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Randomized controlled trial comparing 35% trichloroacetic acid peel and 5‐aminolaevulinic acid photodynamic therapy for treating multiple actinic keratosis
Author(s) -
Holzer G.,
Pinkowicz A.,
Radakovic S.,
Schmidt J.B.,
Tanew A.
Publication year - 2017
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.15272
Subject(s) - trichloroacetic acid , medicine , photodynamic therapy , actinic keratosis , scalp , dermatology , randomized controlled trial , field cancerization , clinical trial , adverse effect , lesion , visual analogue scale , surgery , gastroenterology , biochemistry , chemistry , organic chemistry , basal cell
Summary Background Photodynamic therapy ( PDT ) and chemical peels with trichloroacetic acid ( TCA ) can be applied to large skin areas and thus are suitable treatment options for patients with multiple actinic keratosis ( AK ). However, despite its long use, TCA has been investigated only rarely in this indication. Objectives This randomized, observer‐blinded, intrapatient comparative study sought to investigate the efficacy and safety of 35% TCA vs. aminolaevulinic acid 20% ( ALA ) PDT in patients with extensive field cancerization and multiple AK s in the face or on the scalp. Methods Twenty‐eight patients with at least five AK s in two comparable anatomical areas on the head were treated with 35% TCA and ALA PDT randomly assigned to each area. Their therapeutic efficacy, adverse events and cosmetic outcome were assessed by a blinded investigator at 1, 3, 6 and 12 months after treatment. Results After 12‐months’ follow‐up TCA and ALA PDT reduced the total lesion count, the primary outcome, by 31% and 58%, respectively ( P = 0·006). Complete clearance of pre‐existing AK s were 49% for TCA and 74% for ALA PDT ( P = 0·011). Treatment failure (number of AK s greater than 50% of the baseline count) was observed in seven patients (25%) after TCA and in two patients (7%) after PDT treatment. Treatment‐related pain was significantly higher for ALA PDT (visual analogue scale 7·5 ± 2·3 vs. TCA : 5·1 ± 2·6; P = 0·04), whereas scarring ( n = 6, 21%) was seen only in TCA treated patients. Conclusions ALA PDT provided better clinical results than TCA in the treatment of patients with extensive field cancerization and multiple AK s.