Consensus recommendations on the use of daylight photodynamic therapy with methyl aminolevulinate cream for actinic keratoses in Australia

Abstract

Australia has the highest prevalence of actinic keratoses (AK) worldwide. Because of the risk of transformation of AK to invasive squamous cell carcinomas, consensus guidelines recommend that AK are removed using appropriate therapies to prevent progression to invasive disease. Daylight photodynamic therapy (PDT) is emerging as an efficacious treatment for AK, particularly for patients who require treatment of large areas of chronic actinic damage that can be exposed easily to daylight. Daylight PDT with methyl aminolevulinate (MAL) cream is a simple treatment for AK, almost painless, well tolerated and convenient, requiring minimal time in the clinic. Randomised controlled studies from northern Europe and Australia support the use of daylight PDT as an effective therapy for grade I and II AK on the face and scalp. There is sufficient daylight to conduct daylight PDT in Australia at any time of the year and during most weather conditions. Hence, daylight PDT with MAL can be included as an effective and well‐tolerated new treatment option for the treatment of AK in Australia. These consensus recommendations provide guidelines for Australian clinicians on the use of daylight PDT in the treatment of diagnosed AK.

A randomized, intraindividual, non‐inferiority, Phase III study comparing daylight photodynamic therapy with BF‐200 ALA gel and MAL cream for the treatment of actinic keratosis

“…In recent years, multiple clinical studies documented that PDT can be successfully performed with a 2‐hour exposure to natural or simulated daylight, and guidelines on dPDT were established . The introduction of dPDT offered a concept to reduce pain and simplify the procedure while maintaining high efficacy.…”

British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017

“…In European studies daylight PDT can be performed in all weather conditions, but temperatures > 10 °C are advised for patient comfort. Consensus guidelines have also been produced …”

Use of illuminance as a guide to effective light delivery during daylight photodynamic therapy in the U.K.

“…It is important to note that these presented times do not serve as a recommendation for treatment times, as there are currently no studies that suggest treatment times as low as these can provide effective dPDT. In fact, it is suggested that treatment times < 1 h may provide insufficient time for photosensitizer production . However, these data can give confidence to practitioners of dPDT that interruptions in the patients’ daylight exposure (e.g.…”