Pulse photodynamic therapy reduces inflammation without compromising efficacy in the treatment of multiple mild actinic keratoses of the face and scalp – a randomized clinical trial

Abstract

Background

The main side effects of PDT for actinic keratoses (AK) are post-treatment erythema and oedema, and pain during illumination. Severe erythema after PDT enhances the down-time associated with the treatment.

Objectives

To evaluate in a randomized intraindividual study if pulse-PDT and corticosteroid pulse-PDT would reduce treatment induced erythema compared to conventional PDT.

Methods

Twenty-two patients with multiple mild AK in the face and scalp were treated with methyl aminolevulinate (MAL)-PDT in three similar areas. Two areas were incubated with MAL for 30 minutes (pulse-PDT) and one area was incubated with MAL for 3 hours (c-PDT). All areas were illuminated with red light after 3 hours. In one of the pulse-PDT areas a super potent corticosteroid was applied before and just after PDT (S-pulse-PDT).

Results

Pulse-PDT significantly reduced PDT-induced erythema (p=0.020) and erythema was even further reduced by S-pulse-PDT (p<0.0001). The complete lesion response rate 3 months after PDT did not differ significantly between the three treated areas.

Conclusions

Pulse-PDT and S-pulse-PDT reduced erythema 24h after treatment of multiple mild AK in the face and scalp.

The use of short MAL application time and topical corticosteroid did not affect the efficacy of PDT and may be an easy way to make PDT treatment of large visible areas more acceptable.

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