Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: a randomized controlled trial

Rubel, Diana; Spelman, Lynda; Murrell, Dédée F.; See, Jo‐Ann; Hewitt, D. Brock; Foley, Peter; Bosc, Catherine; Kérob, Delphine; Kerrouche, Nabil; Wulf, Hans Christian; Shumack, Stephen

doi:10.1111/bjd.13138

Cited by 193 publications

(297 citation statements)

References 13 publications

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“…Most lesions that regressed after treatment did not recur by the end of the study (week 24, daylight PDT: 96%, c‐PDT: 97%), showing a high maintenance response at 6 months. Participant‐reported pain was significantly lower with daylight PDT than with c‐PDT (Table 2) and fewer participants experienced treatment‐related adverse events (39/100 vs 59/100 participants, respectively) 13. The most frequently related adverse events were dermatologic in nature.…”

Section: Literature Reviewmentioning

confidence: 97%

“…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%

“…Although most lesions were mild, participants were severely affected, with approximately 14 lesions on each side of the face or scalp 13. Treatment with daylight PDT (1379 lesions at baseline) or c‐PDT (1372 lesions at baseline) was randomly assigned to either side of participants' face or scalp, and findings showed that daylight PDT was noninferior to c‐PDT with regard to lesion response (primary end‐point: 89 vs 93%, respectively; 95% CI: −6.8 to −0.3; week 12).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Although one study showed more severe erythema and desquamation in participants who were treated with daylight PDT than with c‐PDT,11 these effects were most likely a result of sunburn, which can be avoided with the application of a chemical sunscreen to the treatment site and entire sun‐exposed area 13, 16…”

Section: Literature Reviewmentioning

confidence: 99%

“…Since this consensus, a phase III study has been performed in Australia confirming the efficacy and tolerability of daylight PDT 13. Local practice guidelines on the use of daylight PDT in Australia are needed because of the differences in weather conditions from those of Europe and the extent of the solar damage and patients' characteristics in the Australian population.…”

Section: Introductionmentioning

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: Literature Reviewmentioning

confidence: 97%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

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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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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Photodynamic Therapy in Daylight for Actinic Keratoses

Wulf

2016

JAMA Dermatol

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Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: a randomized controlled trial

Abstract: Daylight-mediated PDT was not inferior in efficacy to Metvix c-PDT (mild AK response rate), better tolerated, nearly painless and more convenient for patients.

Cited by 193 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

Artificial White Light vs Daylight Photodynamic Therapy for Actinic Keratoses

Photodynamic Therapy in Daylight for Actinic Keratoses

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