Conventional vs. daylight methyl aminolevulinate photodynamic therapy for actinic keratosis of the face and scalp: an intra-patient, prospective, comparison study in Italy

• Published in: Journal of the European Academy of Dermatology and Venereology 2015-10, Vol.29 (10), p.1926-1932
• Main Authors: Fargnoli, M.C., Piccioni, A., Neri, L., Tambone, S., Pellegrini, C., Peris, K.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aminolevulinic Acid - analogs & derivatives; Aminolevulinic Acid - therapeutic use; Facial Dermatoses - drug therapy; Female; Humans; Italy; Keratosis, Actinic - drug therapy; Male; Middle Aged; Pain - etiology; Pain Measurement; Patient Satisfaction; Photochemotherapy - adverse effects; Photochemotherapy - methods; Photosensitizing Agents - therapeutic use; Prospective Studies; Recurrence; Scalp Dermatoses - drug therapy; Skin Cream; Sunlight; Sunscreening Agents - administration & dosage; Temperature
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/jdv.13076

Introduction Daylight photodynamic therapy (DL‐PDT) with methyl aminolevulinate (MAL) is a simplified PDT procedure that was recently shown in a few trials to be effective for grade I actinic keratosis (AK), with improved tolerability and reduced time of clinical attendance as compared to conventional PDT (c‐PDT). Objective To evaluate the efficacy and tolerability of DL‐PDT vs. c‐PDT with MAL in the treatment of grade I AK on the face and scalp in Italy. Methods Thirty‐five patients with AKs on the face (n = 17) or scalp (n = 18) were prospectively enrolled in an intra‐patient, left‐right, prospective, comparison study between DL‐PDT and c‐PDT at a single centre between September and October 2013. Weather conditions and outdoor temperature during daylight exposure were recorded for each DL‐PDT session. Pain was assessed after the PDT session and local adverse events 2 days after treatment. Lesion response rate was evaluated on both sides at 3 months. AKs with complete regression were followed until 6 months. Patient's preference for either treatment was recorded. Results There was no difference in complete response (CR) rate of AK I at 3 months between DL‐PDT and c‐PDT (87% vs. 91%; RR = 0.96; P = 0.16). A lower CR rate was observed with DL‐PDT than with c‐PDT for AK II (36% vs. 61%; RR = 0.58, P = 0.06) and III (25% vs. 46%; RR = 0.50, P = 0.20). Recurrence rate at 6 months was slightly higher for cleared AK I after DL‐PDT than after c‐PDT (17% vs. 12%, RR = 1.50, P