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

Abstract

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.

Methyl Aminolaevulinic Acid versus Aminolaevulinic Acid Photodynamic Therapy of Actinic Keratosis with Low Doses of Red-Light LED Illumination: Results of Long-Term Follow-Up

“…Reaching a correct immune memory response is more beneficial [ 11 ]. These arguments are similar to the principles of photobiomodulation, which uses LED-light properties without a photosensitizer in modulating biological effects, and consequently, lower doses with conventional red light LED illumination could be as effective [ 5 ], non-suppressive, restorative, and less painful [ 12 ]. None of the patients treated in this study developed any malignancy during the follow-up period, nevertheless, it was a small sample.…”

“…Since PDT was first implemented, 37 J/cm 2 were used in the c-PDT protocol (Aktilite ® ), despite the fact that they were painful and produced side effects such as erythema, crusts, and blisters [ 3 , 4 ]. Subsequently, the development of DL-PDT expanded the knowledge of illumination in a moderate way, and lower doses of red light were applied [ 5 ], demonstrating the same effectivity with more local damage (ROS production), and suggesting that the determinant factor for cytotoxicity is the total doses delivered, and not the irradiance or the PpIX accumulation [ 8 ]. In a comparative study modeling the local damage in PDT, DL-PDT achieved more local damage than C-PDT, suggesting that higher doses of red light are not related with higher lesion destruction [ 9 ] Moreover, when different protocols of illuminations are compared, the best option is likely the one with the best results at three months without pain [ 9 ], a remarkably practical approach.…”

“…Undoubtedly, DL-PDT has emerged as a great alternative for illumination in PDT, even though there is still a lack of exploration of the influence of the light source and doses used in the global results of PDT. With this argument in mind, we performed a previous study comparing red light conventional illumination (Aktilite ® , Galderma, Spain, 630 nm, 37 J/cm 2 ) with half time illumination with MAL, obtaining similar results [ 5 ]. To point up, it seems that the optimal red light doses with the minimal patient discomfort need yet to be defined.…”

How Much Protoporphyrin IX Must Be Activated to Obtain Full Efficacy of Methyl Aminolevulinate Photodynamic Therapy? Implication for Treatment Modifications

“…Therefore, a sensible course could be reducing the illumination time with red light 3 h after MAL application to last just long enough to activate the necessary amount of PpIX. Fernández-Guarino et al [12] halved the illumination time and still obtained the full treatment effect on AK. We have previously determined the minimal total PpIX weighted daylight dose for full efficacy to be 4-8 J/cm 2 [6,11].…”

Combined versus conventional photodynamic therapy with 5‐aminolaevulinic acid nanoemulsion (BF‐200 ALA) for actinic keratosis: A randomized, single‐blind, prospective study

“…Cosmetic outcomes (hypo‐ and hyperpigmentation, scars and skin atrophy on a 0‐3 Likert scale) 23 and patient satisfaction (on a 1‐10 Likert scale) were recorded on the 12‐week follow‐up visit.…”