Pulsed Dye Laser-mediated Photodynamic Therapy is Less Effective than Conventional Photodynamic Therapy for Actinic Field Cancerization: A Randomized Half-side Comparative Study
DOI:
https://doi.org/10.2340/00015555-3754Keywords:
actinic keratosis, photochemotherapy, lasers, dyeAbstract
Previous research presents pulsed dye laser-mediated photodynamic therapy as a promising alternative to conventional red-light photodynamic therapy. In this study, 60 patients with 2 or more actinic keratoses randomly received either of these treatments on each side of the head. A physician blinded to the treatment evaluated treatment response at 6 months for each lesion, as completely, partially or not healed. Significantly lower complete clearance rates (10.3% vs 44.9%) and lesion-specific complete clearance rates were found for pulsed dye laser-mediated photodynamic therapy (47.9%) vs conventional red-light photodynamic therapy (73.4%). Significantly lower pain scores were found for pulsed dye laser-mediated photodynamic therapy, with a mean numerical rating of 2.3, compared with 4.1 for conventional red-light photodynamic therapy. The study population had a mean of 7.9 lesions, and 78% of patients had been treated previously for actinic keratoses on the treatment area. To conclude, in a population with severe sun damage, pulsed dye laser-mediated photodynamic therapy seems less effective than conventional red-light photodynamic therapy. Pulsed dye laser-mediated photodynamic therapy may still be a treatment option for patients who are not compliant with conventional red-light photodynamic therapy.
Downloads
References
Werner RN, Jacobs A, Rosumeck S, Erdmann R, Sporbeck B, Nast A. Methods and results report - evidence and consensus-based (S3) guidelines for the treatment of actinic keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum. J Eur Acad Dermatol Venereol 2015; 29: 1-66.
DOI: https://doi.org/10.1111/jdv.13179
Glogau RG. The risk of progression to invasive disease. J Am Acad Dermatol 2000; 42: 23-24.
DOI: https://doi.org/10.1067/mjd.2000.103339
Frost CA, Green AC. Epidemiology of solar keratoses. Br J Dermatol 1994; 131: 455-464.
DOI: https://doi.org/10.1111/j.1365-2133.1994.tb08544.x
Fleming P, Zhou S, Bobotsis R, Lynde C. Comparison of the treatment guidelines for aktinic keratosis: a critical appraisal and review. J Cutan Med Surg 2017; 21: 408-417.
DOI: https://doi.org/10.1177/1203475417708166
Gupta A RJ. Photodynamic therapy and topical aminolevulinic acid: an overview. Am J Clin Derm 2003; 4: 699-708.
DOI: https://doi.org/10.2165/00128071-200304100-00004
Morton CA, Szeimies RM, Sidoroff A, Braathen LR. European guidelines for topical photodynamic therapy part 2: emerging indications - field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol 2013; 27: 672-679.
DOI: https://doi.org/10.1111/jdv.12026
Braathen LR, Morton CA, Basset-Seguin N, Bissonnette R, Gerritsen MJP, Gilaberte Y, et al. Photodynamic therapy for skin field cancerization: an international consensus. International Society for Photodynamic Therapy in Dermatology. J Eur Acad Dermatol Venereol 2012; 26: 1063-1066.
DOI: https://doi.org/10.1111/j.1468-3083.2011.04432.x
Karrer S, Bäumler W, Abels C, Hohenleutner U, Landthaler M, Szeimies R. Long-pulse dye laser for photodynamic therapy: investigations in vitro and in vivo. Lasers Surg Med 1999; 25: 51-59.
DOI: https://doi.org/10.1002/(SICI)1096-9101(1999)25:1<51::AID-LSM7>3.0.CO;2-Y
Kessels, Janneke PHM, Nelemans PJ, Mosterd K, Kelleners-Smeets NWJ, Krekels GAM, et al. Laser-mediated photodynamic therapy: an alternative treatment for actinic keratosis? Acta Derm Venereol 2016; 96: 351-354.
DOI: https://doi.org/10.2340/00015555-2278
Alexiades-Armenakas MR, Geronemus RG. Laser-mediated photodynamic therapy of actinic keratoses. JAMA Dermatol 2003; 139: 1313-1320.
DOI: https://doi.org/10.1001/archderm.139.10.1313
Kim BS, Kim JY, Song CH, Kim HY, Lee WJ, Lee S, et al. Light-emitting diode laser versus pulsed dye laser-assisted photodynamic therapy in the treatment of actinic keratosis and Bowen's disease. Dermatol Surg 2012; 38: 151-153.
DOI: https://doi.org/10.1111/j.1524-4725.2011.02240.x
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869-871.
DOI: https://doi.org/10.1001/archderm.1988.01670060015008
Olsen EA, Abernethy L, Kulp-Shorten C, Callen JP, Glazer SD, Huntley A et al. A double-blind, vehicle-controlled study evaluating masoprocol cream in the treatment of actinic keratoses on the head and neck. J Am Acad Dermatol 1991; 24: 738-743.
DOI: https://doi.org/10.1016/0190-9622(91)70113-G
Ruohoalho T, Pitkänen S. [Pulsed dye laser-mediated photodynamic therapy of superficial skin cancers and their precursors]. Licentiate thesis at the University of Helsinki, 2007 [in Finnish].
Galderma. Product leaflet. Actilite CL 128 Description. (accessed 14 December 2020). Uppsala: Galderma. Available from: https://www.galderma.com/se/sites/g/files/jcdfhc271/files/inline-files/Produktblad_Aktilite_DK-NO-eng-2018_0.pdf.
Stockfleth E. The importance of treating the field in actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31: 8-11.
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2021 Vivian Lindholm, Sari Pitkänen, Marika Schröder, Sonja Hahtola, Helka Sahi, Heini Halme, Kirsi Isoherranen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
