{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T13:56:23Z","timestamp":1781272583411,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Photoderm Photoimm Photomed"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Purpose<\/jats:title>\n                    <jats:p>Photodynamic therapy (PDT) is a field\u2010directed treatment for actinic keratoses (AK) with additional off\u2010label uses in acne and photoaging. Although effective, conventional PDT is often limited by illumination\u2010related pain. Building on the well\u2010tolerated nature of daylight PDT, short\u2010 or no\u2010incubation protocols have been developed to provide similarly painless treatment experiences within a controlled clinical setting. This review highlights the rationale, clinical outcomes, and practical implementation of these emerging approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a narrative review using searches on PubMed, Embase, and Google Scholar with keywords such as \u2018photodynamic therapy,\u2019 \u2018painless PDT,\u2019 \u2018actinic keratosis,\u2019 and \u2018incubation time.\u2019 The review evaluated the literature on the treatment of AK, focusing on pain, efficacy, and workflow considerations, across evolving PDT protocols, including daylight PDT (dPDT), red and blue light painless PDT (pPDT), simulated daylight PDT (SD\u2010PDT), and other novel delivery systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Evidence suggests these modified protocols achieve clearance rates comparable to conventional PDT while significantly improving patient tolerability. Short\u2010incubation protocols have demonstrated promising clinical results, offering a predictable, low\u2010pain alternative that maintains efficacy and streamlines clinic workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The emergence of painless PDT protocols\u2014developed based on the tolerability and success of daylight PDT\u2014has expanded the therapeutic potential of PDT in dermatology. These protocols enable clinicians to deliver effective, field\u2010directed treatment for AK with reduced patient discomfort, facilitating broader adoption in both academic and community practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/phpp.70068","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T13:20:29Z","timestamp":1765027229000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Painless Photodynamic Therapy: Emerging Protocols and Light Delivery Systems for the Treatment of Actinic Keratoses"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0070-9426","authenticated-orcid":false,"given":"Taylor Albert","family":"Bullock","sequence":"first","affiliation":[{"name":"Department of Dermatology Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3690-8382","authenticated-orcid":false,"given":"Edward Vincent","family":"Maytin","sequence":"additional","affiliation":[{"name":"Department of Dermatology Cleveland Clinic  Cleveland Ohio USA"},{"name":"Department of Biomedical Engineering Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40257\u2010022\u201000674\u20103"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2014.1253"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0190\u20109622(99)70114\u20103"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.142.6.729"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000507926"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.2009.03430.x"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15344"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1523\/jneurosci.4268\u201015.2016"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines6010012"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.22665"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.13326"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.15185"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102133.2008.08450.x"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102133.2011.10209.x"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.2011.04386.x"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2018.11.005"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17061050"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1117\/1.3484255"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12158"},{"issue":"3","key":"e_1_2_13_21_1","first-page":"32","article-title":"Safety and Efficacy of Aminolevulinic Acid 10% Topical Gel Versus Aminolevulinic Acid 20% Topical Solution Followed by Blue\u2010Light Photodynamic Therapy for the Treatment of Actinic Keratosis on the Face and Scalp: A Randomized, Double\u2010Blind Study","volume":"12","author":"Nestor M. S.","year":"2019","journal-title":"Journal of Clinical and Aesthetic Dermatology"},{"key":"e_1_2_13_22_1","unstructured":"\u201cLEVULAN KERASTICK (Aminolevulinic Acid HCL) for Topical Solution 20%. Prescribing Information. Sun Pharmaceutical Industries Inc. \u201d(2018)."},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.09.010"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/dss.0000000000000630"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2022.02.067"},{"issue":"3","key":"e_1_2_13_26_1","first-page":"275","article-title":"Photodynamic Therapy Effectively Treats Actinic Keratoses Without Pre\u2010Illumination Incubation Time","volume":"16","author":"Gandy J.","year":"2017","journal-title":"Journal of Drugs in Dermatology"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2023.03.056"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078\u20100432.CCR\u201017\u20102020"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102133.2010.09873.x"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2025.104698"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23728"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/ski2.226"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2021.102692"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.5436"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.2196\/12990"},{"key":"e_1_2_13_36_1","doi-asserted-by":"crossref","unstructured":"S.Mordon \u201cLight Emitting Fabrics for Photodynamic Therapy: Technology Experimental and Clinical Applications in Translational Biophotonics \u201d(2020).","DOI":"10.1002\/tbio.202000005"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2021.02.082"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/dss.0000000000000800"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/00015550510032887"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.13992"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/dss.0000000000003784"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14183805"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555\u20102612"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2024.104069"}],"container-title":["Photodermatology, Photoimmunology &amp; Photomedicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/phpp.70068","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/phpp.70068","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/phpp.70068","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:03:03Z","timestamp":1769605383000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/phpp.70068"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":43,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/phpp.70068"],"URL":"https:\/\/doi.org\/10.1111\/phpp.70068","archive":["Portico"],"relation":{},"ISSN":["0905-4383","1600-0781"],"issn-type":[{"value":"0905-4383","type":"print"},{"value":"1600-0781","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,6]]},"assertion":[{"value":"2025-06-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70068"}}