Combination-Based Strategies for the Treatment of Actinic Keratoses with Photodynamic Therapy: An Evidence-Based Review

Abstract

Photodynamic therapy (PDT) is a highly effective and widely adopted treatment strategy for many skin diseases, particularly for multiple actinic keratoses (AKs). However, PDT is ineffective in some cases, especially if AKs occur in the acral part of the body. Several methods to improve the efficacy of PDT without significantly increasing the risks of side effects have been proposed. In this study, we reviewed the combination-based PDT treatments described in the literature for treating AKs; both post-treatment and pretreatment were considered including topical (i.e., diclofenac, imiquimod, adapalene, 5-fluorouracil, and calcitriol), systemic (i.e., acitretin, methotrexate, and polypodium leucotomos), and mechanical–physical (i.e., radiofrequency, thermomechanical fractional injury, microneedling, microdermabrasion, and laser) treatment strategies. Topical pretreatments with imiquimod, adapalene, 5-fluorouracil, and calcipotriol were more successful than PDT alone in treating AKs, while the effect of diclofenac gel was less clear. Both mechanical laser treatment with CO2 and Er:YAG (Erbium:Yttrium–Aluminum–Garnet) as well as systemic treatment with Polypodium leucotomos were also effective. Different approaches were relatively more effective in particular situations such as in immunosuppressed patients, AKs in the extremities, or thicker AKs. Conclusions: Several studies showed that a combination-based approach enhanced the effectiveness of PDT. However, more studies are needed to further understand the effectiveness of combination therapy in clinical practice and to investigate the role of acitretin, methotrexate, vitamin D, thermomechanical fractional injury, and microdermabrasion in humans.

Diagnose und Therapie aktinischer Keratosen

“…Außerdem kann die Effektivität der PDT durch weitere Vorbehandlungen der AK gesteigert werden. Die Vorbehandlung kann dabei zum Beispiel mittels topischen, systemischen Präparaten oder ablativen Verfahren erfolgen 54–56 . In einer Studie von Maytin et al.…”

Diagnosis and therapy of actinic keratosis

“…Pretreatment can, for example, be performed by topical, systemic, or ablative procedures. [54][55][56] A study by Maytin et al could show that the doses of accumulated photoactive protoporphyrins measured in skin biopsies were increased 2 to 3-fold compared to non-pretreated AKs after pretreatment of AKs with 5-FU for 6 days and subsequent exposure to MAL for three additional hours. 55 The subsequently performed RL-PDT achieved a significantly higher clearance rate after 3 and 6 months in pretreated AKs.…”

Parestesia Em Cirurgias De Terceiro Molar Inferior: Prevenção, Fatores De Risco E Terapêutica

“…Empregada em várias áreas da saúde, a TFD é um tratamento local bastante eficaz e bem tolerado. Pode ser usado isoladamente ou para complementar os protocolos terapêuticos convencionais (PIASERICO et al, 2022;FERNANDES et al, 2022).…”