Antimicrobial photodynamic therapy for severe acute radiodermatitis in patients undergoing head and neck radiotherapy: a case series.

Introduction: Acute radiodermatitis (ARD) is a frequent and debilitating inflammatory toxicity in patients undergoing head and neck radiotherapy (RT). In severe cases, ARD may progress to moist desquamation, with the potential for ulceration. Colonization or infection with Methods: We conducted a case series, according to the CARE Statement Guideline, over an eight-month period involving five patients with severe ARD (GRA-L scale ≥ 5) who received aPDT following a standardized protocol. The protocol involved the topical application of methylene blue 1% as the photosensitizer followed by irradiation with a 660-nm diode laser delivering an energy density of 91.836 J/cm Results: aPDT led to significant clinical improvement in all five cases. ARD severity decreased from a mean initial grade of 6 (range: 5-8) to grade 1 in all patients, with no progression to more advanced grades after therapy initiation. Clinical stability was maintained until completion of the prescribed RT course, including the case in which aPDT was initiated during treatment. In the post-RT cases, recovery occurred within 6 to 15 days after aPDT initiation. No adverse effects related to aPDT were observed. Conclusions: This case series provides preliminary evidence that aPDT may assist in the management of severe ARD in patients undergoing head and neck RT. While the observed improvements were encouraging, these findings are exploratory and require confirmation in larger, controlled studies before aPDT can be considered within standardized supportive care approaches.