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Intensified fractional CO 2 laser‐assisted photodynamic therapy vs. laser alone for organ transplant recipients with multiple actinic keratoses and wart‐like lesions: a randomized half‐side comparative trial on dorsal hands
Author(s) -
Helsing P.,
TogsverdBo K.,
Veierød M.B.,
Mørk G.,
Hædersdal M.
Publication year - 2013
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12507
Subject(s) - photodynamic therapy , medicine , actinic keratosis , tolerability , ablative case , field cancerization , dermatology , lesion , randomized controlled trial , keratosis , actinic keratoses , urology , surgery , adverse effect , cancer , radiation therapy , basal cell , chemistry , organic chemistry
Summary Background Photodynamic therapy ( PDT ) is a well‐documented treatment for actinic keratosis ( AK ), but achieves inferior efficacy in organ transplant recipients ( OTR s), particularly in acral regions. Ablative fractional laser ( AFXL ) intensifies the PDT response and may improve the efficacy of AK clearance when used as monotherapy. Objectives To compare the efficacy of a single treatment with AFXL ‐assisted PDT vs. AFXL alone for difficult‐to‐treat AK s and wart‐like lesions ( WLL s) in OTR s. Methods Ten OTR s were included with a total of 680 AK s (severity grade I– III ) and 409 WLL s on the dorsal hands. Both hands were initially treated with targeted fractional ablation of thick keratotic lesions followed by AFXL field treatment. Treatment regions were then randomized to (i) PDT ( AFXL ‐ PDT ) or (ii) no further treatment ( AFXL ). The primary end point was complete response ( CR ) at 4 months after treatment; secondary end points were improvement of AK severity grade, overall patient assessment of efficacy and tolerability of treatments. Results CR of AK s was significantly higher for AFXL ‐ PDT (73%) compared with AFXL alone (31%) ( P = 0·002). AFXL ‐ PDT improved 82% of AK s to lower lesion grades compared with 52% after AFXL alone ( P = 0·008). For WLL s, the rate of CR was 37% for AFXL ‐ PDT compared with 14% for AFXL ( P = 0·02). Overall assessment showed a preference for AFXL ‐ PDT compared with AFXL ( AFXL ‐ PDT , n = 8; AFXL , n = 0; equal, n = 2). Mild pigment changes were observed in four patients ( AFXL ‐ PDT , n = 3; AFXL , n = 1). No scarring was observed. Conclusions AFXL ‐ PDT is more effective than AFXL in the treatment of acral AK s and WLL s in OTR s.