Efficacy and safety of daylight photodynamic therapy after tailored pretreatment with ablative fractional laser or microdermabrasion: a randomized, side-by-side, single-blind trial in patients with actinic keratosis and large-area field cancerization.
Aged
Aged, 80 and over
Aminolevulinic Acid
/ administration & dosage
Carcinogenesis
/ drug effects
Combined Modality Therapy
/ adverse effects
Dermabrasion
/ adverse effects
Dose Fractionation, Radiation
Female
Humans
Keratosis, Actinic
/ pathology
Laser Therapy
/ adverse effects
Light
Male
Middle Aged
Photochemotherapy
/ adverse effects
Photosensitizing Agents
/ administration & dosage
Single-Blind Method
Skin
/ drug effects
Treatment Outcome
Journal
The British journal of dermatology
ISSN: 1365-2133
Titre abrégé: Br J Dermatol
Pays: England
ID NLM: 0004041
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
accepted:
08
08
2018
pubmed:
18
8
2018
medline:
21
4
2020
entrez:
18
8
2018
Statut:
ppublish
Résumé
Physical pretreatments can potentiate the efficacy of daylight photodynamic therapy (dPDT), but clinical comparative studies remain limited. Performed in large skin areas with actinic keratoses (AKs) and photodamage, this blinded, randomized clinical trial compared the efficacy and safety of dPDT after tailored skin pretreatment using ablative fractional laser (AFL) or microdermabrasion (MD). Two ≥ 50-cm In 18 patients with 832 AKs, AFL-dPDT provided significantly higher AK clearance (81% vs. 60%, P < 0·001), led to fewer new AKs (P < 0·001) and showed superior improvement in dyspigmentation (P = 0·003) and skin texture (P = 0·001) vs. MD-dPDT. Peaking at days 3-6, AFL-PDT induced more intensified local skin responses (P = 0·004), including instances of Staphylococcus aureus infection (n = 3). Patients nonetheless preferred AFL-dPDT (P = 0·077), due to lower pretreatment-related pain (P = 0·002) and superior cosmesis (P = 0·035) and efficacy compared with MD-dPDT. AFL-dPDT is an effective treatment for patients with AK with extensive field cancerization, although AFL pretreatment is associated with intensified local skin reactions.
Sections du résumé
BACKGROUND
Physical pretreatments can potentiate the efficacy of daylight photodynamic therapy (dPDT), but clinical comparative studies remain limited.
OBJECTIVES
Performed in large skin areas with actinic keratoses (AKs) and photodamage, this blinded, randomized clinical trial compared the efficacy and safety of dPDT after tailored skin pretreatment using ablative fractional laser (AFL) or microdermabrasion (MD).
METHODS
Two ≥ 50-cm
RESULTS
In 18 patients with 832 AKs, AFL-dPDT provided significantly higher AK clearance (81% vs. 60%, P < 0·001), led to fewer new AKs (P < 0·001) and showed superior improvement in dyspigmentation (P = 0·003) and skin texture (P = 0·001) vs. MD-dPDT. Peaking at days 3-6, AFL-PDT induced more intensified local skin responses (P = 0·004), including instances of Staphylococcus aureus infection (n = 3). Patients nonetheless preferred AFL-dPDT (P = 0·077), due to lower pretreatment-related pain (P = 0·002) and superior cosmesis (P = 0·035) and efficacy compared with MD-dPDT.
CONCLUSIONS
AFL-dPDT is an effective treatment for patients with AK with extensive field cancerization, although AFL pretreatment is associated with intensified local skin reactions.
Substances chimiques
Photosensitizing Agents
0
methyl 5-aminolevulinate
585NM85KYM
Aminolevulinic Acid
88755TAZ87
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
756-764Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2018 British Association of Dermatologists.