Actinic keratosis: halving PDT duration reduces pain but not efficacy

  • Fernández-Guarino M & al.
  • J Eur Acad Dermatol Venereol
  • 13 Mar 2019

  • International Clinical Digest
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Takeaway

  • Methylaminolevulinic acid (MAL) photodynamic therapy (PDT) with half-time red-light illumination is associated with similar effectiveness and reduced pain compared with full-time illumination in patients with multiple actinic keratoses (AK).

Why this matters

  • Conventional MAL PDT is effective for AK, but is associated with significant pain.

Key results

  • Full-time and half-time illuminations were associated with similar rates of complete response at 3 months (85% vs 82%; P=.573) and 6 months (70% vs 65%; P=.433).
  • Half-time illumination was associated with reduced pain during treatment compared with full-time illumination (mean visual analogue scale [VAS], 5.59 vs 6.41; P=.000), although this difference was not present 48 hours after treatment (mean VAS, 0.83 vs 0.90; P=.489).
  • Full-time and half-time illumination were associated with similar rates of adverse effects.
    • Erythema VAS, 1.41 vs 1.24; P=.202.
    • Edema VAS, 0.34 vs 0.38; P=.712.
    • Crusts VAS, 0.55 vs 0.59; P=.745.
    • Blister VAS, 0.24 vs 0.14; P=.264.

Study design

  • Of 774 AK lesions (29 patients) treated with MAL PDT, 385 were treated with a full-time protocol (8 minutes) and 289 were treated with a half-time protocol (4 minutes).
  • Funding: None.

Limitations

  • Small patient sample size.
  • Method of evaluating adverse effects not well validated.

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