Fluorescence Diagnosis and Photodynamic Therapy of Skin Diseases

A Introduction and Historical Landmarks.- A.1 Definition of the Photodynamic Action.- A.2 Optimum Photosensitizing Agent for Photodynamic Action.- A.3 Definition of Fluorescence Detection with ALA-Induced Porphyrins (FDAP).- A.4 Mechanisms of Action in PDT.- B ?-Aminolevulinic Acid (ALA).- B.1 Chemistry of ALA and ALA Methylester (ALA).- B.2 Metabolism of ALA.- B.3 Pharmacodynamics of ALA.- C Light Used in FDAP and PDT.- D Unresolved Issues in FDAP and PDT.- E Fluorescence Detection of ALA-induced Porphyrins (FDAP).- E.1 FDAP: Evaluation of the ALA-Induced Fluorescence in Skin Diseases.- F Ex vivo - Investigations on ALA-induced Porphyrins.- F.1 Porphyrin Accumulation in Cells (in vitro).- F.2 Porphyrin Accumulation in Skin Tumors, Colon and Bronchial Carcinomas after Administration of ALA (ex vivo).- G In vivo - Investigations on ALA-Induced Porphyrin/FDAP.- G.1 FDAP: Kinetics of ALA-Induced Porphyrins in Human Cutaneous Tumors, Psoriasis Lesions and Normal Skin.- G.2 FDAP: Kinetics of Porphyrin Accumulation in Solar Keratoses: ALA versus ALA Methylester.- G.3 FDAP: Use of the in vivo - Fluorescence for Surgical Planning.- G.4 FDAP: Evaluation of the Optimum Photosensitizing Substance or its Prodrug.- G.5 FDAP: Evaluation of the Optimum Exciting Light Source.- G.6 FDAP: Correlation of in vivo - Tumor Fluorescence and Histopathology.- G.7 FDAP: Course of FDAP in Relation to the Number of PDT-Sessions.- H The Clinical Use of FDAP.- H.1 FDAP in Clinically Well-defined Tumors.- H.2 FDAP in Clinically Ill-defined Lesions.- H.3 FDAP in Pretreated or Damaged Skin.- H.4 Limitations of FDAP.- H.5 Usefulness of FDAP in Guiding Tumor Therapies.- I Photodynamic Therapy in Cutaneous Diseases.- I.1 PDT: Evaluation of the Efficacy in Solar Keratoses.- I.2 PDT: Evaluation ofthe Efficacy in Bowen's Disease.- I.3 PDT: Evaluation of the Efficacy in Basal Cell Carcinoma.- I.4 PDT: Evaluation of the Efficacy in Squamous Cell Carcinoma.- I.5 PDT: Evaluation of the Efficacy in Psoriatic Lesions.- I.6 PDT: Evaluation of the Efficacy in Selected Cutaneous Diseases.- I.7 PDT: Evaluation of the Optimum Photosensitizing Substance or its Prodrug.- I.8 PDT: Evaluation of the Optimum Exciting Light Source.- J General Discussion.- J.1 FDAP: Indications and Limits.- J.2 PDT: Indications and Limits.- J.3 Safety and Tolerability of ALA-PDT.- J.4 Regulatory Affairs Concerning Aminolevulinic Acid.- J.5 Regulatory Affairs Concerning Aminolevulinic Acid Methylester.- K Conclusion.- L Summary.- Acknowledgements.