Single versus two-treatment schedule of methyl aminolevulinate daylight photodynamic therapy for actinic keratosis of the face and scalp: An intra-patient randomized trial

• Published in: Photodiagnosis and photodynamic therapy 2019-09, Vol.27, p.100-104
• Main Authors: Gutiérrez García-Rodrigo, Carlota, Pellegrini, Cristina, Piccioni, Antonella, Tambone, Sara, Fargnoli, Maria Concetta
• Format: Article
• Language: English
• Subjects: Actinic keratosis; Aged; Aged, 80 and over; Aminolevulinic Acid - administration & dosage; Aminolevulinic Acid - adverse effects; Aminolevulinic Acid - analogs & derivatives; Aminolevulinic Acid - therapeutic use; Daylight photodynamic therapy; Drug Administration Schedule; Face - pathology; Female; Humans; Keratosis, Actinic - drug therapy; Male; Methyl aminolevulinate; Middle Aged; Pain - chemically induced; Patient Satisfaction; Photochemotherapy - adverse effects; Photochemotherapy - methods; Photosensitizing Agents - administration & dosage; Photosensitizing Agents - adverse effects; Photosensitizing Agents - therapeutic use; Pilot Projects; Prospective Studies; Scalp - pathology; Sunlight
• ISSN: 1572-1000; 1873-1597
• DOI: 10.1016/j.pdpdt.2019.05.031

•No data on the efficacy of repeated treatments of MAL DL-PDT for AKs of the face and scalp is available.•We demonstrated that two-treatment schedule of MAL DL-PDT has similar efficacy to the single-treatment for AKs.•The second treatment was associated with higher pain than the first treatment.•Alternative strategies might be recommended to optimize the efficacy of DL-PDT. Efficacy of daylight-photodynamic therapy (DL-PDT) with methyl aminolaevulinate (MAL) has been reported to gradually decrease as the severity of actinic keratosis (AK) lesions increases. Repeated treatments have been suggested to increase the efficacy of DL-PDT. Aim of our pilot study was to evaluate the efficacy and tolerability of a single versus two-treatment schedule of MAL DL-PDT for the treatment of multiple AKs of the face/scalp in a prospective, intra-patient, comparison study. Patients with multiple AKs of the face/scalp received a single treatment of MAL DL-PDT or 2 treatments, 1 week apart, on either half-side. Weather conditions and outdoor temperature were recorded during daylight exposure. Visual analog scale for pain was assessed immediately after each session, and severity of local skin reactions after 2 days. Treatment efficacy was evaluated at 3 months. Thirty-one patients with multiple AKs of the face/scalp were enrolled and completed the study. No significant difference was observed between single and two-treatment schedule in the lesion complete response rate for total AKs (80.7% vs 85.6%, p = 0.28) and for AKs divided by grade (grade I: 88.5% vs 89.2%, p = 0.79; grade II: 67.3% vs 71.0%, p = 0.71; grade III: 50.0% vs 55.6%, p≈1.00). Pain was significantly higher during the second session (p = 0.04). Local skin reactions were generally mild, but more severe after the first treatment (p