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Intensified photodynamic therapy of actinic keratoses with fractional CO 2 laser: a randomized clinical trial
Author(s) -
TogsverdBo K.,
Haak C.S.,
ThaysenPetersen D.,
Wulf H.C.,
Anderson R.R.,
Hædesdal M.
Publication year - 2012
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/j.1365-2133.2012.10893.x
Subject(s) - medicine , university hospital , family medicine , library science , dermatology , computer science
Summary Background Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is effective for thin actinic keratoses (AKs) in field‐cancerized skin. Ablative fractional laser resurfacing (AFXL) creates vertical channels that facilitate MAL uptake and may improve PDT efficacy. Objectives To evaluate efficacy and safety of AFXL‐assisted PDT (AFXL‐PDT) compared with conventional PDT in field‐directed treatment of AK. Methods Fifteen patients with a total of 212 AKs (severity grade I–III) in field‐cancerized skin of the face and scalp were randomized to one treatment with PDT and one treatment with AFXL‐PDT in two symmetrical areas. Following curettage of both treatment areas, AFXL was applied to one area using 10 mJ per pulse, 0·12 mm spot, 5% density, single pulse (UltraPulse ® , DeepFx handpiece; Lumenis Inc., Santa Clara, CA, U.S.A.). MAL cream was then applied under occlusion for 3 h and illuminated with red light‐emitting diode light at 37 J cm −2 . Fluorescence photography quantified protoporphyrin IX (PpIX) before and after illumination. Results At 3‐month follow‐up, AFXL‐PDT was significantly more effective than PDT for all AK grades. Complete lesion response of grade II–III AK was 88% after AFXL‐PDT compared with 59% after PDT ( P = 0·02). In grade I AK, 100% of lesions cleared after AFXL‐PDT compared with 80% after PDT ( P = 0·04). AFXL‐PDT‐treated skin responded with significantly fewer new AK lesions (AFXL‐PDT n = 3, PDT n = 11; P = 0·04) and more improved photoageing (moderate vs. minor improvement, P = 0·007) than PDT‐treated skin. Pain scores during illumination (6·5 vs. 5·4; P = 0·02), erythema and crusting were more intense, and long‐term pigmentary changes more frequent from AFXL‐PDT than PDT ( P = not significant). PpIX fluorescence was higher in AFXL‐pretreated skin [7528 vs. 12 816 arbitrary units (AU); P = 0·003] and photobleached to equal intensities after illumination (AFXL‐PDT 595 AU, PDT 454 AU; P = 0·59). Conclusions AFXL‐PDT is more effective than conventional PDT for treatment of AK in field‐cancerized skin.