Photodynamic therapy using topical toluidine blue for the treatment of oral leukoplakia: A prospective case series

•Photodynamic therapy (PDT) is a valid treatment option for treatment of oral lesions.•Toluidine Blue as photosensitizer is still discussed in the treatment of oral lesions.•Leukoplakia is a white patch that can't be identified clinically as any other disease.•This study focuses on feasibility of topical toluidine blue-based PDT for leukoplakia.•Topical toluidine blue PDT is easy to perform, well tolerated and effective method. Photodynamic therapy (PDT) is a minimally invasive method for the treatment of oral leukoplakia (OL) through the activation of a photosensitizer, after exposure to a specific wavelength light source. To investigate the effectiveness of toluidine blue as topical photosensitizer. Eleven patients participated in this study; fifteen oral leukoplakia lesions were treated, in several sessions, with 2.5 % toluidine blue and an LED source of 630 nm wavelength. Patients were evaluated at baseline (t0), at the end of treatment cycles (t1) and one year from the end of treatment (t2). All the treated sites were photographed at each visit. Images were processed with ImageJ 1.52 software in order to obtain the areas (mm2) of the treated lesions. Comparison between data at different follow-up was performed using a paired T-test. At t1, complete response was obtained in six lesions, partial response in seven lesions while only two lesions showed no response. At t2, a further improvement was observed in two patients. The analysis of the areas showed significant reduction of the lesion size from t0 to t1 (p = 0.003), and from t1 to t2 (p = 0.01). Toluidine blue appears to be a promising photosensitizer in the photodynamic therapy of oral leukoplakia.