Increased protoporphyrin IX accumulation does not improve the effect of photodynamic therapy for actinic keratosis: a randomized controlled trial

Self Cite

Background Guidelines for photodynamic therapy (PDT) of actinic keratosis (AK) recommend pretreatment with curettage. The impact of curettage on cure rate is, however, not well established. Objective The present study aimed to evaluate whether daylight PDT without curettage could be as effective as daylight PDT with curettage. Methods Twenty‐five patients with multiple AKs were treated in two even‐sized areas on the face and scalp. One area was treated with standard daylight PDT starting with curettage followed by incubation with methyl aminolevulinate (MAL) for 30 min before 2 h of daylight exposure. The other area was incubated with MAL for 1 h without prior curettage before 2 h of daylight exposure. The longer incubation time was used to obtain a sufficiently high protoporphyrin IX concentration in the non‐curettaged area. Results There was no difference in cure rate 3 months after daylight PDT in areas pretreated with curettage (86%) compared to non‐curettaged areas (84%) (P = 0.1). Neither was there any difference between reported pain during daylight exposure (P > 0.7) or clinically evaluated erythema the day after treatment (P = 1.0). Conclusion Daylight PDT without curettage but with 1 h of MAL incubation before daylight exposure was shown to be as effective in treatment of thin AKs on the face and scalp as standard daylight PDT with curettage. This modification of daylight PDT eases the task for the clinic and makes it more convenient for the patients as well, creating the possibility of performing daylight PDT as an entirely home‐based treatment for AKs of the face and scalp without training the patients to perform pretreatment.

Section: Introductionmentioning

confidence: 84%

Daylight photodynamic therapy of actinic keratosis without curettage is as effective as with curettage: a randomized clinical trial

Heerfordt

Wulf

2019

Self Cite

“…A mathematic model has demonstrated that daylight produced more local damage (more single oxygen radicals) that the conventional illumination with Aktilite ® even in cloudy days, but this accumulation has not demonstrated more efficacy in in vitro models or clinical trials, suggesting that the determinant factor for cytotoxicity is the total doses applied and not the irradiance or the PpIX accumulation . Moreover, a recent in vitro study has founded that half doses of red light, applied in half time, without changing irradiance are more effective in the induction of cell death of squamous cell carcinoma cells . In this way, a recent study based in a mathematical model compared 10 different protocols of illumination, including conventional red light PDT, daylight PDT and blue light.…”

Section: Discussionmentioning

confidence: 99%

Split‐face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half‐time red light LED conventional illumination

Fernández‐Guarino

Fonda‐Pascual

Gomez

et al. 2019

Background Conventional photodynamic therapy (PDT) with methylaminolevulinic acid (MAL) and daylight PDT have demonstrated similar efficacy in the treatment of actinic keratosis (AK). The reason for the use of daylight is to reduce pain during illumination but daylight has the limitation of the weather conditions. The difference in the doses of red light applied between these two methods suggests that an intermediate dose with red light conventional illumination could be effective in PDT of AK. Objective To compare the efficiency of conventional MAL‐PDT with half‐time conventional red light illumination in patients with multiple AK. Material and methods Adult patients with more than five symmetrically distributed AK were selected. After randomization, one area was treated with conventional PDT (Aktilite®, 630 nm, 37 J/cm2, 8 min), while the contralateral was illuminated half time (Aktilite®, 630 nm, 37 J/cm2, 4 min). Patients evaluated pain in each different side. Patients were evaluated at baseline, 3 and 6 months after PDT treatment by a blinded dermatologist. A questionnaire to be done at home 24 h after completing treatment was deliver to the patients to evaluate any side‐effects. Results A total of 774 lesions were treated, 385 with conventional PDT and 389 with half‐time PDT (P > 0.05). Conventional PDT was 85% of complete response of AK (327/385) at 3 months, and half‐time PDT was 82% (319/389). At 6 months, conventional PDT was 70% (268/385) of complete response and half‐time PDT was 65% (252/389). Pain during illumination was significantly lower in the VAS with the half‐time protocol with a mean of 5.59 (SD 1.48) vs. 6.41 (SD 1.66) in conventional PDT. No difference in adverse effects was found between protocols. Conclusion Conventional PDT with half‐time illumination in multiple actinic keratosis is as effective as complete time illumination and decreased pain significantly.

“…They are either applied to remove hyperkeratotic AK in order to improve the permeation capability of topical drugs or to remove single lesions that were not cleared by previous topical therapies. However, high‐quality evidence is lacking as no RCTs and only few case series have been published on shave and complete excision for AK …”

Section: Combination Of Lesion‐ and Field‐directed Regimensmentioning

confidence: 99%

The more the better? An appraisal of combination therapies for actinic keratosis

Steeb

Wessely

Leiter³

et al. 2019

Actinic keratoses (AK) are common precancerous lesions of the skin. Numerous interventions exist for the treatment of AK, including lesion‐ and field‐directed approaches. In daily practice, different treatment modalities are often combined to maximize clearance rates. However, whether a combination therapy is preferable to monotherapy in terms of efficacy and safety has been subject of intense debate. In this review, we summarize the current knowledge on the efficacy and safety of local combination therapies for the treatment of patients with AK. Combination approaches of cryosurgery followed by photodynamic therapy (PDT), laser‐assisted PDT, PDT in combination with topical interventions and microneedling‐assisted PDT have shown slightly better efficacy results with similar tolerability compared to the respective monotherapy. However, the individual usage of combination therapies should be checked on a case‐by‐case basis and take into account individual patient‐ and lesion‐specific aspects as more resources are needed and because the individual monotherapies are already highly effective.