Immune-mediated inflammatory diseases (IMIDs) of the skin can significantly affect individuals' work functioning and pose societal challenges. This systematic review examined the burden of common skin IMIDs (alopecia areata, atopic dermatitis, hidradenitis suppurativa, psoriasis, vitiligo) on work outcomes. Eight databases (PubMed, Web of Science Core Collection, Embase, SciELO, KCI Korean Journal Database, Global Index Medicus, Informit, and Google Scholar) were searched through June 2024. Eligible studies included adults with 1 of these IMIDs and quantitative designs (trials, cohorts, case-control, or cross-sectional studies) reporting work outcomes. From 8176 records, 196 studies were included. Sample sizes ranged from small (n = 28) to nationwide (n = 2,638,681) datasets. Psoriasis (56.12%) and atopic dermatitis (31.12%) dominated, mainly from Europe (54.08%). Most studies (92.35%) assessed productivity and predominantly used validated tools. The evidence shows that skin IMIDs affect multiple work domains, extending beyond productivity loss to psychosocial factors, such as burnout or employment status. Heterogeneity in measurement methods limits external validity. Research gaps persist for rarer IMIDs and low- to middle-income settings, particularly sub-Saharan Africa (only 0.51%). The evidence indicates a substantial effect of skin IMIDs on work, yet consensus on work-related outcomes is lacking. Greater conceptual clarity is needed to understand their impact on employment and support sustainable work participation.

Importance:Hidradenitis suppurativa (HS) is a chronic inflammatory dermatological disease with prevalence estimates ranging from 0.1% to 0.5% in clinical settings to 1% to 2% in general populations. While tertiary care data show that 22% of patients progress to severe disease within 2 years, estimates of disease development outside the hospital setting remain unknown. Objective:To investigate HS development in a non-hospital-based setting and to identify baseline factors associated with remission and progression to severe disease in the community. Design, Setting, and Participants:This prospective cohort study used 10-year follow-up data on HS disease severity among a municipality-based cohort identified via a questionnaire in the Danish General Suburban Population Study conducted from 2010 to 2013. Disease severity (mild, moderate, severe) was determined using a modified Hurley score. Progression (severe disease at follow-up) and remission (no active HS symptoms for 6 months or longer at follow-up) rates were calculated by severity level. Separate Cox proportional hazard regression analyses explored whether baseline demographic variables associated with disease severity at follow-up in 2023 could be used to estimate changes in disease severity. Data analysis was performed from March 2024 to September 2025. Main Outcomes and Measures:HS remission and progression rates across baseline severity groups as determined at follow-up in January to February 2023. Measures included baseline HS disease severity, body mass index, smoking history, employment status, and number of anatomical areas with active lesions. Results:The analysis included 107 patients with HS (mean [SD] age, 47.1 [8.8] years; 88 female [82.2%] and 19 male [17.8%] individuals). At baseline, 57 patients (53.3%) had mild, 20 (18.7%) had moderate, and 30 (28.0%) had severe disease. During the follow-up period, 16.9% of patients with nonsevere disease progressed (13.0% to severe disease), while 71.0% of all patients experienced regression (63.6% to full remission). Stratified by baseline severity, 73.7%, 60.0%, and 46.7% of patients with mild, moderate, and severe disease, respectively, experienced full remission. Cox regression analyses did not reveal any baseline demographic factors capable of predicting disease development at follow-up. Conclusions and Relevance:This cohort study found that estimates from hospital-based cohorts likely overstate HS disease progression and underestimate its remission. In this community-based cohort, HS progression to severe disease was 10.4 times lower and rates of HS remission were 3.8 times higher than reported within hospitals, suggesting a more favorable disease course than previously reported.

