Photodynamic therapy using intense pulsed light for treating actinic keratoses and photoaged skin of the dorsal hands: a randomized placebo‐controlled study

Abstract

On the dorsal hands, MAL-IPL reduced AK more efficaciously than placebo-IPL; both treatment modalities significantly improved photoaged skin.

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

“…However, in a right/left comparison study with imiquimod, conventional ALA‐PDT cleared significantly more moderate thickness AK lesions (58% vs. 37%), and equivalent numbers of thin AK on the hands/forearms (72% lesions) . A further randomized placebo‐controlled study of MAL‐PDT using an IPL to treat AK on the dorsal hands achieved complete remission of 55% compared with 3% with light alone . Similar to conventional PDT, 7 days pretreatment with 5‐fluorouracil cream has enhanced DL MAL‐PDT in a study treating AK on dorsum of hands, with superior clearance rates after single PDT session of 62.7% vs. 51.8% compared with PDT alone …”

“…86 A further randomized placebo-controlled study of MAL-PDT using an IPL to treat AK on the dorsal hands achieved complete remission of 55% compared with 3% with light alone. 87 Similar to conventional PDT, 7 days pretreatment with 5-fluorouracil cream has enhanced DL MAL-PDT in a study treating AK on dorsum of hands, with superior clearance rates after single PDT session of 62.7% vs. 51.8% compared with PDT alone. 88 PDT for actinic cheilitis A series of 40 patients saw complete clinical response at 3 months in 26 patients with actinic cheilitis following conventional ALA-PDT although with histological evidence of recurrence in nine patients over 18 months of followup.…”

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

“…But one of the most searched goals is to reduce pain during illumination without losing efficacy. With this porpoise, different studies have been published in the last years with a variety of lights used, as variable pulsed light, low irradiance light‐emitting diodes, laser, daylight and IPL . Among artificial lights, most of them have demonstrated utility in PDT for AK and good tolerability, but there is a lack of comparative studies between them, probably due to the great variability of devices and possibilities of management and parameters in these light sources.…”

Intense pulsed light combined with methyl aminolaevulinate for treating actinic keratoses and photoaged skin of the dorsal hands has considerable advantages. However, is it worth the extra expense?

“…Photodynamic therapy (PDT) using IPL for the treatment of actinic keratoses (AKs) of the face has been described before, with increasing fluence of IPL increasing the efficacy of treating facial AKs . Kohl et al ., in this issue of the BJD , present a study using the same combination to treat AKs on the dorsa of the hands. Therapies for AKs are significantly less effective on the hands than on the face and scalp.…”

“…Therapies for AKs are significantly less effective on the hands than on the face and scalp. Kohl et al . present a prospective randomized placebo‐controlled, inpatient observer‐blinded, single‐centre trial in which patients were randomly allocated to different treatment groups.…”