermore, PDT offers an excellent cosmetic outcome compared with conventional therapies. In general the treatment is well tolerated, side effects such as erythema, scaling and crusts are normal after treatment. The most problematic side effect is pain, especially when large areas of extensive AKs are treaded in the face and/or scalp. The overall aim of this thesis was to investigate and identify factors of pain associated with PDT, and try to achieve effective methods to reduce the pain during treatment. In the first study (Paper I), 377 patients treated with PDT during the year 2004 were investigated. Of special interest was the patients’ pain experience and identifying pain predictors. The strongest predictor of pain during PDT was size of the treated area, followed by diagnosis and location. In Study II (Paper II), we examined transcutaneous electrical nerve stimulation (TENS) as a method of pain relief during PDT. During treatment the strength of the stimulation was controlled by the patient. The result of the TENS stimulation was a minor decrease in pain during PDT compared with the patient’s previous pain assessments without TENS. In Study III (Paper III), the pain-relieving effect of frontal nerve block (NB) in combination with occipital NBs was examined. The NBs were applied unilaterally in the occipital and frontal area, with the other side of the face serving as the patient’s own control. In the nerve-blocked area the mean VAS score was 1.0 during PDT, compared with 6.4 on the non-blocked side. One limitation was that the temple area is not completely covered by current NBs. Finally, in Study IV (Paper IV), the patients, being the PDT users, were interviewed about how they experienced and perceived PDT. All interviewees had been treated for AKs with PDT on the face and scalp and had undergone PDT with and without NB. The patients had experienced the pain as very intense without NB but said that the result in the end had made it worth it. The NBs had given satisfactory relief from pain; however, the injections could be transiently painful. Key words: actinic keratosis (AK), field cancerization, interviews, nerve block (NB), pain, photodynamic therapy (PDT), transcutaneous electrical nerve stimulation (TENS) ISBN 978-91-628-8388-1, hptt://hdl.handle.net / 2077 / 26592 Gothenburg 2011
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| 5. |
- Halldin, Christina, 1957, et al.
(författare)
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Predictors of Pain Associated with Photodynamic Therapy: A Retrospective Study of 658 Treatments.
- 2011
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555.
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Tidskriftsartikel (refereegranskat)abstract
- Pain is the most common side-effect of photodynamic therapy (PDT). Our main objective was to identify pain predictors in PDT. In total, we performed 658 treatments on 377 patients at our department during 2004. Larger sized treatment areas were the strongest pain predictor, and actinic keratoses were more painful to treat than basal cell carcinomas and Bowen's disease. The most sensitive areas to treat were the face and scalp. Gender and age did not influence pain. Although treatment outcome was not our primary objective, 62% of 95 superficial basal cell carcinomas that were followed for 3 years showed complete clearance. Also, perforation of nodular basal cell carcinomas did not lead to better clinical results. In conclusion, the size of the treatment area, the diagnosis and the lesion location influence pain during PDT. Never-theless, there is a large variance in visual analogue scale assessment within each group, thereby limiting the ability to predict pain.
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| 6. |
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| 7. |
- Hörfelt, Camilla, 1970, et al.
(författare)
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Single Low-dose Red Light is as Efficacious as Methyl-aminolevulinate-Photodynamic Therapy for Treatment of Acne: Clinical Assessment and Fluorescence Monitoring
- 2009
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Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555. ; 89:4, s. 372-378
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Tidskriftsartikel (refereegranskat)abstract
- This controlled study investigated single low-dose red light photodynamic therapy and methyl-aminolevulinate (MAL) for treatment of moderate to severe facial acne in 19 patients. The right cheek was treated with MAL (160 mg/g) for 3 h prior to illumination. The left cheek received red light only. Both cheeks were illuminated with narrow-band red light (635 nm) at a light dose of 15 J/cm(2). The global severity of acne was assessed at baseline and at follow-up, 10 and 20 weeks after treatment. Fluorescence images, clinical photographs and skin surface biopsies were obtained. Both MAL-photodynamic therapy and control areas showed a significant decrease in acne score at follow-up; no significant difference was found compared with control. MAL-photodynamic therapy was associated with adverse effects such as erythema and stinging. Fluorescence images revealed poor selectivity of MAL-induced fluorescence to the acne lesions, suggesting a general photoablating mechanism rather than selective destruction of sebaceous glands. No significant reduction in Propionibacterium acnes or sebum excretion was found.
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| 8. |
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| 9. |
- Paoli, John, 1975, et al.
(författare)
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Nerve blocks provide effective pain relief during topical photodynamic therapy for extensive facial actinic keratoses
- 2008
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Ingår i: Clinical and Experimental Dermatology. - : Oxford University Press (OUP). - 1365-2230 .- 0307-6938. ; 33:5, s. 559-64
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Photodynamic therapy (PDT) is a first-line therapeutic option for skin areas with multiple actinic keratoses (AKs). Its main drawback is the pain perceived during the irradiative phase, especially when treating field cancerization in the facial area. Effective pain-relieving strategies are needed. AIM: To determine the effectiveness of peripheral nerve blocks in achieving pain relief during PDT for extensive facial AKs. METHODS: In total, 16 patients with symmetrically distributed facial AKs, mainly on the forehead, were enrolled in the study. Nerve blocks were applied unilaterally, and the nonanaesthetized side of the treatment area served as control. Maximum pain during PDT was evaluated using a visual analogue scale (VAS). Pain experienced after PDT was evaluated by telephone interview within 2 weeks of treatment. Cure rates were assessed at follow-up at least 4 weeks after treatment. RESULTS: Pain was significantly reduced on the anaesthetized side (P < 10(-8)). The mean +/- SEM VAS score on the blocked side of the face was 1.3 +/- 0.3 compared with 7.5 +/- 0.5 on the nonanaesthetized side. Pain relief persisted 1-2 h after PDT. The nerve block was generally not experienced as painful (14/16 patients). Almost all patients (15/16 patients) would like to receive nerve blocks bilaterally if future PDT were needed. Excellent clinical results were observed in all patients after 4-20 weeks. CONCLUSION: Nerve blocks provide efficient pain relief during PDT when treating patients with field cancerization of the forehead. Nerve blocks were not found to affect the clinical outcome of PDT, and were generally well tolerated by the patients.
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| 10. |
- Paoli, John, 1975, et al.
(författare)
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Teaching peripheral nerve blocks for the head and neck area to dermatologists.
- 2012
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Ingår i: Journal of the European Academy of Dermatology and Venereology : JEADV. - : Wiley. - 1468-3083 .- 0926-9959. ; 26:8, s. 1035-1037
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Tidskriftsartikel (refereegranskat)abstract
- Background Peripheral nerve blocks in the head and neck region can be useful for a large number of surgical or otherwise painful procedures carried out by dermatologists. As anaesthesiologists cannot always be available to help dermatologists place nerve blocks in outpatient settings, training courses for these physicians are warranted. Objectives To present a method of teaching nerve blocks for the face and scalp to dermatologists during residency and/or continuing medical education programmes. Methods Half-day courses with theoretical education, video demonstrations and supervised 'hands-on' training were organized to teach supraorbital/supratrochlear, infraorbital, mental and occipital nerve blocks. The outcome and effects of these training courses were analysed with a survey amongst participants 1-2years after the course. Results All the 20 participants who responded the survey successfully placed at least one type of nerve block during the course. Thirteen of 20 participants (65%) reported to be able to perform all the nerve block techniques at follow-up. Conclusions Dermatologists can learn how to perform nerve blocks for the face and scalp in a safe and controlled manner through half-day courses, including theory, video demonstrations and supervised 'hands-on' training.
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