Actinic keratosis is a common, chronic, and potentially pre-cancerous skin disease that can negatively impact patients' health-related quality of life. This systematic review aimed to identify and describe the questionnaires used to assess health-related quality of life in patients with actinic keratosis and summarize reported impacts. Four databases (EMBASE, PsycINFO, PubMed, and Cochrane Library) were searched up to February 2025. Two reviewers independently screened articles, and risk of bias was assessed using tools appropriate to study design. Of 639 records, 37 studies including 9,326 patients met inclusion criteria. Most studies were interventional (59%) and of moderate to high quality (64%). Health-related quality of life was assessed using 3 disease-specific, 3 dermatology-specific, and 2 generic questionnaires. The most frequently used instruments were the Actinic Keratosis Quality of Life (n = 13) and the Dermatology Life Quality Index (n = 16). All questionnaires detected health-related quality of life impairment, especially during treatment. Actinic Keratosis Quality of Life identified patient subgroups with greater health-related quality of life reduction, including females, younger individuals, patients with comorbidities, and those with a history of skin cancer. All health-related quality of life questionnaires captured impairment in patients with actinic keratosis. The Actinic Keratosis Quality of Life and Dermatology Life Quality Index questionnaires were widely used. Actinic Keratosis Quality of Life identified subpopulations with health-related quality of life impairment. Among studies reporting mean health-related quality of life scores, the Dermatology Life Quality Index ranged from 1.55 to 24 and the Actinic Keratosis Quality of Life from 4.22 to 17, reflecting very broad variability and underlying differences in actinic keratosis severity across study populations.

ABSTRACT Background Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin condition often accompanied by malodorous drainage. Drainage affects quality of life, contributing to stigma, emotional distress, and physical challenges. Recognising the role of drainage in HS, the HiSTORIC (Hidradenitis SuppuraTiva cORe outcomes set International Collaboration) initiative identified it as a key symptom in clinical trials and developed the The HIdradenitis suppurativa DrainagE (HIDE) Scale. Objectives This study aimed to explore patients' experiences of drainage to guide person‐centred care approaches. Methods A qualitative secondary analysis was conducted using data from the parent study on The HIDE Scale©️. The data included 38 interviews with patients aged ≥ 18 years, diagnosed with HS, and experiencing drainage. Reflexive thematic analysis was applied using an inductive and semantic approach, guided by person‐centred theoretical perspectives. Results Three overarching themes emerged: (1) Drainage is difficult to explain due to its unpredictable and complex nature; (2) Drainage impacts mental well‐being, contributing to feelings of social stigma, frustration, and emotional distress; and (3) Drainage involves significant physical difficulties, including malodour, frequent dressing changes, and daily activity disruption. Patients described drainage by volume, consistency, colour, and location, emphasising its multidimensional impact. Despite these challenges, pain was identified as the most debilitating symptom of HS. Conclusions This study highlights the physical, psychological, and social impact of drainage in HS, emphasising its complexity and unpredictability. Patients described drainage as a multifaceted experience that profoundly affects their quality of life. To improve care, healthcare providers should integrate an assessment of drainage into clinical practice, utilising standardised tools like The HIDE Scale©️. Addressing physical and psychosocial aspects of drainage through open and empathetic discussions can reduce stigma, foster a sense of support, and enhance patient–clinician relationships. Adopting person‐centred approaches validates patients' experiences and holistic assessment is essential for improving care strategies and the well‐being of individuals living with HS.

BACKGROUND:We report the first study of anumigilimab, a novel anti-G-CSFR antibody, in patients with neutrophil-driven skin diseases [hidradenitis suppurativa (HS) and palmoplantar pustulosis (PPP)]. METHODS:This phase 1b, open-label, repeat-dose study (NCT03972280) comprised 15-week treatment and 9-week follow-up periods. Enrolled patients had International HS Severity Score System (IHS4) score ≥4 or PPP Area and Severity Index (ppPASI) score ≥12. After ≥10 patients completed anumigilimab 0.3 mg/kg IV at 21-day intervals (Cohort 1), pharmacokinetic/pharmacodynamic modelling determined the Cohort 2 dose (0.6 mg/kg). Primary endpoints were treatment-emergent adverse events (TEAEs). Secondary endpoints were pharmacokinetics and immunogenicity. Exploratory endpoints were pharmacodynamics and clinical response. RESULTS:Of 39 patients (HS, n = 22; PPP, n = 17), 33 patients (84.6%) experienced 198 TEAEs. Sixteen patients (41.0%) experienced 70 anumigilimab-related TEAEs; the most common were fatigue and neutropenia (both n = 7), which resolved spontaneously, and no association between neutropenia and infections was observed. No deaths or serious treatment-related TEAEs occurred. Presence of antidrug antibodies was negligible. Anumigilimab exposure and absolute neutrophil count reduction (pharmacodynamic endpoint) were dose dependent. In signal-finding exploratory analyses, 57.9% of patients with HS (n = 11/19 with data at Week 15) achieved ≥50% HS Clinical Response, IHS4 score decreased by 40.3%, and patients with PPP experienced a 40.4% reduction in ppPASI score. These clinical responses were not dose dependent, possibly due to imbalanced baseline characteristics and small sample size. CONCLUSIONS:Anumigilimab was generally well tolerated in patients with HS or PPP, with no serious treatment-related safety concerns, and demonstrated dose-dependent pharmacology. While clinical responses in HS and PPP were observed, it should be noted that these observations were exploratory and signal-finding in nature. Importantly, the study was not powered to statistically confirm efficacy and lacked a placebo control, underscoring the need for future randomized, placebo-controlled trials to validate these preliminary signal-finding observations.

