{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:22:53Z","timestamp":1789993373789,"version":"4.0.1"},"reference-count":10,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Photomedicine and Laser Surgery"],"published-print":{"date-parts":[[2018,3]]},"abstract":"\n \n Objective:<\/jats:italic>\n <\/jats:bold>\n To evaluate the ability of two-step irradiance to maintain pain control during red light 5-aminolevulinic acid (ALA) photodynamic therapy (PDT) for actinic keratoses (AK) and assess factors influencing pain.\n \n Background:<\/jats:italic>\n <\/jats:bold>\n PDT provides excellent clinical and cosmetic results in the treatment AK and early basal cell carcinomas (BCC). Widespread use of PDT is limited, in part, by pain. A two-step irradiance method for PDT has previously been shown to significantly reduce PDT-associated pain during the treatment of BCC, but the ability of this method to limit pain during the treatment of AKs has not been reported.\n \n Methods:<\/jats:italic>\n <\/jats:bold>\n We performed a retrospective chart review to assess the level of pain during AK treatment by red light PDT (\n n<\/jats:italic>\n \u2009=\u200999). Natural density filter was used to reduce the irradiance of the light source and initially 10\u2009J\/cm\n 2<\/jats:sup>\n dose was delivered at 35\u2009mW\/cm\n 2<\/jats:sup>\n and then, 65\u2009J\/cm\n 2<\/jats:sup>\n dose was delivered at 70\u2009mW\/cm\n 2<\/jats:sup>\n . Pain level was measured using a 10-point visual analog scale at three points during the procedure.\n \n Results:<\/jats:italic>\n <\/jats:bold>\n Pain was low to moderate in most patients (mean\u2009\u00b1\u2009standard error of the mean pain score: 2.35\u2009\u00b1\u20090.19). Higher pain was seen midprocedure versus at the beginning (\n p<\/jats:italic>\n \u2009<\u20090.0001) and at the end (\n p<\/jats:italic>\n \u2009=\u20090.003) of PDT. There was no significant difference in pain perception between genders and different treatment areas.\n \n Conclusions:<\/jats:italic>\n <\/jats:bold>\n Our results provide evidence that red light ALA PDT of AKs is very well tolerated with the two-step irradiance protocol.\n <\/jats:p>","DOI":"10.1089\/pho.2017.4351","type":"journal-article","created":{"date-parts":[[2017,12,11]],"date-time":"2017-12-11T11:14:35Z","timestamp":1512990875000},"page":"174-176","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Two-Step Irradiance Treatment Can Achieve Excellent Pain Control During Red Light 5-Aminolevulinic Acid Photodynamic Therapy for Actinic Keratoses"],"prefix":"10.1177","volume":"36","author":[{"given":"Gyorgy","family":"Paragh","sequence":"first","affiliation":[{"name":"Roswell Park Cancer Institute"},{"name":"Roswell Park Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie C.","family":"Zeitouni","sequence":"additional","affiliation":[{"name":"University of Arizona Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,3,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-5890(03)00083-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","first-page":"4475","DOI":"10.1158\/1078-0432.CCR-07-5199","article-title":"Irradiance-dependent photobleaching and pain in delta-aminolevulinic acid-photodynamic therapy of superficial basal cell carcinomas","volume":"14","author":"Cottrell WJ","year":"2008","unstructured":"Cottrell WJ, , Paquette AD, , Keymel KR, , Foster TH, , Oseroff AR. Irradiance-dependent photobleaching and pain in delta-aminolevulinic acid-photodynamic therapy of superficial basal cell carcinomas. Clin Cancer Res, 2008; 14:4475\u20134483.","journal-title":"Clin Cancer Res"},{"key":"e_1_3_2_4_2","first-page":"1329","article-title":"New methods for the clinical enhancement of photodynamic therapy","volume":"14","author":"Taub AF","year":"2015","unstructured":"Taub AF, , Schieber AC. New methods for the clinical enhancement of photodynamic therapy. J Drugs Dermatol, 2015; 14:1329\u20131334.","journal-title":"J Drugs Dermatol"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.jaad.2009.03.048","article-title":"Pain associated with