Comparative Study of Photodynamic Therapy with Topical Methyl Aminolevulinate versus 5-Aminolevulinic Acid for Facial Actinic Keratosis with Long-Term Follow-Up

Abstract

BackgroundFew studies have compared the efficacy, cosmetic outcomes, and adverse events between 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate-PDT (MAL-PDT) for actinic keratoses (AKs) in Asian ethnic populations with dark-skin.ObjectiveWe retrospectively compared the long-term efficacy, recurrence rates, cosmetic outcomes, and safety of ALA-PDT versus MAL-PDT for facial AKs in Koreans.MethodsA total of 222 facial AKs in 58 patients were included in this study. A total of 153 lesions (29 patients) were treated with 5-ALA, and 69 lesions (29 patients) with MAL. ALA and MAL creams were applied for 6 hours and 3 hours, respectively; the lesions were then illuminated with a halogen lamp at 150 J/cm2 for ALA-PDT and a diode lamp at 37 J/cm2 for MAL-PDT.ResultsThe complete response rates of ALA-PDT and MAL-PDT were 56.9% and 50.7%, respectively, with no significant difference at 12 months after treatment. No significant difference in recurrence rates was observed between the 2 PDT modalities at either 6 or 12 months after treatment. There was no significant difference in the cosmetic outcomes between the 2 treatment modalities at 12 months after PDT. However, ALA-PDT caused significantly more painful than MAL-PDT (p=0.005). The adverse events were mild to moderate, transient, and self-limiting for both modalities.ConclusionMAL-PDT was similar to ALA-PDT in terms of long-term efficacy, recurrence rates, cosmetic outcomes, and adverse events; however, it was a significantly less painful procedure than ALA-PDT in our study.

Aminolevulinic acid and methyl aminolevulinate equally effective in topical photodynamic therapy for non‐melanoma skin cancers

“…However, only a few small clinical studies have directly compared ALA‐ with MAL‐PDT and this has only been done for AKs and nBCC. To our knowledge, no studies have compared the efficacy of ALA‐ and MAL‐PDT for sBCC and BD . Although in vitro studies have shown some differences concerning penetration and accumulation between the two compounds, which can be demonstrated in different models, the clinical response seems to be quite similar.…”

“…Another comparative retrospective study on facial AKs showed similar efficacy, recurrence rates, cosmetic outcomes and adverse events between MAL‐PDT ( n = 29) and ALA‐PDT ( n = 29) after 12 months with an application time of 3 h for MAL and 6 h for ALA. However, MAL‐PDT was significantly less painful than ALA‐PDT . Recently, however, the nanoemulsion BF‐200 ALA was compared with MAL for thin/moderate thickness AKs in the face and scalp with higher complete clearance rates with BF‐200 ALA‐PDT (78%) as compared to MAL‐PDT (64%) .…”

“…On the other hand, ALA is reported to result in higher PpIX levels than MAL, but with less selectivity for the diseased tissue . Despite the widespread use of both ALA‐ and MAL‐PDT, there are only a few small clinical studies comparing the clinical results with ALA and MAL …”

Ingenol mebutate in low amounts for the treatment of actinic keratosis in Korean patients

“…Nevertheless, the reason why AK should be treated is because we cannot predict which AK will transform into an invasive SCC. Various therapeutic approaches have been used for the treatment of AKs, including lesion-specific therapies, such as cryotherapy, laser therapy, and curettage, as well as field-directed therapies, such as imiquimod and topical photodynamic therapy 14–16. While deciding on the treatment method, a number of factors should be considered.…”

A new optical intra-tissue fiber irradiation ALA-PDT in the treatment of acne vulgaris in rabbit model: improved safety and tolerability

“…6-8 The reasons are related with the concentration of photosensitizer, energy of light, skin conditions of patients, and so on. But we cannot ignore that the whole face irradiation lack of accuracy is also an important reason.…”