Repetitive Daylight Photodynamic Therapy versus Cryosurgery for Prevention of Actinic Keratoses in Photodamaged Facial Skin: A Prospective, Randomized Controlled Multicentre Two-armed Study

Abstract

Actinic keratoses are a chronic condition in ultraviolet-damaged skin, with a risk of progressing to invasive skin cancer. The aim of this study was to investigate the preventive potential of field-directed repetitive daylight photodynamic therapy for actinic keratoses. A randomized trial was performed, including 58 patients with ≥5 actinic keratoses on photodamaged facial skin, who received either 5 full-face sessions of day-light photodynamic therapy within a period of 2 years or lesion-directed cryosurgery. Primary outcome was the mean cumulative number of new actinic keratoses developed between visits 2 and 6 (visit 6 being a follow-up). This outcome was lower after daylight photodynamic therapy (7.7) compared with cryosurgery (10.2), but the difference did not reach significance (–2.5, 95% confidence interval –6.2 to 1.2; p =0.18). Several signs of photoageing (fine lines, pigmentation, roughness, erythema, sebaceous gland hyperplasia) were significantly reduced after daylight photodynamic therapy, but not after cryosurgery. Significantly less pain and fewer side-effects were reported during day-light photodynamic therapy than during cryosurgery. This study found that repetitive daylight photodynamic therapy had photo-rejuvenating effects. However, the prevention of actinic keratoses by this therapy could not be proven in a statistically reliable manner.

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

“…However, at 9 months, the number of new AKs was significantly lower with field therapy compared with lesion-directed therapy ( p = 0.014) [ 30 ]. Another study comparing multiple full-face MAL-dlPDT sessions with cryosurgery [ 31 ] demonstrated no significant difference in AK clearance ( p = 0.154) or number of new AKs ( p = 0.542) between the therapies over 24 months. However, this study did show significant reductions in 6 of 9 parameters of photoaging with MAL-dlPDT compared with cryosurgery: fine lines ( p < 0.001), mottled pigmentation ( p = 0.007), tactile roughness ( p < 0.001), skin color ( p = 0.016), facial erythema ( p < 0.001), and sebaceous gland hyperplasia ( p = 0.017).…”

“…Taken together, these studies suggest field therapy may delay development of new AKs and have photo-rejuvenating effects [ 31 ]. However, a combination of lesion-directed and field therapy may have additional cosmetic advantages to the patient [ 27 , 28 ], consequently improving treatment adherence.…”

Effects of Blue Light on the Skin and Its Therapeutic Uses: Photodynamic Therapy and Beyond

“…The DL-PDT treatment group benefited from decreased photoaging signs (fine lines, mottled pigmentation, tactile roughness, erythema, and sebaceous gland hyperplasia) and had less burden of side effects. 48 Similar to cPDT, DL-PDT is also only recommended for Grade I and II AKs because of concern it will not penetrate thicker lesions, unless pretreated to remove excess hyperkeratosis. [49][50][51][52] Interestingly, the previously mentioned study found that Grade III AKs responded better to DL-PDT than cryotherapy.…”

“…[49][50][51][52] Interestingly, the previously mentioned study found that Grade III AKs responded better to DL-PDT than cryotherapy. 48 This could be due to the deeper penetration of red light over BL.…”

Improved Simulated-Daylight Photodynamic Therapy and Possible Mechanism of Ag-Modified TiO2 on Melanoma

“…To solve this problem, daylight PDT or simulated-daylight PDT has attracted much attention. Although it cannot penetrate deep tissues, it is very safe, nearly painless, well-tolerated, and mostly nonsurgical [ 17 , 18 , 19 , 20 , 21 ]. Because skin disease is a superficial disease, it has no limitation of tissue depth.…”