5‐aminolaevulinic acid nanoemulsion is more effective than methyl‐5‐aminolaevulinate in daylight photodynamic therapy for actinic keratosis: a nonsponsored randomized double‐blind multicentre trial

Räsänen, Janne; Neittaanmäki, Noora; Ylitalo, Leea; Hagman, J.; Rissanen, Pekka; Ylianttila, Lasse; Salmivuori, Mari; Snellman, Erna; Grönroos, Mari

doi:10.1111/bjd.17311

Cited by 28 publications

(33 citation statements)

References 32 publications

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“…Our evaluation after 24 h was nearly ‘zero’ so maybe this point of evaluation pain has no sense. Conventional PDT usually appeared with a mean of 4.4–5.7 in the VAS and daylight nearly painless . These data are similar to our patients and in our group of patients the half‐time illumination decrease pain significantly but the treatment continued to be painful.…”

Section: Discussionsupporting

confidence: 90%

“…Patient selection (multiple symmetrical AK on scalp or face) and protocol of evaluation of response and pain were similar to other comparative intrapatient studies of PDT in multiple AK . We performed the evaluation of quality of life routinely with a validated questionnaire .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the differences, most were mild and disappeared in 7 days . Some of these reactions were subjective and assessed by the patient (as itching or burning) and objective, and assessed by medical care professionals (erythema, oedema, crust or pustules), but some authors assessed them by a photograph or divided the assessment immediately or after some days or months . Only in one study was the assessment of side‐effects done by patients and also by a dermatologist with a good correlation .…”

Section: Discussionmentioning

confidence: 99%

“…At 24 h, pain had almost disappeared in both groups (0.90 and 0.83). The most frequent scale used to evaluate pain during PDT in the literature is the visual analogue scale (VAS) from 0 to 10 . Some authors evaluated it during and in some cases after some hours .…”

Section: Discussionmentioning

confidence: 99%

“…Some of them described it as excellent, good, poor or described the presence of hyper/hypopigmentation or scarring moths after the treatment either as an adverse effect or a cosmetic outcome. But in most of them, as in ours, the cosmetic outcome was excellent, and when these parameters were evaluated, they were not present as in our study, and the most assessed punctuations were ‘zero’ or ‘not present’. So maybe a better approach is to use Dover modified score of photodamaged, similar to studies of photodynamic rejuvenation …”

Section: Discussionmentioning

confidence: 99%

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Split‐face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half‐time red light LED conventional illumination

Fernández‐Guarino

Fonda‐Pascual

Gomez

et al. 2019

Acad Dermatol Venereol

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Background Conventional photodynamic therapy (PDT) with methylaminolevulinic acid (MAL) and daylight PDT have demonstrated similar efficacy in the treatment of actinic keratosis (AK). The reason for the use of daylight is to reduce pain during illumination but daylight has the limitation of the weather conditions. The difference in the doses of red light applied between these two methods suggests that an intermediate dose with red light conventional illumination could be effective in PDT of AK. Objective To compare the efficiency of conventional MAL‐PDT with half‐time conventional red light illumination in patients with multiple AK. Material and methods Adult patients with more than five symmetrically distributed AK were selected. After randomization, one area was treated with conventional PDT (Aktilite®, 630 nm, 37 J/cm2, 8 min), while the contralateral was illuminated half time (Aktilite®, 630 nm, 37 J/cm2, 4 min). Patients evaluated pain in each different side. Patients were evaluated at baseline, 3 and 6 months after PDT treatment by a blinded dermatologist. A questionnaire to be done at home 24 h after completing treatment was deliver to the patients to evaluate any side‐effects. Results A total of 774 lesions were treated, 385 with conventional PDT and 389 with half‐time PDT (P > 0.05). Conventional PDT was 85% of complete response of AK (327/385) at 3 months, and half‐time PDT was 82% (319/389). At 6 months, conventional PDT was 70% (268/385) of complete response and half‐time PDT was 65% (252/389). Pain during illumination was significantly lower in the VAS with the half‐time protocol with a mean of 5.59 (SD 1.48) vs. 6.41 (SD 1.66) in conventional PDT. No difference in adverse effects was found between protocols. Conclusion Conventional PDT with half‐time illumination in multiple actinic keratosis is as effective as complete time illumination and decreased pain significantly.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Split‐face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half‐time red light LED conventional illumination

Fernández‐Guarino

Fonda‐Pascual

Gomez

et al. 2019

Acad Dermatol Venereol

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Principles of Photodynamic Therapy

Ibbotson,

McKenna

2024

Rook's Textbook of Dermatology

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Topical photodynamic therapy (PDT) is widely used as an effective and well‐tolerated treatment for field change actinic keratosis, Bowen disease and superficial basal cell carcinoma. There is a strong evidence base to support its use and guidelines, which summarise the evidence and clinical utility of this therapy. There are also standards available for guidance with respect to establishing PDT services in dermatology and emphasis is placed on the availability of PDT for practitioners affiliated with a skin cancer multi‐disciplinary team. Developments in photosensitisers and light delivery, such as through the increasing application of daylight PDT, have greatly improved the tolerance, acceptability and uptake of PDT, such that this should be widely available through dermatology services. Further refinements in photosensitiser and light delivery will be expected to continue to improve PDT outcomes and the uptake of this invaluable therapeutic approach.

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