A prospective, randomized, within‐subject study of ALA‐PDT for actinic keratoses using different irradiation regimes

• Published in: Photodermatology, photoimmunology & photomedicine Vol. 34; no. 5; pp. 338 - 342
• Main Authors: Zaar, Oscar, Sjöholm Hylén, Alexandra, Gillstedt, Martin, Paoli, John
• Format: Journal Article
• Language: English
• Published: England 01.09.2018
• Subjects: actinic keratosis; Adult; daylight; Dermatologi och venereologi; Dermatology and Venereal Diseases; double-blind; efficacy; Female; field cancerization; guidelines; Humans; Keratosis, Actinic - drug therapy; Keratosis, Actinic - pathology; Keratosis, Actinic - physiopathology; light-sources; Male; Pain - etiology; Pain - physiopathology; Pain Measurement; pain reduction; pain relief; Photochemotherapy - adverse effects; Photochemotherapy - methods; photodynamic therapy; Prospective Studies; squamous-cell carcinoma; topical photodynamic therapy; pain reduction; actinic keratosis; photodynamic therapy
• ISSN: 0905-4383; 1600-0781; 1600-0781
• DOI: 10.1111/phpp.12394

Summary Background Photodynamic therapy (PDT) can be used to treat large fields of actinic keratoses (AKs) with high clearance rates. A notable downside is the amount of pain that accompany the treatment. This study aimed to optimize the illumination protocol during conventional PDT in order to reduce pain without compromising treatment effectiveness. Methods In this prospective, randomized study with a split‐face design, patients with, symmetrically distributed AKs were included. All patients were treated using a ALA 78 mg/g gel. One side was illuminated with the Aktilite® CL‐128 lamp and the other side with the RhodoLED® lamp in which the light intensity gradually increased to a maximum of 60%. Both sides received a total light dose of 37 J/cm2. Pain during the treatment was measured using a visual analogue scale. The clinical effectiveness of the 2 treated sides was assessed after 12 weeks. Results Twenty‐nine patients with 399 AKs were included. Illumination with the gradually increasing light intensity resulted in a decrease in the median visual analogue scale score by 1.1 points. Clearance rates were similar between the 2 lamps. Conclusion Minimizing the light intensity during the illumination phase of PDT reduces pain, while still preserving a high clearance rate of AKs.