A randomized trial comparing methyl aminolaevulinate photodynamic therapy with and without Er:YAG ablative fractional laser treatment in Asian patients with lower extremity Bowen disease: results from a 12-month follow-up

• Published in: British journal of dermatology (1951) Vol. 170; no. 1; pp. 165 - 172
• Main Authors: Ko, D.Y., Kim, K.H., Song, K.H.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.01.2014; Wiley-Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Aminolevulinic Acid - analogs & derivatives; Aminolevulinic Acid - therapeutic use; Asian Continental Ancestry Group; Biological and medical sciences; Bowen's Disease - ethnology; Bowen's Disease - therapy; Dermatology; Dyskeratosis; Female; Follow-Up Studies; Humans; Laser Therapy - methods; Lasers, Solid-State - therapeutic use; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - ethnology; Neoplasm Recurrence, Local - etiology; Photochemotherapy - adverse effects; Photochemotherapy - methods; Photosensitizing Agents - therapeutic use; Prospective Studies; Skin Neoplasms - therapy; Treatment Outcome; Tumors of the skin and soft tissue. Premalignant lesions; Human; Dyskeratosis; Skin disease; Premalignant lesion; Photodynamic therapy; Dermatology; YAG laser; Lower limb; Patient; Lower extremity; Bowen disease; Result; Randomization; Surveillance; Clinical trial; Methyl aminolevulinate; Comparative study
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.12627

Summary Background Methyl aminolaevulinate photodynamic therapy (MAL‐PDT) is an effective treatment for Bowen disease (BD) of the lower extremities. Er:YAG (erbium:yttrium‐aluminium‐garnet) ablative fractional laser (AFL) treatment removes the stratum corneum to increase MAL uptake and may improve efficacy. However, no studies have directly compared the efficacy of MAL‐PDT with and without Er:YAG AFL therapy in treating BD of the lower extremities in Asians. Objectives To compare the efficacy, recurrence rate, cosmetic outcomes and safety between Er:YAG AFL‐assisted MAL‐PDT (Er:YAG AFL‐PDT) and standard MAL‐PDT. Methods Twenty‐one patients with a total of 58 BD lesions randomly received either one session of Er:YAG AFL‐PDT or two sessions of MAL‐PDT in two symmetrical areas. Er:YAG AFL therapy was performed with 550–600 μm ablation depth, level 1 coagulation, 22% treatment density and a single pulse. MAL cream was then applied under occlusion for 3 h and illuminated with a red light‐emitting diode lamp at 37 J cm−2. A second session of MAL‐PDT was administered 7 days later. Overall response rate, recurrence rate, cosmetic outcomes and safety were assessed at 1 week, 3 and 12 months after treatment. Results After 3 months, Er:YAG AFL‐PDT was significantly more effective (93·8%) than MAL‐PDT (73·1%; P = 0·031), and the recurrence rate was significantly lower for Er:YAG AFL‐PDT (6·7%) than MAL‐PDT (31·6%) at 12 months (P = 0·022). No significant difference was found between Er:YAG AFL‐PDT and MAL‐PDT in terms of cosmetic outcomes or safety. Conclusions Er:YAG AFL‐PDT showed significantly higher efficacy and lower recurrence rate than did standard MAL‐PDT for treating lower extremity BD in an Asian population. What's already known about this topic? Methyl aminolaevulinate (MAL) photodynamic therapy (PDT) is a promising treatment for Bowen disease. Use of an Er:YAG ablative fractional laser (AFL) improves the MAL penetration into deeper portions of lesions. What does this study add? We show that compared with conventional MAL‐PDT, Er:YAG AFL‐assisted MAL‐PDT provides better efficacy in treating Bowen disease and with fewer sessions.