Comparison of clinical and histologic findings in daylight photodynamic therapy for skin field cancerization: A randomized controlled four-arm study on physical methods-assisted delivery of methyl aminolevulinate

• Published in: Photodiagnosis and photodynamic therapy 2021-09, Vol.35, p.102404-102404, Article 102404
• Main Authors: Bento, Camila de Oliveira, Pantaleão, Luciana, de Souza, Mariana Boechat, Vilar, Enoi Aparecida Guedes, Luiz, Ronir Raggio, Filho, Porphirio José Soares, Gismondi, Ronaldo Altenburg Odebrecht Curi, Issa, Maria Claudia Almeida
• Format: Article
• Language: English
• Subjects: Actinic keratosis; Daylight photodynamic therapy; Methyl aminolevulinate; Physical; Physical methods-assisted delivery; Skin field cancerization
• ISSN: 1572-1000; 1873-1597
• DOI: 10.1016/j.pdpdt.2021.102404

•Daylight photodynamic therapy (DL-PDT) associated with physical methods have been reported with good clinical outcomes, but a comparison of different methods and histologic studies is lacking.•Our results showed more substantial improvement in the groups in which physical methods were associated with DL-PDT for skin field cancerization of the face and pointed to the pretreatment with laser as a better option. Daylight photodynamic therapy (DL-PDT) has similar efficacy to conventional photodynamic therapy in treating actinic keratosis (AKs). Good clinical outcomes have been reported when associated with physical methods such as microneedles, but a comparison of different methods and histologic studies is lacking. To evaluate clinical and histologic modifications induced by standard DL-PDT and compare with DL-PDT associated with physical methods in treating skin field cancerization of the face. Forty patients with photodamaged skin and at least one AK lesion on the face were randomly distributed into four groups, ten patients in each (I: Standard DL-PDT; II: DL-PDT + microneedles; III: DL-PDT + CO2 laser; IV: DL-PDT + microdermabrasion) and underwent two DL-PDT sessions with methyl aminolevulinate cream and 2-hour daylight exposure. Skin biopsies were performed on all patients before and 3 months after. All fragments were stained using the hematoxylin-eosin, orcein, and picrosirius. All 40 patients completed the study. Group III had a higher AK-clearance after 1 (p = 0,002) and 3 (p = 0,034) months, but it was similar in every group at 6 months (p = 0,441). Group III and IV had better clinical global improvement on texture, pigmentation and fine lines. In the groups associated with physical methods, the improvement of the keratinocytes' atypia and solar elastosis were remarkable. Only group III showed a significant reduction in solar elastosis (p = 0.034) and increased collagen type I (p = 0.028) after treatment. DL-PDT-associated with physical methods had better clinical and histologic results. AK-clearance were significantly higher after 1 and 3 months with pretreatment-CO2 laser. Photorejuvenation were more evident with pretreatment-CO2 laser and microdermabrasion. Pretreatment-CO2 laser showed a significant reduction in solar elastosis and increase of collagen type 1. These results pointed to the pretreatment with laser as a potentially better option for skin field cancerization of the face.