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Many infectious diseases, including COVID-19, are transmitted by airborne pathogens. There is a need for effective environmental control measures which, ideally, are not reliant on human behaviour. One potential solution is Krypton Chloride (KrCl) excimer lamps (often referred to as Far-UVC), which can efficiently inactivate pathogens, such as coronaviruses and influenza, in air. Research demonstrates that when KrCl lamps are filtered to remove longer-wavelength ultraviolet emissions they do not induce acute reactions in the skin or eyes, nor delayed effects such as skin cancer. While there is laboratory evidence for Far-UVC efficacy, there is limited evidence in full-sized rooms. For the first time, we show that Far-UVC deployed in a room-sized chamber effectively inactivates aerosolised Staphylococcus aureus . At a room ventilation rate of 3 air-changes-per-hour (ACH), with 5 filtered-sources the steady-state pathogen load was reduced by 98.4% providing an additional 184 equivalent air changes (eACH). This reduction was achieved using Far-UVC irradiances consistent with current American Conference of Governmental Industrial Hygienists threshold limit values for skin for a continuous 8-h exposure. Our data indicate that Far-UVC is likely to be more effective against common airborne viruses, including SARS-CoV-2, than bacteria and should thus be an effective and “hands-off” technology to reduce airborne disease transmission. The findings provide room-scale data to support the design and development of effective Far-UVC systems.

Successful daylight photodynamic therapy (DPDT) relies on the interaction of light, photosensitisers and oxygen. Therefore, the ‘dose’ of light that a patient receives during treatment is a clinically relevant quantity, with a minimum dose for effective treatment recommended in the literature. However, there are many different light measurement methods used in the published literature, which may lead to confusion surrounding reliable and traceable dose measurement in DPDT, and what the most appropriate method of light measurement in DPDT might be. Furthermore, for the majority of practitioners who do not carry out any formal dosimetry and for the patients receiving DPDT, building confidence in the evidence supporting this important treatment option is of key importance. This review seeks to clarify the methodology of DPDT and discusses the literature relating to DPDT dosimetry.

Porphyria patients face a difficult dillema every day: how best to protect themselves from harmful light (photo-protection). Medicines, sun-avoidance, and protective clothing all play a part in a patient’s photo-protection strategy, but so too do sunscreens. Therein lies another struggle, which is the choice of sunscreen. Available in hundreds of brands, at a variety of prices, and with myriad claims on photo-protection efficacy across the Ultraviolet (UVB and UVA) and visible bands of the spectrum, the decision-making can prove difficult even for non-photosensitive individuals. Moreover, porphyria patients are sensitive across the PPIX spectrum, which has multiple peaks across the breadth of the UV and visible spectrum. Therefore, whilst a UV-sunscreen will protect from some of these bands, it will be ineffective against others. Similarly, whilst visible sunscreens provide broad protection in both the UV and visible bands, they come with their own range of drawbacks. Compared to their UV counterparts, visible sunscreens are not so widely known, are often not available on the supermarket shelves, and, importantly, are pigmented. This means that a patient must match the pigment of their skin to that of the sunscreen, and given the limited choices available, this can prove difficult from person to person, and even across areas of the body. Furthermore, sunscreen is no guarantee of protection, but rather increases the time allowed until a photosensitive reaction occurs. This will also vary depending on the manner in which the individual has applied the sunscreen; how light or how heavy, in patches, over make up, in wet or dry conditions.Our research brings these issues into focus in a number of areas. Firstly, we have been routinely testing sunscreens of all types using our spectrophotometer in order to analyse their protective qualities, some of which has been previously published (Eadie et al., 2023, doi.org/10.1093/bjd/ljac112). We have found that protection varies from product to product, which is a particular issue for porphyria patients who may have to test multiple products before settling on the best protection for them. Secondly, we have been polling our photosensitive patients to understand more about the role sunscreens play in their photo-protection strategies. Through this type of patient-engagement, we have learned about the value patients place on factors such as cost, availability and application against other photo-protection methods such as sun-avoidance and protective clothing. We are extending this to porphyria patients in conjunction with the British Porphyria Association (BPA) and will present the results of this survey. Thirdly, we have begun building a public-access database of sunscreens with the intention of allowing patients to discover the protective qualities of these products for themselves, whilst comparing them side-by-side. We plan to engage with the BPA to facilitate patient-friendly guidance on photo-protection.

