Photodynamic therapy is more effective than imiquimod for actinic keratosis in organ transplant recipients: a randomized intraindividual controlled trial. (5th February 2018)

• Record Type: Journal Article
• Authors: Togsverd‐Bo, K.; Halldin, C.; Sandberg, C.; Gonzalez, H.; Wennberg, A.M.; Sørensen, S.S.; Wulf, H.C.; Hædersdal, M.
• Is Part Of: British journal of dermatology. Volume 178:Number 4(2018)
• Page Start: 903
• Page End: 909
• Publication Date: 2018-02-05
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.15884
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Actinic keratoses (AKs) in solid organ transplant recipients (OTRs) are difficult‐to‐treat premalignancies and comparison of topical therapies is therefore warranted. Objectives: In an intraindividual study to compare the efficacy and safety of field treatment with methyl aminolaevulinate photodynamic therapy (MAL‐PDT) and imiquimod (IMIQ) for AKs in OTRs. Methods: OTRs ( n = 35) with 572 AKs (grade I–III) in two similar areas on the face, scalp, dorsal hands or forearms were included. All patients received one MAL‐PDT and one IMIQ session (three applications per week for 4 weeks) in each study area according to randomization. Treatments were repeated after 2 months (IMIQ) and 3 months (PDT) in skin with incomplete AK response. Outcome measures were complete lesion response (CR), skin reactions, laboratory results and treatment preference. Results: The majority of study areas received two treatment sessions (PDT n = 25 patients; IMIQ n = 29 patients). At 3 months after two treatments, skin treated with PDT achieved a higher rate of CR (AK I–III median 78%; range 50–100) compared with IMIQ‐treated skin areas (median 61%, range 33–100; P < 0·001). Fewer emergent AKs were seen in PDT‐treated skin vs. IMIQ‐treated skin (0·7 vs. 1·5 AKs, P = 0·04). Patients developed more intense inflammatory skin reactions following PDT, which resolved more rapidly compared with IMIQ (median 10 days vs. 18 days, P < 0·01). Patient preference ( P = 0·47) and cosmesis ( P > 0·30) were similar for PDT and IMIQ. Conclusions: Compared with IMIQ, PDT treatment obtained a higher rate of AK clearance at 3‐month follow‐up and achieved shorter‐lasting, but more intense, short‐term skin reactions. Abstract : What's already known about the topic? Field treatment of actinic keratoses (AKs) in organ transplant recipients includes photodynamic therapy (PDT) and imiquimod (IMIQ), but a comparison of treatment efficacy is warranted. What does this study add? At a 3‐month follow‐up assessment in an intrapatient study, PDT achieved a higher complete response rate and better prevention of new AKs than IMIQ treatment. Patients experienced higher levels of pain sensation and more intense, but shorter‐lasting, inflammatory skin reactions for PDT compared with IMIQ. Patients had an equal preference for both PDT and IMIQ treatments. Linked Comment: Ibbotson. Br J Dermatol 2018; 178 :829–830 . Plain language summary available online