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DL‐PDT for AK: multicentre trial comparing BF‐200 ALA with MAL
Author(s) -
Räsänen J.E.,
Neittaanmäki N.,
Ylitalo L.,
Hagman J.,
Rissanen P.,
Ylianttila L.,
Salmivuori M.,
Snellman E.,
Grönroos M.
Publication year - 2019
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.18181
Subject(s) - medicine , photodynamic therapy , photosensitizer , skin cancer , dermatology , tolerability , scalp , actinic keratoses , basal cell , surgery , cancer , photochemistry , chemistry , adverse effect , organic chemistry
Summary Actinic keratoses (AK) are areas of sun‐damaged skin found mainly on parts of the body which have received lots of sun exposure. At first, they can be hard to see, and are more easily felt, being rough, like sandpaper. They may grow to a centimetre or two in diameter. Up to 20% of AKs may progress to a type of skin cancer called squamous cell carcinoma (SCC) within 10 to 25 years. One treatment option is a type of photodynamic therapy called Daylight photodynamic therapy (DL‐PDT) in which a cream, containing a ‘photosensitiser’, is applied to the lesion (affected area of skin). This photosensitiser is, by itself, inactive. However, when light of a certain wavelength shines onto skin to which the photosensitiser has been applied, the photosensitiser is activated and the treatment kills the abnormal cells in the skin. This study aimed to compare the efficacy (how well it works), tolerability (including pain and side effects) and cost‐effectiveness of two types of photosensitizer, called BF‐200 ALA and MAL. Altogether 69 patients with a total of 767 AKs located symmetrically on the face or scalp were treated at three centres in Finland. A single session of DL‐PDT was given in a randomized split‐face design, i.e. one half of the face was treated with one photosensitizer and the other half of the face with the other. The results were assessed at 12 months after treatment by a blinded observer, meaning they did not know which treatment was used on each side. The authors found out that BF‐200 ALA cleared significantly more AKs than MAL (79.7% vs. 73.5%). When comparing the half‐faces per single patient, the clearance of AKs was significantly better for the BF‐200 ALA treated sides than for those treated with MAL. The patient‐reported pain during the light treatment was low for both photosensitizers with no significant difference between them. The treatment‐related skin reactions a week after DL‐PDT were stronger on the sides treated with BF‐200 ALA. The cosmetic outcome (meaning how it looked) at 12 months was excellent or good in >90% of cases with both photosensitizers. The costs of DL‐PDT were similar for both photosensitizers, but the effectiveness was slightly higher for BF‐200 ALA. The authors conclude that BF‐200 ALA is more effective and provides slightly better value for money than MAL in DL‐PDT for mild and moderate AKs.