methyl aminolevulinate (meth-il a-meen-oh-lev-yoo-lin-late)
Pharmacologic: photodynamic agents
Thin and moderately thick nonhyperkeratotic, nonpigmented actinic keratoses of the face/scalp in immunocompetent patients (with débridement and specific wavelength red light therapy).
Converted to photoactive porphyrins which when exposed to specific wavelength red light result in a photodynamic cytotoxic reaction. Therapeutic Effects: Resolution of precancerous lesions.
Adverse Reactions/Side Effects
Derm: burning, contact sensitization, erythema, irritation, itching, pain in area of application, edema at site.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess the area being treated to help document whether drug therapy is successful in resolving skin lesions.
Watch for any new or increased reactions at the site of application, including irritation, burning, itching, and swelling. Report severe or prolonged skin reactions to the physician.
Make sure patient understands how this drug works; that is, red light exposure activates the cytotoxic effects and decreases cell growth in precancerous skin lesions.
Instruct patient to prevent new lesions by limiting sun exposure, using sunscreens, and wearing protective clothing.
Metabolism and Excretion: Unknown.
TIME/ACTION PROFILE (lesion resolution)
|ROUTE ||ONSET ||PEAK ||DURATION |
|topical ||within days ||unknown ||3 mo |
Contraindicated in: Cutaneous photosensitivity or allergy to porphyrins, peanuts or almonds; Lactation/Pedi: Lactation or children.
Use Cautiously in: Bleeding disorders; OB: Use only if clearly needed.
Drug-Drug: Concurrent use with other photosensitizing agents may result in an exaggerated reaction.
Topical (Adults): Following local débridement, apply a 1-mm layer of cream to lesion and surrounding 5 mm of skin (not to exceed 1 g/treatment), cover with occlusive, nonabsorbent dressing for 3 hr. Dressing is then removed, excess cream rinsed off, and skin exposed to red light treatment. Treatment is repeated 7 days later.