QuestionCan investigators agree on morphological definitions and methods of assessment for lesions in clinical trials for hidradenitis suppurativa (HS)?FindingThrough a modified Delphi process involving expert dermatologists, consensus was achieved on 11 morphologic lesion definitions and on 16 of 18 statements guiding standardized HS lesion assessments.MeaningConsensus on detailed morphologic definitions to support classification of HS lesions and guidance that standardizes assessment of these lesions can be implemented in study protocols and investigator trainings with the goal of improving accuracy and reliability of investigator ratings in clinical trials for HS. This consensus statement establishes consensus-based morphological definitions of hidradenitis suppurativa (HS) lesions and guidance statements that standardize investigator lesion assessments for implementation in clinical trials. ImportanceAccurate classification and reliability in assessment for lesions of hidradenitis suppurativa (HS) by investigators is critical to the determination of responder status and to overall data quality in clinical trials.ObjectiveTo establish consensus-based morphological definitions of HS lesions and guidance statements that standardize investigator lesion assessments for implementation in clinical trials.Evidence ReviewHealth professionals (primarily dermatologists) with expertise in the measurement of HS disease activity as well as novice raters completed a preliminary questionnaire in which participants were asked to assess images of HS lesions and provide qualitative feedback on their decision making. Based on this feedback, detailed morphologic definitions for lesions and guidance statements that standardize lesion assessments were formulated and presented for consensus voting in 2 electronic Delphi surveys. A virtual group discussion after round 1 supported participants in round 2 voting.FindingsResponse rates were 84.7% (50 of 59), 86.0% (43 of 50), and 90.9% (40 of 44) in the preliminary, electronic Delphi round 1, and electronic Delphi round 2 surveys, respectively. Morphological definitions for 11 lesion types achieved the prespecified 70% consensus threshold, with 9 definitions reaching at least 90% agreement. After 2 electronic Delphi rounds, 16 of 18 guidance statements achieved the prespecified consensus threshold, with 13 statements receiving endorsement from more than 80% of participants. Two guidance statements related to assessment of tunneled plaques with multiple openings and assessment of scalp lesions failed to reach consensus.Conclusions and RelevanceCommon morphologic definitions and guidance that standardize assessment of HS lesions can be implemented in clinical trial protocols and investigator trainings with the goals of improving accuracy and reliability of investigator ratings.

Hidradenitis suppurativa (HS) has a profound negative impact on patients' Quality of Life (QoL). The European Academy of Dermatology and Venereology (EADV) Task Force (TF) on QoL and Patient Oriented Outcomes and TF on Acne, Rosacea and Hidradenitis Suppurativa (ARHS), together with external experts, decided to provide an updated position statement on QoL measurement in HS. In our previous position statement on HS, we stated that a Dermatology Life Quality Index (DLQI) score of 0-1, corresponding to no effect on patient's life according to the DLQI banding descriptions, may be considered as a difficult to reach but important treatment goal: achievement of this goal has since been used as an efficacy criterion in several clinical trials. For many HS treatment methods, there is still a lack of well-organized randomized clinical trials with sufficient participant numbers in which QoL instruments have been used as outcome measures. The DLQI is the most widely used QoL instrument in HS. Clinical recommendations and treatment efficacy are based on its score grading system and minimal clinically important difference (MCID). The HS-specific QoL instruments HSIA, HSQoL-24, HiSQOL, and QoL-HS have a satisfactory number of items for routine clinical use and short recall periods. HiSQOL and HSQoL-24 have score grading systems and the MCID for HiSQOL has been established. The TF on QoL and Patient Oriented Outcomes and TF on ARHS recommend that QoL be assessed in HS: dermatology-specific and HS-specific instruments may be used alongside each other.