Afamelanotide has been licensed for the phototoxicity of erythropoietic protoporphyria (EPP) in Europe since 2014. However, it has not yet been approved for use in the National Health Services of the United Kingdom (UK) countries. In Scotland, a framework has recently been developed by the Scottish Medicines Consortium (SMC) to assess ‘ultra-orphan’ medicines for very rare conditions. Through this route, the SMC has allowed some use of Afamelanotide in Scotland by making it available for a period of up to three years while clinical effectiveness data are gathered.To be considered as an ultra-orphan medicine four criteria must be met:the condition has a prevalence of 1 in 50,000 or less in Scotlandthe medicine has a Great Britain (GB) orphan marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA)the condition is chronic and severely disablingthe condition requires highly specialised managementAdditionally, the criteria for use of Afamelanotide in Scotland in this pathway are:recommendation by Scottish Cutaneous Porphyria Service (SCPS) and two consultant dermatologistsvisual analogue score for quality of life (QoL) effects ≥7/10 (on a 0 to 10 scale, with 10 being worst effects)time to prodrome ≤ 30 minutesinadequate response to narrowband ultraviolet B phototherapy.Response criteria that must be met if it is to be continued for a patient aredoubling of time to prodrome andat least a 2 point improvement of QoL VASThe first patient was treated in Scotland in 2022. By the end of 2023, 8 patients (7 treated in Dundee; 1 in Glasgow) had been treated in Scotland with 4 more being treated in 2024. So far, all individuals have continued treatment as responses have been good, with patients noting major improvements in quality of life for themselves and their families. This has been exemplified by one of our patients within a podcast as part of a patient engagement project to raise awareness and improve the lives of our patients: https://www.youtube.com/watch?v=Kkg0_T2sWs8Three patients have now had treatment for 3 consecutive years. We have observed a phenomenon of longer lasting improvement after the initial year of treatment with all but one patient and one patient has requested just two implants last year (2023) as she is doing so well.A number of challenges have been encountered, including:difficulty sourcing equipment to administer Afamelanotide implantsobtaining agreements for reimbursement from the patient’s resident Health Boardtime-consuming nature of implanting and documenting post-marketing study information which has been largely unfundedOverall, our experience so far has been positive and the use of Afamelanotide has currently been extended until September 2025 to enable further data to be collected. We remain hopeful that a favourable decision will be made by the SMC after this time to continue to make Afamelanotide available in Scotland.

This pilot study evaluated the design, usability, and practicality of the dPDT@home kit for treating actinic keratoses (AKs) on the face and scalp. The kit allowed patients to manage their treatment at home, reducing hospital visits and utilizing natural sunlight. While patients were very willing to use the kit again, further studies are required to evaluate outcomes and ascertain the need for additional improvements and support. Background/Objectives: Daylight photodynamic therapy (dPDT) is an established effective therapy for superficial mild-to-moderate actinic keratoses (AKs) on the face and scalp. In this project, we redesigned the delivery of dPDT using design principles and the concept of Realistic Medicine to create the dPDT@home kit. This user-friendly and environmentally conscious kit allows patients to manage their AKs at home, reducing the need for hospital visits and ensuring timely treatment to coincide with appropriate weather conditions and to prevent disease progression due to delays in diagnosis and treatment. The initial pilot phase of the study was to evaluate the usability and convenience of the practicalities of the dPDT@home kit. Methods: Patients were instructed to conduct two dPDT@home kit treatments approximately three weeks apart on suitable weather days. After a follow-up telephone consultation from the specialist PDT nurse following the first treatment, patients then completed an initial questionnaire (Questionnaire 1, Q1) to share their experience. A second questionnaire (Q2) was completed 3–6 months after their final treatment to assess treatment outcomes. Results: A total of 16 patients with AK on the face and/or scalp used the dPDT@home kit. Five patients formed an initial pilot group in 2020/21, whose feedback and involvement informed the final product for the larger group of eleven patients (2021/22). All patients reported no issues with receiving the kit or the pro-drug used in the treatment (Q1). Q2 had an 81.25% return rate, with an average willingness score of 8.9/10 to use dPDT@home again. However, patients expressed doubts about their confidence in the treatment’s efficacy, giving an average score of 6.9/10, with preferences leaning towards other treatments, such as hospital-based PDT or cryotherapy. Conclusions: The pilot deployment of the dPDT@home kit identified suitable patients and highlighted the need for comprehensive training and support for both patients and clinicians to deliver dPDT through this novel approach. The kit can reduce the number of hospital visits, but patients still require supervision, which can be provided remotely. The questionnaire outcomes emphasize the importance of setting patient expectations and taking a holistic approach to managing chronic field-change AK. Additionally, the kit’s recyclable components and reliance on natural sunlight promote sustainability and reduce patient travel. Further evaluation is required to determine cost-efficacy, safety, and the potential place of the dPDT@home kit in the therapeutic management of patients with this common and challenging condition.

For an intense pulsed light (IPL) device, knowledge of the spectral output is useful in order to provide effective treatment and target specific structures in the skin. It is also a requirement in order to perform a safety assessment. A novel spectral measurement system has been developed to detect the optical radiation output of intense pulsed light devices. The system has a time resolution of 450 μs and a wavelength resolution of 0.6 nm. This enabled us to observe spectral changes, both within a pulse and between pulses, in a pulse train. The output from a free discharge IPL source and four different treatment handpieces was measured. A shift in the spectral distribution between pulses, and within a pulse, was discovered. The spectral shift is more prominent for higher radiant exposures.