The safety and efficacy of daylight photodynamic therapy in the treatment of actinic keratoses: a systematic review and meta‐analysis

Abstract

Daylight photodynamic therapy (DLPDT) is a novel therapeutic approach for actinic keratoses (AKs). This study aimed to evaluate the safety and efficacy of DLPDT in treating patients with AKs as compared to conventional photodynamic therapy (CPDT). PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for relevant randomized controlled trials (RCTs) published before November 2017, based on the following search terms: "solar keratoses", "actinic keratoses", "photodynamic therapy", "daylight photodynamic therapy", "conventional photodynamic therapy", and "randomized". The complete response rate, patient satisfaction, and patient-reported pain after intervention with DLPDT or CPDT were primarily measured. Sensitivity analysis was conducted to determine the reliability of results. Begg's and Egger's tests were used to assess the likelihood of publication bias. Eight RCTs, comprising a total of 424 patients with AKs treated with DLPDT or CPDT, were included. No significant difference was found between the lesion response rate and the mean lesion response in a comparison of DLPDT and CPDT treatments. Generally, DLPDT was associated with higher patient satisfaction than CPDT. The patients who underwent DLPDT experienced less pain than those who underwent CPDT. Most of our results were of high stability and low sensitivity. Meanwhile, no statistical evidence of publication bias among studies was found under all comparisons. In conclusion, DLPDT is a safe and effective therapy, which could help in selecting the most appropriate therapeutic method for treating AKs and in guiding physicians to optimize treatment strategies.

A Review of the Dermatologic Clinical Applications of Topical Photodynamic Therapy

“…patients. 31 These findings align with our experience treating a 72-year-old male with chronic facial actinic damage and AKs with 4 repeated sessions of daylight-PDT with MAL (Figure 1). There have been some methodological studies to guide the selection of a daylight-PDT AK treatment protocol.…”

“…More patients were satisfied with daylight-PDT compared to conventional PDT (RR: 4.001; 95% CI: 2.017-7.938) in a meta-analysis of 5 RCTs with a total of 318 patients. 31 These findings align with our experience treating a 72-year-old male with chronic facial actinic damage and AKs with 4 repeated sessions of daylight-PDT with MAL (Figure 1). There have been some methodological studies to guide the selection of a daylight-PDT AK treatment protocol.…”

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

“…For this reason, different alternatives have been used for the treatment of AKs, such as daylight photodynamic therapy (dPDT) or the combination of dPDT and cPDT—one dPDT session according to the Spanish‐Portuguese consensus statement, followed immediately by cPDT 13 . These have had similar results in AK clearance rates, especially in grade I AKs, and a similar tolerability profile when compared with dPDT alone 12,14,15 . However, there are few studies about this new combined photodynamic therapy, none of which compare it to cPDT.…”

“…13 These have had similar results in AK clearance rates, especially in grade I AKs, and a similar tolerability profile when compared with dPDT alone. 12,14,15 However, there are few studies about this new combined photodynamic therapy, none of which compare it to cPDT.…”