Importance:Accurate classification and reliability in assessment for lesions of hidradenitis suppurativa (HS) by investigators is critical to the determination of responder status and to overall data quality in clinical trials. Objective:To establish consensus-based morphological definitions of HS lesions and guidance statements that standardize investigator lesion assessments for implementation in clinical trials. Evidence Review:Health professionals (primarily dermatologists) with expertise in the measurement of HS disease activity as well as novice raters completed a preliminary questionnaire in which participants were asked to assess images of HS lesions and provide qualitative feedback on their decision making. Based on this feedback, detailed morphologic definitions for lesions and guidance statements that standardize lesion assessments were formulated and presented for consensus voting in 2 electronic Delphi surveys. A virtual group discussion after round 1 supported participants in round 2 voting. Findings:Response rates were 84.7% (50 of 59), 86.0% (43 of 50), and 90.9% (40 of 44) in the preliminary, electronic Delphi round 1, and electronic Delphi round 2 surveys, respectively. Morphological definitions for 11 lesion types achieved the prespecified 70% consensus threshold, with 9 definitions reaching at least 90% agreement. After 2 electronic Delphi rounds, 16 of 18 guidance statements achieved the prespecified consensus threshold, with 13 statements receiving endorsement from more than 80% of participants. Two guidance statements related to assessment of tunneled plaques with multiple openings and assessment of scalp lesions failed to reach consensus. Conclusions and Relevance:Common morphologic definitions and guidance that standardize assessment of HS lesions can be implemented in clinical trial protocols and investigator trainings with the goals of improving accuracy and reliability of investigator ratings.

BACKGROUND:Patients with immune-mediated inflammatory diseases (IMIDs) of the skin face challenges beyond visible signs. Despite their significant psychosocial burden, the global impact of skin IMIDs on work productivity has not been systematically reviewed. OBJECTIVE:To evaluate the global burden of skin IMIDs on work productivity. METHODS:We conducted a systematic review and meta-analysis. Eight electronic databases (PubMed, Web of Science Core Collection, Embase, SciELO, KCI Korean Journal Database, Global Index Medicus, Informit and Google Scholar) were searched from inception to June 2024. We included quantitative studies reporting work-related outcomes in adults (≥18 years) with alopecia areata, atopic dermatitis, hidradenitis suppurativa, psoriasis or vitiligo. For the meta-analysis, studies had to report Work Productivity and Activity Impairment (WPAI), Work Limitations Questionnaire (WLQ) or sick leave duration. Two reviewers independently screened and extracted data. Risk of bias was assessed using validated tools. Data were pooled using frequentist and Bayesian approaches to ensure estimations robustness across heterogeneous designs and sample sizes. RESULTS:Across 100 studies with a cumulative sample of 306,619 participants worldwide, skin IMIDs were consistently associated with impaired work functioning. Notably, the mean WPAI overall work impairment was 28.96 (95% CI 25.61; 32.31), and participants averaged 16.74 days of sick leave per year (95% CI 7.39; 26.1). Findings suggest that occupational impairment was influenced by psychosocial factors, thereby highlighting broader societal and economic consequences. CONCLUSION:Skin IMIDs substantially reduce work functioning and productivity worldwide, representing an underrecognized burden on individuals, employers and health systems. Better multidisciplinary strategies are needed to prevent occupational disadvantage and mitigate the economic and social impact of these chronic conditions.

