Retrospective analysis evaluating the effect of a keratolytic and physical pretreatment with salicylic acid, urea and curettage on the efficacy and safety of photodynamic therapy of actinic keratoses with methylaminolaevulinate

Gholam, Patrick; Fink, Christine; Bosselmann, Ina; Enk, Alexander

doi:10.1111/jdv.13449

Cited by 16 publications

(21 citation statements)

References 12 publications

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“…Improved uptake of photosensitiser and light penetrance can be achieved for hyperkeratotic AKs by physical or chemical keratolytic pretreatment [62]. Topical 10% salicylic acid and 40% urea have similar efficacy to curettage, although chemical pretreatment is associated with increased pain [62].…”

Section: Actinic Keratosismentioning

confidence: 99%

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Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population. Photodynamic therapy (PDT) is gaining popularity for the treatment of basal cell carcinoma (BCC), Bowen’s disease (BD) and actinic keratosis (AK). A topical or systemic exogenous photosensitiser, results in selective uptake by malignant cells. Protoporphyrin IX (PpIX) is produced then activated by the introduction of a light source. Daylight-mediated MAL (methyl aminolaevulinate) PDT for AKs has the advantage of decreased pain and better patient tolerance. PDT is an effective treatment for superficial BCC, BD and both individual and field treatment of AKs. Excellent cosmesis can be achieved with high patient satisfaction. Variable results have been reported for nodular BCC, with improved outcomes following pretreatment and repeated PDT cycles. The more aggressive basisquamous, morphoeic infiltrating subtypes of BCC and invasive squamous cell carcinoma (SCC) are not suitable for PDT. Prevention of “field cancerization” in organ transplant recipients on long-term immunosuppression and patients with Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a promising development. The optimisation of PDT techniques with improved photosensitiser delivery to target tissues, new generation photosensitisers and novel light sources may expand the future role of PDT in NMSC management.

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Section: Actinic Keratosismentioning

confidence: 99%

“…Topical 10% salicylic acid and 40% urea have similar efficacy to curettage, although chemical pretreatment is associated with increased pain [62]. Ablative fractional laser resurfacing pretreatment may be beneficial for field treatment of moderate to severe AKs [49,63,64].…”

Section: Actinic Keratosismentioning

confidence: 99%

Photodynamic Therapy and Non-Melanoma Skin Cancer

Griffin

Lear

2016

Cancers

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“…They are either applied to remove hyperkeratotic AK in order to improve the permeation capability of topical drugs or to remove single lesions that were not cleared by previous topical therapies. However, high‐quality evidence is lacking as no RCTs and only few case series have been published on shave and complete excision for AK …”

Section: Combination Of Lesion‐ and Field‐directed Regimensmentioning

confidence: 99%

“…Gholam et al . retrospectively compared the efficacy of pretreatment of MAL‐PDT with either curettage ( n = 15), salicylic acid 10% ( n = 15) or urea cream 40% ( n = 14) . The combination with curettage achieved the highest response rates (68.5%), followed by salicylic acid (61.4%) and urea cream (60.8%), albeit without statistical significance.…”

Section: Combination Of Lesion‐ and Field‐directed Regimensmentioning

confidence: 99%

“…However, high-quality evidence is lacking as no RCTs and only few case series have been published on shave and complete excision for AK. [23][24][25] Curettage Another question in this context is whether curettage of lesions can be considered as true surgical treatment. In many cases, curettage is performed on hyperkeratotic lesions prior to PDT to improve the penetration of the photosensitizers and to remove crusts or keratotic components.…”

Section: Surgical Procedures and Topical Interventionsmentioning

confidence: 99%

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The more the better? An appraisal of combination therapies for actinic keratosis

Steeb

Wessely

Leiter³

et al. 2019

Acad Dermatol Venereol

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Actinic keratoses (AK) are common precancerous lesions of the skin. Numerous interventions exist for the treatment of AK, including lesion‐ and field‐directed approaches. In daily practice, different treatment modalities are often combined to maximize clearance rates. However, whether a combination therapy is preferable to monotherapy in terms of efficacy and safety has been subject of intense debate. In this review, we summarize the current knowledge on the efficacy and safety of local combination therapies for the treatment of patients with AK. Combination approaches of cryosurgery followed by photodynamic therapy (PDT), laser‐assisted PDT, PDT in combination with topical interventions and microneedling‐assisted PDT have shown slightly better efficacy results with similar tolerability compared to the respective monotherapy. However, the individual usage of combination therapies should be checked on a case‐by‐case basis and take into account individual patient‐ and lesion‐specific aspects as more resources are needed and because the individual monotherapies are already highly effective.

