Ablative Fractional Laser-assisted Low-irradiance Photodynamic Therapy for Treatment of Actinic Keratoses in Organ Transplant Recipients: A Prospective, Randomized, Intraindividual Controlled Trial

• Published in: Acta dermato-venereologica Vol. 102; p. adv00694
• Main Authors: Lonsdorf, Anke S, Keller, Aric, Hartmann, Julia, Enk, Alexander H, Gholam, Patrick
• Format: Journal Article
• Language: English
• Published: Sweden Society for Publication of Acta Dermato-Venereologica 13.04.2022; Medical Journals Sweden
• Subjects: actinic keratosis; Aminolevulinic Acid - adverse effects; Humans; immunosuppression; keratinocyte cancer; Keratosis, Actinic - diagnosis; Keratosis, Actinic - drug therapy; Lasers; organ transplant recipients; Organ Transplantation - adverse effects; Original; Pain - drug therapy; Photochemotherapy - adverse effects; photodynamic therapy; Photosensitizing Agents - adverse effects; Prospective Studies; Treatment Outcome
• ISSN: 0001-5555; 1651-2057
• DOI: 10.2340/actadv.v102.1057

Pain and inferior efficacy are major limiting factors of conventional photodynamic therapy for the field treatment of actinic keratoses in immunosuppressed organ transplant recipients. This prospective randomized controlled study evaluates the efficacy and tolerability of ablative fractional laser system pretreatment combined with low-irradiance photodynamic therapy (18.5 mW/cm2) compared with conventional photodynamic therapy (61.67 mW/cm2) in the treatment of actinic keratoses on the face and scalp in organ transplant recipients, using a red light-emitting diode lamp at a total light dose of 37 J/cm2. Low-irradiance photodynamic therapy combined with Er:YAG pretreatment achieved a significantly superior lesion response rate (mean ± standard deviation 77.3 ± 23.6%) compared with conventional photodynamic therapy (61.8 ± 21.4%; p = 0.025) in intra-individual fields at 3 months without negatively impacting pain (p = 0.777) or cosmetic outcome (p = 0.157).