Fully home‐based methyl aminolevulinate daylight photodynamic therapy for actinic keratosis of the face or scalp: A real life open study

Abstract

Methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) is highly efficacious for the treatment of nonhyperkeratotic actinic keratosis (AK), even when partially performed at home. To evaluate the long-term effectiveness, safety, and patient-reported outcomes of MAL DL-PDT performed completely by the patient in real life conditions. An open prospective study was conducted in Spain among patients diagnosed with at least five AK lesions on the face or the scalp. Patients received instruction and information in infographic format to perform MAL DL-PDT at home. All had been treated with 30% urea daily for 7 days before the day of MAL DL-PDT. Meteorological conditions on the day of the treatment and adverse effects were recorded. Patients underwent follow-up, and a second session of home-based MAL DL-PDT if deemed necessary, 3, 6, and 12 months after the initial treatment session. The study population consisted of 22 patients (19 men and three women, mean [standard deviation, SD] age, 72.05 [6.96] years). A complete response was observed in 47.7% of AK lesions at 3 months (p < 0.001) and 65.9% (n = 199) at 12 months (p < 0.001). Olsen grade II lesions showed the highest rate of response (76.07% at 12 months). The mean (SD) actinic keratosis area and severity index score decreased significantly from 4.99 (2.43) at baseline to 2.33 (1.01) at 12 months (p = 0.0234). Adverse effects were mild and expected. A majority of patients were "satisfied" or "very satisfied" with the treatment instruction provided (90.9%) and the treatment outcome (72.7%). MAL DL-PDT can be applied at home like any other topical treatment for AK. Our results indicate good long-term effectiveness, a high level of patient satisfaction, and no significant side effects.

Diagnosis and therapy of actinic keratosis

“…After 3 and 12 months, complete clearance was observed in 47.7% (p < 0.001) and 65.9% (p < 0.001) of AK lesions, respectively, with the best response rate achieved for AK according to Olsen II and a significant reduction in AKASI score after 12 months. 53 Furthermore, the effectiveness of PDT can be increased by additional pretreatment of AK. Pretreatment can, for example, be performed by topical, systemic, or ablative procedures.…”

Diagnose und Therapie aktinischer Keratosen

“…durchgeführt wurde, konnte zeigten, dass die daheim durchgeführte TL‐MAL‐PDT erfolgreich umgesetzt werden kann, wenn AK‐Läsionen 7 Tage vor der Therapie mit 30% Harnstoff vorbehandelt werden. Nach 3 Monaten konnte eine vollständige Abheilung in 47,7% der AK Läsionen (p < 0,001) und in 65,9% nach 12 Monaten (p < 0,001) mit der besten Ansprechrate für AK nach Olsen II und einer signifikanten Abnahme im AKASI‐Score nach 12 Monaten beobachtet werden 53 . Außerdem kann die Effektivität der PDT durch weitere Vorbehandlungen der AK gesteigert werden.…”

“…Nach 3 Monaten konnte eine vollständige Abheilung in 47,7% der AK Läsionen (p < 0,001) und in 65,9% nach 12 Monaten (p < 0,001) mit der besten Ansprechrate für AK nach Olsen II und einer signifikanten Abnahme im AKASI-Score nach 12 Monaten beobachtet werden. 53 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.…”

A Review of MAL-PDT for the Treatment Strategy of Actinic Keratosis: Broader Clinical Perspectives Beyond the Data and Guideline Recommendations

“…Studies to determine the feasibility of home-based MAL-dlPDT [ 20 , 21 ] have shown that, after lesion preparation by a physician and a single home-based treatment session, 62% of overall lesions achieved CR at 3 months [ 21 ]. Similarly, in a fully home-based study, CR was observed in 65.9% of lesions ( n = 199) at 12 months (after one or two sessions) [ 20 ]. In addition to efficacy, both studies demonstrated low pain levels and high patient satisfaction with regard to overall outcome.…”