Intraindividual, right-left comparison of topical 5-aminolevulinic acid photodynamic therapy vs. 5% imiquimod cream for actinic keratoses on the upper extremities

Sotiriou, Eleni; Apalla, Zoe; Maliamani, F.; Zaparas, N; Panagiotidou, D; Ioannides, Dimitrios

doi:10.1111/j.1468-3083.2009.03259.x

Cited by 68 publications

(75 citation statements)

References 21 publications

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“…18,19 Published studies have demonstrated high clearance rates with multiple topical PDT regimens that are comparable with other topical therapies used for the treatment of AKs, particularly on the face and scalp. 8,9,20 However, the efficacy of PDT on the extremities is greatly reduced. 1,2,10,21,22 The strong relationship between temperature and porphyrin synthesis in biologic tissue [23][24][25][26][27][28] suggests that increasing the temperature of the skin during the incubation of ALA may improve the efficacy of PDT, particularly for areas that are naturally lower in temperature such as the distal extremities.…”

Section: Resultsmentioning

confidence: 98%

“…8,9,20 Warming the skin within the threshold of thermal tolerability was well tolerated by subjects, despite moderate increases in stinging during light exposure and increased PDT skin reactions after treatment. A long-term follow-up study is currently underway to evaluate the longevity of AK clearance.…”

Section: Discussionmentioning

confidence: 95%

“…[1][2][3][4][5][6][7][8][9][10] Emerging literature supporting long-term response rates underscores the potential benefits of PDT in the management of nonmelanoma skin cancer. [11][12][13][14][15][16][17] Photodynamic therapy is particularly advantageous for the treatment of large surface areas and is especially suitable for the treatment of multiple actinic keratoses (AKs) and areas of field cancerization.…”

Section: Resultsmentioning

confidence: 99%

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Temperature-Modulated Photodynamic Therapy for the Treatment of Actinic Keratosis on the Extremities

Willey

Anderson

Sakamoto

2014

Dermatologic Surgery

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

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Temperature-Modulated Photodynamic Therapy for the Treatment of Actinic Keratosis on the Extremities

Willey

Anderson

Sakamoto

2014

Dermatologic Surgery

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“…Despite this pretreatment, thicker AKs respond at a reduced rate and may require more treatment sessions to achieve clearance. 22,61,39 PDT does not effect a full reversal of photodamage in all instances; AKs may begin to emerge after 4 to 6 months. 18,62 In patients with a history of NMSC, 2 sessions of ALA-PDT delayed the emergence of AKs and other lesions from severely photodamaged skin, relative to placebo treatment.…”

Section: Pdt and Daylight Pdtmentioning

confidence: 99%

“…AK research is singularly well suited to intraindividual comparison studies-for example, split-face or split-scalp studies, in which different therapies are used to treat otherwise-identical areas of photodamaged skin. 22,26,[32][33][34] Efficacy outcomes differ across studies in the AK literature, making comparisons difficult. In particular, some studies report the proportion of lesions that respond to treatment, whereas others report the rate of complete clearance within the treatment field.…”

Section: Overview Of the Clinical Literature On Aksmentioning

confidence: 99%

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

et al. 2015

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Background Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). Objective To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Methods Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Results Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Conclusions Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the longterm immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.

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Efficacy of Photodynamic Therapy vs Other Interventions in Randomized Clinical Trials for the Treatment of Actinic Keratoses

2014

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IMPORTANCE Photodynamic therapy (PDT) is used extensively to treat actinic keratoses(AKs). An analysis of the effectiveness of PDT compared with other treatments may help physicians decide what role it should play in their own clinical practices.OBJECTIVE To determine the effectiveness of PDT for the treatment of AKs relative to other methods.DATA SOURCES MEDLINE, EMBASE,Web of Knowledge, and Cochrane Central Register. No restrictions on years were placed, and all searches extended to the year of each data base inception. Our search was conducted on March 20, 2013, and included the search terms solar keratosis, actinic keratosis, photodynamic therapy, and photochemotherapy. No restrictions were used for the search string.STUDY SELECTION Only randomized PDT trials that used aminolevulinic acid hydrochloride ormethyl aminolevulinate hydrochloride as stabilizers with 10 or more participants were considered. Two of the authors undertook the search independently.DATA EXTRACTION AND SYNTHESIS Data were extracted independently by the 2 authors.We assessed data quality using the Jadad scoring system and used a random-effects model for pooled data analysis.MAIN OUTCOMES AND MEASURES Primary outcome measures specified a priori were lesion response, cosmetic results, and patient satisfaction after the intervention.RESULTS Our search identified 875 journal articles and meeting abstracts.We excluded 862 owing to lack of adherence to our inclusion criteria or lack of author response to our queries for further information.We assessed 13 studies for inclusion in our final synthesis, of which 4 were eligible for final meta-analysis. The only comparator for which meta-analysis was performed was cryotherapy. The meta-analysis consisted of 641 participants, with a total of 2174 AKs treated with cryotherapy and 2170 AKs treated with PDT. Compared with cryotherapy, the pooled relative risk for the meta-analysis for complete response (lesion clearance) was 1.14 (95%CI, 1.11-1.18) at 3 months after treatment. Visual inspection of a funnel plot revealed no publication bias, which was confirmed by the Begg test (P = .80).CONCLUSIONS AND RELEVANCE Photodynamic therapy has a 14%better chance of complete lesion clearance at 3 months after treatment than cryotherapy for thin AKs on the face and scalp.

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Intraindividual, right-left comparison of topical 5-aminolevulinic acid photodynamic therapy vs. 5% imiquimod cream for actinic keratoses on the upper extremities

Abstract: Our study shows that ALA-PDT and 5% IMIQ cream are both attractive treatment options for upper extremities AKs with comparable efficacy and cosmetic outcomes.

Cited by 68 publications

References 21 publications

Temperature-Modulated Photodynamic Therapy for the Treatment of Actinic Keratosis on the Extremities

Temperature-Modulated Photodynamic Therapy for the Treatment of Actinic Keratosis on the Extremities

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

Efficacy of Photodynamic Therapy vs Other Interventions in Randomized Clinical Trials for the Treatment of Actinic Keratoses

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