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Comparison of Physical Pretreatment Regimens to Enhance Protoporphyrin IX Uptake in Photodynamic Therapy

et al. 2017

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IMPORTANCE Skin pretreatment is recommended for adequate penetration of topical photosensitizing agents and subsequent protoporphyrin IX (PPIX) accumulation in photodynamic therapy (PDT).OBJECTIVE To compare the relative potential of different physical pretreatments to enhance PPIX fluorescence in normal skin. DESIGN, SETTING, AND PARTICIPANTSThis intraindividual, randomized clinical trial was performed from November 28 to December 20, 2014, at Bispebjerg Hospital, Copenhagen, Denmark, among 12 healthy volunteers 18 years or older. Analysis was based on intention to treat. All participants completed the study protocol.INTERVENTIONS Participants were each exposed to standardized skin preparation with curettage, microdermabrasion with abrasive pads, microneedling with dermarollers, ablative fractional laser (AFXL), non-AFXL, and no pretreatment, followed by 3 hours of methyl aminolevulinate hydrochloride incubation and subsequent red light illumination. MAIN OUTCOMES AND MEASURESThe primary outcome measure was methyl aminolevulinate-induced PPIX fluorescence accumulation. Secondary outcome measures were PPIX photobleaching and clinical local skin reactions, supported by noninvasive reflectance measurements of percentage of skin redness, transepidermal water loss, and participant-assessed pain.RESULTS Among the 12 healthy study participants (8 men; 4 women; mean [SD] age, 33 [15] years), histologic findings confirmed standardization of interventions with partial removal of the stratum corneum after curettage and microdermabrasion and similar vertical penetration depths for microneedling, AFXL, and non-AFXL (median, 125 μm). PPIX fluorescence reached highest intensities in skin pretreated with AFXL (median, 8661 arbitrary units [AU]) compared with microdermabrasion (median, 6731 AU), microneedling (median, 5609 AU), and curettage (median, 4765 AU) (P < .001), among which similar enhancement was shown. Comparatively lower fluorescence levels were demonstrated for skin pretreated with non-AFXL (median, 2898 AU), methyl aminolevulinate-treated controls (median, 2254 AU), and untreated controls (median, 239 AU) (P < .03). Increasing laser densities (2% vs 4% vs 6%) and the number of pretreatment passes (1, 2, and 3 passes) did not enhance PPIX fluorescence. Local skin reactions were most intensified in AFXL-pretreated skin and correlated with PPIX fluorescence and degree of PPIX photobleaching.CONCLUSIONS AND RELEVANCE Under standardized conditions, PPIX accumulation was most enhanced after AFXL pretreatment, followed by microdermabrasion, microneedling, and curettage. Increasing the number of pretreatment passes and laser densities did not further augment PPIX accumulation. These results may indicate relatively enhanced PDT response by AFXL pretreatment in diseased skin. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02372370

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Retrospective analysis evaluating the effect of a keratolytic and physical pretreatment with salicylic acid, urea and curettage on the efficacy and safety of photodynamic therapy of actinic keratoses with methylaminolaevulinate

Abstract: Keratolytic therapy with SA or UR is an effective pretreatment for PDT. However, it leads to an increase in pain during PDT and pronounced local reactions.

Cited by 16 publications

References 12 publications

Photodynamic Therapy and Non-Melanoma Skin Cancer

Photodynamic Therapy and Non-Melanoma Skin Cancer

The more the better? An appraisal of combination therapies for actinic keratosis

Comparison of Physical Pretreatment Regimens to Enhance Protoporphyrin IX Uptake in Photodynamic Therapy

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