aminolevulinic acid-photodynamic therapy of skin disease","volume":"61","author":"Warren CB","year":"2009","unstructured":"Warren CB, , Karai LJ, , Vidimos A, , Maytin EV. Pain associated with aminolevulinic acid-photodynamic therapy of skin disease. J Am Acad Dermatol, 2009; 61:1033\u20131043.","journal-title":"J Am Acad Dermatol"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1111\/bjd.13326","article-title":"Daylight photodynamic therapy for actinic keratoses: a randomized double-blinded nonsponsored prospective study comparing 5-aminolaevulinic acid nanoemulsion (BF-200) with methyl-5-aminolaevulinate","volume":"171","author":"Neittaanmaki-Perttu N","year":"2014","unstructured":"Neittaanmaki-Perttu N, , Karppinen TT, , Gronroos M, , Tani TT, , Snellman E. Daylight photodynamic therapy for actinic keratoses: a randomized double-blinded nonsponsored prospective study comparing 5-aminolaevulinic acid nanoemulsion (BF-200) with methyl-5-aminolaevulinate. Br J Dermatol, 2014; 171:1172\u20131180.","journal-title":"Br J Dermatol"},{"key":"e_1_3_2_7_2","first-page":"19","article-title":"In-office painless aminolevulinic acid photodynamic therapy: a proof of concept study and clinical experience in more than 100 patients","volume":"9","author":"Martin GM","year":"2016","unstructured":"Martin GM. In-office painless aminolevulinic acid photodynamic therapy: a proof of concept study and clinical experience in more than 100 patients. J Clin Aesthet Dermatol, 2016; 9:19\u201326.","journal-title":"J Clin Aesthet Dermatol"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1097\/DSS.0000000000000183","article-title":"A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer","volume":"40","author":"Zeitouni NC","year":"2014","unstructured":"Zeitouni NC, , Sunar U, , Rohrbach DJ, et al. A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer. Dermatol Surg, 2014; 40:1390\u20131394.","journal-title":"Dermatol Surg"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.jaad.2015.04.050","article-title":"Acute pain management in dermatology: risk assessment and treatment","volume":"73","author":"Glass JS","year":"2015","unstructured":"Glass JS, , Hardy CL, , Meeks NM, , Carroll BT. Acute pain management in dermatology: risk assessment and treatment. J Am Acad Dermatol, 2015; 73:543\u2013560; quiz 561\u2013542.","journal-title":"J Am Acad Dermatol"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/bjd.13547","article-title":"Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial","volume":"173","author":"Klein A","year":"2015","unstructured":"Klein A, , Karrer S, , Horner C, et al. Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial. Br J Dermatol, 2015; 173:192\u2013200.","journal-title":"Br J Dermatol"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/j.1365-2133.2010.09817.x","article-title":"Photodynamic therapy of multiple actinic keratoses: reduced pain through use of visible light plus water-filtered infrared A compared with light from light-emitting diodes","volume":"163","author":"von Felbert V","year":"2010","unstructured":"von Felbert V, , Hoffmann G, , Hoff-Lesch S, et al. Photodynamic therapy of multiple actinic keratoses: reduced pain through use of visible light plus water-filtered infrared A compared with light from light-emitting diodes. Br J Dermatol, 2010; 163:607\u2013615.","journal-title":"Br J Dermatol"}],"container-title":["Photomedicine and Laser Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/pho.2017.4351","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pho.2017.4351","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pho.2017.4351","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:43:17Z","timestamp":1777678997000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/pho.2017.4351"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1089\/pho.2017.4351"],"URL":"https:\/\/doi.org\/10.1089\/pho.2017.4351","relation":{},"ISSN":["1549-5418","1557-8550"],"issn-type":[{"value":"1549-5418","type":"print"},{"value":"1557-8550","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}