BACKGROUND:Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that imposes significant physical and psychological burdens, making self-management essential. Agenda-setting tools, such as conversation cards (CCs), have improved patient engagement and supported self-management in other chronic diseases, yet no analogous tool exists for HS. OBJECTIVE:To design, test and evaluate a set of CCs for patients with HS to facilitate patient-centred dialogue during consultations to support self-management. METHODS:Development followed three stages with inspiration from the Participatory Design (PD) approach. (i) Identification of needs: patient interviews were conducted, transcribed and analysed to extract key themes that informed the initial prototype. (ii) Design: two workshops, one with healthcare professionals (HCPs) and one with patients, were held to refine the prototypes. (iii) Evaluation and testing: The finalized set of CCs was implemented in clinical consultations. Patients were allocated to either Group A (incorporating CCs) or Group B (standard consultations). Post-consultation questionnaires captured the experiences and perceptions of both patients and HCPs. RESULTS:The initial prototype consisted of eight cards. Workshop feedback led to the addition of a ninth card addressing pain. In clinical testing, patients in Group A (n = 22) selected between one and three cards, and their consultations lasted approximately 15 min, almost identical to Group B (n = 22). No statistical differences were found between the groups. Both groups reported high confidence in discussing HS, felt able to address difficult topics and perceived influence over the consultation's content. Group A expressed a positive attitude towards future use of CCs. HCPs found the cards user-friendly and indicated interest in using them in future clinical encounters. CONCLUSION:A nine-card CC set was designed and positively evaluated by patients and HCPs. CCs appear to be a practical, patient-focused tool to support consultations. However, a larger prospective study is needed to confirm their impact on self-management.

On 24 May 2025, the Seventy-Eighth World Health Assembly (WHA78) adopted a resolution recognizing skin diseases as a global public health priority. This reflects a collective commitment from WHO member states to strengthen policies, secure resources and improve care for those affected by skin diseases. This milestone comes a decade after the launch of the Grand Challenges in Global Skin Health initiative (GSHi).

BACKGROUND:The results of a previous phase IIa trial suggested efficacy of the anti-C5a compound vilobelimab in a small number of patients with severe hidradenitis suppurativa (HS) refractory to adalimumab treatment. OBJECTIVES:To study the efficacy of vilobelimab in a larger-scale randomized phase IIb trial (SHINE) of patients with moderate-to-severe HS. METHODS:In total, 177 patients with moderate-to-severe HS were treated either with placebo or one of four doses of vilobelimab, a monoclonal antibody that targets the complement split product C5a. Hidradenitis Suppurativa Clinical Response (HiSCR) at 16 weeks was the primary endpoint. Those who achieved HiSCR switched to open-label low-dose vilobelimab; those who did not were switched to medium-dose vilobelimab. The trial was registered with the EU Clinical Trials Register (EudraCT number 2017-004501-40) and ClinicalTrials.gov (NCT03487276). RESULTS:The study did not meet the primary endpoint, perhaps due, in part, to an unexpectedly high HiSCR placebo response rate of 47.1%. HS flares decreased and post hoc analysis showed that high-dose vilobelimab significantly decreased the median draining tunnel counts and IHS4 score by 63%. Following the switch to medium-dose vilobelimab at week 16, 45.5% of those who did not respond to treatment achieved HiSCR at week 40. CONCLUSIONS:Compared with placebo, vilobelimab treatment did not result in significant HiSCR improvements in patients with moderate-to-severe HS. Post hoc analysis revealed significant effects for the highest tested dose on draining tunnel reduction and IHS4 score, which captures reductions in draining tunnels. These findings warrant further investigation.

Introduction: Hidradenitis suppurativa (HS) is a painful, chronic, recurring, debilitating, inflammatory skin disease affecting the areas rich in apocrine glands, with typical lesions (abscesses, nodules, discharging sinuses, and scars) and distribution (intertriginous areas). The prevalence of HS varies across geographical locality with lower rates reported in Asia. METHODS:A cross-sectional, descriptive study, involving 500 consecutive healthy adults in Hospital Kuala Lumpur (HKL), was done from December 2022 to April 2023, to estimate the prevalence of HS in HKL, via a validated questionnaire. We included healthy hospital staff and those accompanying patients in the Department of Medicine. Consented participants would answer the screening questionnaire for HS, as well as the socio-demographic data questionnaire. The screened-positive participants were evaluated by a dermatologist to confirm the diagnosis of HS and to take clinical photos. RESULTS:Ten participants were screened-positive for HS, but only 7 were confirmed cases. The prevalence of this study was 7/500 (1.4%). Majority had mild diseases (71% Hurley stage 1, 29% Hurley stage 2). HS was more prevalent among males (n = 4), lower education level (n = 4), and Chinese ethnicity (n = 3). There was no significant difference among the HS participants when compared to non-HS participants based on their age, gender, education level, income status, BMI, or smoking status (p > 0.05). CONCLUSION:HS is a complex disease with multifactorial elements to consider in its pathogenesis. The availability for early detection of mild HS disease, via a validated screening questionnaire, may change the paradigm of management of HS in the future. .

