Daylight-mediated photodynamic therapy of moderate to thick actinic keratoses of the face and scalp: a randomized multicentre study

Wiegell, Stine Regin; Fabricius, Susanne; Gniadecka, Monika; Stender, Ida‐Marie; Berne, Berit; Kroon, S; Andersen, Barbara L.; Mørk, Cato; Sandberg, Carin; Ibler, Kristina Sophie; Jemec, Gregor B. E.; Brocks, K. M.; Philipsen, Peter Alshede; Heydenreich, Jakob; Hædersdal, Merete; Wulf, Hans Christian

doi:10.1111/j.1365-2133.2012.10833.x

Cited by 134 publications

(152 citation statements)

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“…Although patients enrolled in the Australian study had individual lesions treated,13 the expert panel agreed that daylight PDT is recommended for use in patients who require field therapy (i.e., large areas of actinic damage) to treat visible lesions and subclinical disease, depending on the clinical need. This is consistent with current guidelines for treatment of AK7 and is supported by findings from the studies of daylight PDT (including field treatment) in northern Europe 11, 14, 15, 16…”

Section: Whom To Treat With Daylight Pdt With Methyl Aminolevulinate supporting

confidence: 90%

“…Findings from a subgroup analysis of AK severity showed that following daylight PDT, lesion response rates of thin AK (76% [1572 lesions at baseline]) were higher than with moderate or thick AK (61% (974 lesions at baseline), 49% (222 lesions at baseline), as is also the case with c‐PDT and other topical treatments 14. Hence, the expert panel agreed that daylight PDT is suitable for lesions that are grade I or grade II based on the Olsen three‐point scale 3.…”

Section: Whom To Treat With Daylight Pdt With Methyl Aminolevulinate mentioning

confidence: 91%

“…The efficacy and safety of daylight PDT with MAL in the treatment of AK has been assessed in four randomised trials conducted in Europe11, 14, 15, 16, 17 and one randomised controlled trial conducted in Australia 13. The European trials consisted of a small exploratory study comparing daylight PDT with c‐PDT,11 two comparative studies with different concentrations of MAL cream16 and daylight exposure times14, 15 and, most recently, a phase III randomised trial comparing daylight PDT with c‐PDT (only preliminary results reported) 17.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The European trials consisted of a small exploratory study comparing daylight PDT with c‐PDT,11 two comparative studies with different concentrations of MAL cream16 and daylight exposure times14, 15 and, most recently, a phase III randomised trial comparing daylight PDT with c‐PDT (only preliminary results reported) 17. In all trials, daylight PDT resulted in high total lesion response rates (> 70% grade I) with participants experiencing little to no pain during daylight exposure (Table 2).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Evidence from the clinical trials conducted to date suggest that the affected area should be prepared before the application of MAL cream13, 14, 15, 16 as follows (Table 4). Firstly, the affected area(s) should be washed (e.g.…”

Section: How To Treat Patients With Daylight Pdt With Methyl Aminolevmentioning

confidence: 99%

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

See¹,

Shumack

Murrell

et al. 2015

Aust J Dermatology

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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.

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Section: Whom To Treat With Daylight Pdt With Methyl Aminolevulinate supporting

confidence: 90%

Section: Whom To Treat With Daylight Pdt With Methyl Aminolevulinate mentioning

confidence: 91%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: How To Treat Patients With Daylight Pdt With Methyl Aminolevmentioning

confidence: 99%

See 3 more Smart Citations

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

See¹,

Shumack

Murrell

et al. 2015

Aust J Dermatology

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Efficacy of Photodynamic Therapy vs Other Interventions in Randomized Clinical Trials for the Treatment of Actinic Keratoses

2014

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IMPORTANCE Photodynamic therapy (PDT) is used extensively to treat actinic keratoses(AKs). An analysis of the effectiveness of PDT compared with other treatments may help physicians decide what role it should play in their own clinical practices.OBJECTIVE To determine the effectiveness of PDT for the treatment of AKs relative to other methods.DATA SOURCES MEDLINE, EMBASE,Web of Knowledge, and Cochrane Central Register. No restrictions on years were placed, and all searches extended to the year of each data base inception. Our search was conducted on March 20, 2013, and included the search terms solar keratosis, actinic keratosis, photodynamic therapy, and photochemotherapy. No restrictions were used for the search string.STUDY SELECTION Only randomized PDT trials that used aminolevulinic acid hydrochloride ormethyl aminolevulinate hydrochloride as stabilizers with 10 or more participants were considered. Two of the authors undertook the search independently.DATA EXTRACTION AND SYNTHESIS Data were extracted independently by the 2 authors.We assessed data quality using the Jadad scoring system and used a random-effects model for pooled data analysis.MAIN OUTCOMES AND MEASURES Primary outcome measures specified a priori were lesion response, cosmetic results, and patient satisfaction after the intervention.RESULTS Our search identified 875 journal articles and meeting abstracts.We excluded 862 owing to lack of adherence to our inclusion criteria or lack of author response to our queries for further information.We assessed 13 studies for inclusion in our final synthesis, of which 4 were eligible for final meta-analysis. The only comparator for which meta-analysis was performed was cryotherapy. The meta-analysis consisted of 641 participants, with a total of 2174 AKs treated with cryotherapy and 2170 AKs treated with PDT. Compared with cryotherapy, the pooled relative risk for the meta-analysis for complete response (lesion clearance) was 1.14 (95%CI, 1.11-1.18) at 3 months after treatment. Visual inspection of a funnel plot revealed no publication bias, which was confirmed by the Begg test (P = .80).CONCLUSIONS AND RELEVANCE Photodynamic therapy has a 14%better chance of complete lesion clearance at 3 months after treatment than cryotherapy for thin AKs on the face and scalp.

