JAAD onlineA randomized pilot comparative study of topical methyl aminolevulinate photodynamic therapy versus imiquimod 5% versus sequential application of both therapies in immunocompetent patients with actinic keratosis: Clinical and histologic outcomes
Section snippets
Study population
Patients were prospectively recruited from the Dermatology Service of the Instituto Valenciano de Oncología (Valencia, Spain) and randomized to one of 3 groups according to their treatment options: group 1, PDT; group 2, imiquimod; and group 3, sequential application of PDT and imiquimod. Recruitment was from January 2009 until November 2010.
To be eligible for the study, patients had to have at least 5 nonhyperkeratotic AK or skin alterations indicating field cancerization in a 25-cm2 area of
Patient population
The study population comprised 136 patients, of whom 105 (92 men and 13 women) completed the study. The most common explanation for leaving the study was personal reasons (23 patients). Group 1 comprised 40 patients, group 2 comprised 33 patients, and group 3 comprised 32 patients. The 3 groups were matched with respect to age, sex, skin type, and number of AK before treatment (Table I).
Efficacy
The clinical response, histologic response, and clinicopathologic response of the 3 groups are shown in Table
Discussion
PDT and imiquimod are excellent treatments for AK, as they provide high response rates with good cosmetic results.2, 4 Both approaches have been well compared with other therapeutic options, especially 5-fluorouracil,7, 9, 11 cryotherapy,5, 9, 18 and diclofenac.10 The only study comparing PDT with imiquimod12 analyzed AK on the arms; therefore, conclusions cannot be drawn for AK on the face and scalp, which are the most common sites of these lesions. Our results showed imiquimod to be superior
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Sequential daylight photodynamic therapy and ingenol mebutate versus 2 sessions of daylight photodynamic therapy for the treatment of actinic keratosis: An observational, prospective, comparative study
2019, Photodiagnosis and Photodynamic TherapyCitation Excerpt :Most studies evaluating the potential synergistic effects of sequential treatment have been performed with conventional PDT. In AK patients, sequential treatment with MAL-PDT and imiquimod appears to produce a significantly better clinical and histologic response than either MAL-PDT or imiquimod alone [13], and less intense local reactions and better tolerance and satisfaction than imiquimod monotherapy. Our results obtained in patients treated with PDT followed by IM are in good agreement with those of Berman et al. [14], who evaluated the efficacy and tolerability of conventional ALA-PDT or IM with or without prior treatment with ALA-PDT in 24 healthy subjects with 4–8 clinically visible AK lesions in a discrete facial area of 25 cm2 (follow-up period, 71 days).
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Funding sources: None.
Conflicts of interest: None declared.