Comparative study for the effect of photodynamic therapy, imiquimod immunotherapy and combination of both therapies on 40 lesions of actinic keratosis in Japanese patients

Abstract

We treated 12, 15 and 13 Japanese actinic keratosis (AK) lesions with 5-aminolevulinic acid photodynamic therapy (PDT), 5% imiquimod cream and combination of both therapies, respectively, and compared the effects. Patients underwent the second course, when AK lesions remained after the first course. Efficacy was evaluated 1 month after each treatment. Combination therapy cleared all AK lesions only after the first course, while PDT and imiquimod therapy cleared 41.7% and 66.7% of AK lesions after the first course, respectively. All residual AK lesions after the first course were cleared by the second courses of PDT or imiquimod therapy. During the course, erosion and crust developed significantly more frequently in combination therapy (P < 0.001). Most Japanese AK lesions can be satisfactorily treated with either PDT or imiquimod monotherapy. However, only severe cases may better be treated with combination therapy, which show higher efficacy even though adverse events occur frequently.

Efficacy of photodynamic therapy combined with topical interventions for the treatment of actinic keratosis: a meta‐analysis

“…Pain as outcome was available from three studies. 24,28,30 However, the results were inconsistently reported. In the study comparing the combination of PDT with calcipotriol ointment with PDT monotherapy, the former approach was perceived as more painful than monotherapy (mean AE SD: 5.40 AE 1.43 and 3.95 AE 0.69, respectively).…”

“…Information on the proportion of patients who had at least 75% of their baseline lesions cleared at the end of treatment was PDT combined with topical interventions for actinic keratosis available from four studies. 17,19,26,28 Participants treated with a combination approach showed higher participant partial clearance rates than monotherapy only. However, this difference was not statistically significant (RR 1.19; 95% CI 0.84-1.67; P = 0.33) (Fig.…”

“…Six studies assessed PDT monotherapy 17,19,24,25,27,30 and one study diclofenac monotherapy 21 as comparison. The remaining three studies had a threearmed design and investigated both PDT and the topical approach as control interventions 16,26,28 (Table 1).…”

“…Seven studies were identified reporting participant complete clearance rates. 17,19,21,[26][27][28]30 PDT in combination with a topical approach showed significantly higher participant complete clearance rates compared to monotherapy (RR 1.63; 95% CI 1.15-2.33; P = 0.007) ( Fig. 2a).…”

“…24 Data on pain from the study by Tanaka et al could not be evaluated, because it was indicated per treated lesion and not measured on the VAS. 28 Local skin reactions assessed by the LSR score was reported in only one trial. 16 LSR was most prevalent in the group treated with ingenol mebutate monotherapy (mean 12.625), followed by the combination group (mean 10.275).…”