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Artificial White Light vs Daylight Photodynamic Therapy for Actinic Keratoses

et al. 2016

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IMPORTANCE Daylight photodynamic therapy using topical methyl 5-aminolevulinic acid (MAL) for actinic keratoses (AKs) is as effective as conventional photodynamic therapy but has the advantage of being almost pain free. Daylight photodynamic therapy, however, requires dry and warm weather conditions. OBJECTIVE To establish if topical MAL photodynamic therapy using a white light light-emitting diode (LED) lamp is as effective and well-tolerated as daylight photodynamic therapy for the treatment of AKs. DESIGN, SETTING, AND PARTICIPANTS Overall, 22 men with significant photodamage and a high number of AKs were enrolled in this prospective, randomized, single-blind study, employing a split-scalp design, comparing the effectiveness and adverse effects of daylight photodynamic therapy and artificial white light (AWL) LED photodynamic therapy for the treatment of AKs on the forehead and scalp. Organ transplant recipients were excluded. Patients were treated and evaluated at an academic tertiary referral dermatology center. Treatment lasted from April 2014 to July 2014 and follow-up visits occurred for 9 months posttreatment. INTERVENTIONS Two symmetrical treatment fields were defined and AKs counted, mapped, and photographed at baseline, 1, 3, 6, and 9 months. Patients had half of their scalp treated with daylight photodynamic therapy and the other half treated with AWL photodynamic therapy 1 week apart and randomly allocated. MAL was applied, and treatment commenced 30 minutes later and lasted 2 hours. Irradiance, illuminance, and light spectra measurements were performed. The integrated dose in J/cm 2 was measured. The effective light dose, weighted to the absorption spectrum for protoporphyrin IX, was calculated. MAIN OUTCOMES AND MEASURES The primary end point was the reduction in total AK count per treatment field. Secondary end points included adverse effects and patient satisfaction. RESULTS We enrolled 22 men with a median age of 72 years (range, 47-85 years) at baseline, the total (median of AKs per field) were 469 (20.5) for the DPDT group and 496 (20.5) for the AWLPDT group (P = .34). The median number and percentage of reduction in AKs per field were 12 and 62.3% for DPDT and 14 and 67.7% for AWLPDT at 1 month (P = .21 and P = .13, respectively). There was no significant difference in the reduction percentage of AKs for either treatment at 1, 3, and 6 months. At 9 months, the median number and percentage of reduction in AKs per field was 9.0 and 48.4% for DPDT and 12.0 and 64.4% for AWLPDT (P = .13 and P = .05, respectively). Pain was reported by 14 patients with DPDT and 16 patients with AWLPDT (median maximum score [out of 100], 4 vs 6; P = .51). Moderate erythema was reported by 9 patients after DPDT and 14 patients after AWLPDT. On a scale of 0 (intolerable) to 10 (very tolerable) patients rated DPDT as 9.5 and AWLPDT as 9 (P = .37). CONCLUSIONS AND RELEVANCE Photodynamic therapy using an AWL source was as effective and well-tolerated as daylight photodynamic therapy. TRIAL REGISTRATION clinicaltrials.g...

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Daylight-mediated photodynamic therapy of moderate to thick actinic keratoses of the face and scalp: a randomized multicentre study

Abstract: Daylight-mediated PDT of moderate to thick AKs was less effective than daylight-mediated PDT of thin AKs especially in some centres. However, nearly all thicker lesions (grades II and III) were reduced to a lower lesion grade at 3 months after a single treatment of daylight-mediated PDT.

Cited by 134 publications

References 13 publications

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

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

Efficacy of Photodynamic Therapy vs Other Interventions in Randomized Clinical Trials for the Treatment of Actinic Keratoses

Artificial White Light vs Daylight Photodynamic Therapy for Actinic Keratoses

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