TABLE 3.

Clinical studies involving PDT in other types of ulcerations.

Country	Design	Patients	Wounds	PS	Light	Treatment	Outcomes	Conclusion
United Kingdom (75)	RCT	27 healthy older men	4-mm punch biopsy wound in upper inner arm	16% MAL, incubate for 3 h	red light (80 mW/cm2 for 9 min, total light dose: 37 J/cm2)	wounds was treated immediately and again on days 2 and 4	Wound re-epithelialization delayed at 7 days after MAL-PDT, with smaller wounds at 3 weeks, and greater and more ordered collagen and elastin deposition at 9 months.	MAL-PDT acts on the matrix remodeling process and ultimately improves wound appearance
Italy (123)	case report	a 38-year-old woman with SLE and APS	two symmetric paramalleolar ulcers	10% ALA in PEG ointment, incubate for 2 h	red light (630 nm, 160 mW/cm2, 8 min, light dose: 75 J/cm2)	the left ulcer dressing only, the right with dressing and PDT (once a week)	The ulcers healed within 3 months leaving depressed white scars, and have not recurred since.	PDT may be a valid alternative strategy to control the ulcers caused by systemic vascular and immunological process.
Greece (124)	case report	a 69-year-old patient with CL	an ulcerated lesion on the left cheek	20% 5-ALA solution, incubate for 4 h in the dark	red light (630 nm, 45 mW/cm2, light dose: 100 J/cm2)	once a week for 3 sessions	The lesion had subsided and remain clinically clear at 2 years follow up.	ALA-PDT may be an alternative treatment in recurrent CL.
Israel (114)	single-center controlled study	31 patients with CL	leishmanial lesions	16% MAL, incubate for 0.5 h	daylight for 2.5 h	once a week until cure	The overall cure rate for DA-PDT was 89, 86% in hospital group and 92% in the self-administered group.	DA-PDT is effective in the treatment of CL.
Denmark (115)	case report	a 15-year old boy with CL	a single, ulcer on the leg	BAF 200 ALA	−	twice a week for 12 weeks	Repeated ALA-PDT resulted in complete healing of the ulcer.	The complete healing of the ulcer suggests the utility of PDT in resistant cases of CL.
Italy (116)	case report	a 44 year old woman with NL	widespread ulcerative NL	10% ALA in polyethylene glycol ointment, incubate for 3 h	red light (630 nm, 160 mW/cm2, 8 min, light dose: 75 J/cm2)	2 weeks intervals for 6 sessions	The ulcers were completely healed, and the erythema was significantly reduced after 6 sessions of treatment.	PDT-stimulation of wound healing may influenced the course of NL positively.
Brazil (117)	case report	A 30-year-old woman with pemphigus vulgaris	persistent neck ulceration	MAL, incubate for 3 h	LED (635 nm, 10 min, light dose: 37 J/cm2)	once a week for 2 sessions	Two sessions of MAL-PDT healed the lesion completely.	MAL-PDT may be a useful adjunct in the management of recalcitrant ulcers in patients with pemphigus vulgaris.
China (118)	case series	Seven patients	skin ulcers with sinus tract formation	20% ALA in an oil-in-water emulsion	a red LED (633 nm, 84 mW/cm2, light dose: 100 J/cm2)	every 10 days for 1–5 sessions.	Six patients completely cured after PDT combined with antibiotics for 3 months. In another case, the sinus tract healed and wound size reduced.	ALA-PDT combined with antibiotics is safe and effective to treat skin ulcers with sinus tract.