Combination of ablative fractional laser and daylight‐mediated photodynamic therapy for actinic keratosis in organ transplant recipients – a randomized controlled trial. (15th December 2014)

• Record Type: Journal Article
• Authors: Togsverd‐Bo, K.; Lei, U.; Erlendsson, A.M.; Taudorf, E.H.; Philipsen, P.A.; Wulf, H.C.; Skov, L.; Hædersdal, M.
• Is Part Of: British journal of dermatology. Volume 172:Number 2(2015:Feb.)
• Page Start: 467
• Page End: 474
• Publication Date: 2014-12-15
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.13222
• Languages: English
• ISSNs: 0007-0963

Abstract

<abstract abstract-type="main" id="bjd13222-abs-0001"> <title>Summary</title> <sec id="bjd13222-sec-0001" sec-type="section"> <title>Background</title> <p>Topical photodynamic therapy (PDT) for actinic keratoses (AK) is hampered by pain during illumination and inferior efficacy in organ‐transplant recipients (OTR).</p> </sec> <sec id="bjd13222-sec-0002" sec-type="section"> <title>Objectives</title> <p>We assessed ablative fractional laser (AFL)‐assisted daylight photodynamic therapy (PDT) (AFL‐dPDT) compared with daylight PDT (dPDT), conventional PDT (cPDT) and AFL alone (AFL) in field treatment of AK in OTR.</p> </sec> <sec id="bjd13222-sec-0003" sec-type="section"> <title>Methods</title> <p>In each patient, four areas in the same region were randomized to one treatment with AFL‐dPDT, dPDT, cPDT and AFL. AFL was delivered with a 2940‐nm AFL at 2·3 mJ per pulse, 1·15 W, two stacks, 50‐μs pulse‐duration, 2·4% density. In dPDT and AFL‐dPDT, methyl aminolaevulinate (MAL) was applied for 2·5 h without occlusion during daylight exposure. For cPDT, MAL was occluded for 3 h followed by red‐light (630 nm) irradiation at 37 J cm<sup>−2</sup>. The primary end‐point was complete response (CR) 3 months post‐treatment.</p> </sec> <sec id="bjd13222-sec-0004" sec-type="section"> <title>Results</title> <p>Sixteen patients with 542 AK (grades I–III) in field‐cancerized skin of the scalp, chest and extremities were treated during August and September 2012. After 3 months, CR (AK I–III) rates were 74% after AFL‐dPDT, 46% after dPDT, 50% after cPDT and 5% after AFL (<italic>P </italic><<italic> </italic>0·001). CR rates in AFL‐dPDT, dPDT and cPDT were also significantly different (<italic>P </italic>=<italic> </italic>0·004). Median maximal pain scores differed significantly during AFL‐dPDT (0), dPDT (0), AFL (0) and cPDT (5) (<italic>P </italic><<italic> </italic>0·001). Erythema and crusting were more intense following AFL‐dPDT than dPDT and cPDT, but only transient hypopigmentation was observed.</p> </sec> <sec id="bjd13222-sec-0005" sec-type="section"> <title>Conclusions</title> <p>AFL‐dPDT is a novel PDT modality that enhances CR with excellent tolerability compared with dPDT and cPDT in difficult‐to‐treat AK in OTR.</p> </sec> </abstract>