Introduction: Hidradenitis suppurativa (HS) is a persistent and inflammatory skin condition that greatly diminishes the quality of life of the patients and frequently develops because of occlusion of the hair follicles. This study aimed to determine the prevalence of HS among the Iranian population residing in Fars province. METHODS:This study was a cross-sectional study that was conducted at Shahid Faghihi Clinic at Shiraz University of Medical Sciences, Iran. The study included over 18-year-old healthy individuals who accompanied patients that had attended our center for non-dermatological care. The interviewers handed out a screening questionnaire on HS to the study participants, and then those individuals who were suspicious of having HS were examined by a dermatologist to verify if the individual has HS. The dermatologist also examined 10% of participants who reported no HS symptoms to reduce bias. The data analysis was conducted by using RStudio version 1.3.1093. RESULTS:The results of our study indicated that 3 out of the 990 study participants suffered from HS, putting the prevalence of HS at 0.3% (95% CI: 0.10%-0.89%). After physically examining 3 questionnaire-positive HS individuals, we confirmed their assertion (sensitivity: 1.0). After screening 10% of the individuals negative for HS, the specificity was 0.83, positive predictive value was 0.13, and negative predictive value was 1. Moreover, this study found that the participants with and without HS had similar characteristics in terms of gender, age, and body mass index. CONCLUSION:It seems that the prevalence of HS in Iran is lower in comparison with many other countries. Gender, age, and BMI were similar in HS and non-HS participants. Future research is recommended to evaluate the other characteristics of this disease in Iran. .

Introduction: Prevalence of hidradenitis suppurativa (HS) differs between countries and the worldwide prevalence of the disease remains unknown. Prevalence of HS has never been studied in Greece. The aim of this study was to estimate the HS prevalence in Athens, the capital of Greece. METHOD:Healthy adults accompanying patients to the outpatient department of internal medicine of ATTIKON University Hospital were approached by physicians familiar with HS. All eligible persons signed an informed consent form and answered the questionnaire. This study was a part of the Global Hidradenitis Suppurativa Atlas (GHiSA) initiative and therefore followed the objective and approach previously published by Bouazzi et al. [Dermatology. 2024 Feb;240(3):369-75]. RESULTS:Out of 553 participants, 20 screened positive for HS. Of these, only one was diagnosed with HS, resulting in a prevalence of 0.18% (95% CI, 0.03%-1.02%). The sensitivity of the HS questionnaire was 100%, specificity 75.9%, positive predictive value 5.0%, and negative predictive value 100%. CONCLUSION:The prevalence of HS in our study was relatively low. A further study with a larger number of participants is needed to confirm the findings. .

Introduction: The exact prevalence of hidradenitis suppurativa (HS) remains elusive, in France as elsewhere. The Global Hidradenitis Suppurativa Atlas (GHiSA) project is a unique opportunity not only to determine the exact prevalence in each participating center but also to help estimate the global prevalence and provide a basis for comparing centers with each other and obtaining potential pathophysiological indications. METHODS:A French version of the questionnaire developed for the GHiSA initiative was proposed to healthy adults accompanying a patient to the outpatient clinic. RESULTS:The prevalence of HS in the 525 participants was 3.43% (95% confidence interval: 2.2%-5.4%). The HS patients were 10 females and 8 males and were significantly younger than non-HS controls and more frequently smokers. The screening questionnaire showed a 100% sensitivity and negative predictive value. CONCLUSION:The estimated prevalence here is more than three times higher than the 1% prevalence usually recognized in Western countries. It remains to be determined whether this increase is apparent (freedom of speech; methodological differences compared with previous studies, which contribute to the usual figure of 1%) or real. In the latter case (gross increase in the prevalence of the disease), the underlying mechanisms need to be explored, and comparison with the results observed in other GHiSA centers will be decisive. .

This study was an exploratory, single-centre, open-label, uncontrolled investigation of methylene blue photodynamic therapy (MB-PDT) for the treatment of antifungal-resistant dermatophytosis. One-third of participants with antifungal-resistant dermatophytosis responded to two sessions of MB-PDT therapy. The small sample size and limited number of treatment sessions were possibly insufficient to investigate the true potential of this approach.