Eur J Dermatol 2014; 24(6): 707

Letter to the editor Daniele TORCHIA Pietro CAPPUGI

Photodynamic therapy for Zoon balanitis

Italian Group Radiofrequencies Photodynamic Therapy, LED Phototherapy (GIRTEL), Via della Scala 58, 50123 Florence (Italy), e-mail: [email protected]

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recent EJD paper described the successful treatment of Zoon balanitis (ZB) with topical photodynamic therapy (PDT) [1]. We wish to add our personal experience to the literature. Four cases of ZB (mean age 60.0 years, range 5270) were seen in our clinic between 2009 and 2012. Patients were diagnosed on clinical and histopathological grounds (figures 1A-B), previously untreated and gave their informed consent to off-label treatment with PDT. A galenic gel containing 16% 5-aminolaevulinic acid (5-ALA) was applied topically. After two hours, the application site was irradiated with 140 mJ/cm2 /sec of continuous-mode red light featuring a peak emission at 618 nm (PDT-CLD 100, E.P.E.M. s.r.l., Florence, Italy) for a total dose of 120 J/cm2 . The same procedure was possibly repeated every other week. All patients showed high compliance to treatment, did not complain of significant side effects and healed completely after an average 2.75 PDT sessions (range 2-3) (figure 1C), remaining disease-free at the last visit (average follow-up 14.5 months, range 12-18). These data confirm the effectiveness of PDT in the treatment of ZB, as shown in the case by Pinto-Almeida et al. [1], but are in partial contrast with the only other study available in the literature, in which PDT achieved complete resolution of ZB only in one out of six cases and partial remission in another three [2]. The main differences

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between our treatment protocol and that of others were the different photosensitizer used (5-ALA and methylaminolaevulinate, respectively) and dose of red light administered (120 J/cm2 and 37 J/cm2 , respectively) [1, 2]. Taking into consideration that the treatment for plasma cell mucositides such as ZB has not yet been well established, being mostly based on anecdotal reports and the physician’s judgment, PDT can be considered a moderately effective and safe option for ZB.  Disclosure. Financial support: none. Conflict of interest: none.

References 1. Pinto-Almeida T, Vilac¸a S, Amorim I, Costa V, Alves R, Selores M. Complete resolution of Zoon balanitis with photodynamic therapy - a new therapeutic option? Eur J Dermatol 2012; 22: 540-1. 2. Calzavara-Pinton PG, Rossi MT, Aronson E, Sala R, The Italian Group For Photodynamic Therapy R. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 1: Inflammatory and aesthetic indications. Photochem Photobiol Sci 2013; 12: 148-57.

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doi:10.1684/ejd.2014.2439

Figure 1. A) Erythematous and shiny patch of the balanopreputial sulcus. B) Dense inflammatory infiltrate with many plasma cells in the superficial dermis (haematoxylin & eosin, original magnification ×40). C) Complete healing of the lesion in (A) two weeks after the third photodynamic therapy session.

EJD, vol. 24, n◦ 6, November-December 2014 To cite this article: Torchia D, Cappugi P. Photodynamic therapy for Zoon balanitis. Eur J Dermatol 2014; 24(6): 707 doi:10.1684/ejd.2014.2439

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Photodynamic therapy for Zoon balanitis.

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