Pretreatment with ablative fractional carbon dioxide laser improves treatment efficacy in a synergistic PDT protocol for actinic keratoses on the head

• Published in: Photodiagnosis and photodynamic therapy Vol. 34; p. 102249
• Main Authors: Falkenberg, C., Schmitz, L., Dicke, K., Dervenis, V., Szeimies, R.M., Dirschka, T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2021
• Subjects: Actinic keratosis; AKASI; ALA; Aminolevulinic Acid - therapeutic use; Fractional CO2laser; Humans; Keratosis, Actinic - drug therapy; Lasers, Gas - therapeutic use; NMSC; Photochemotherapy - methods; Photodynamic therapy; Photosensitizing Agents - therapeutic use; Treatment Outcome; Actinic keratosis; Fractional CO2laser; AKASI; Photodynamic therapy; NMSC; ALA; Fractional COlaser
• ISSN: 1572-1000; 1873-1597
• DOI: 10.1016/j.pdpdt.2021.102249

•S-PDT with AFXL pretreatment is safe and effective for AKs on the head.•Compared to s-PDT without pretreatment, AFXL showed significantly superior efficacy.•S-PDT and AFXL procedure worked out to be almost painless. A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment. 28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm2, power 30 W, beam size 4−18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS). Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0–2.4]) compared to baseline (5.3 [4–7.75]). Median reduction rate was 75.5 % (61.3 %–100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0−0), 0 (0–2) and 0 (0–2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]). S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.