TY - JOUR
T1 - Combination of ablative fractional laser and daylight mediated photodynamic therapy for actinic keratosis in organ transplant recipients - a randomized controlled trial
AU - Togsverd-Bo, K
AU - Lei, U
AU - Erlendsson, A M
AU - Taudorf, Elisabeth Hjardem
AU - Philipsen, P A
AU - Wulf, H C
AU - Skov, L
AU - Haedersdal, M
N1 - British Journal of Dermatology
Volume 172, Issue 2, pages 467–474, February 2015
PY - 2015
Y1 - 2015
N2 - BACKGROUND: Topical photodynamic therapy (PDT) for actinic keratoses (AK) is hampered by pain during illumination and inferior efficacy in organ-transplant recipients (OTR). We assessed ablative fractional laser (AFL)-assisted daylight photodynamic therapy (PDT) (AFL-dPDT) compared to daylight PDT (dPDT), conventional PDT (cPDT) and AFL alone (AFL) in field treatment of AK in OTR.MATERIALS AND METHODS: In each patient, four areas in the same region were randomized to one treatment with AFL-dPDT, dPDT, cPDT and AFL. AFL was delivered with a 2,940 nm ablative fractional laser at 2.3 mJ/pulse, 1.15W, two stacks, 50 microsecond pulse-duration, 2.4% density. In dPDT and AFL-dPDT, MAL was applied for 2½ hours without occlusion during daylight exposure. For cPDT, MAL occluded for 3 hours followed by red light (630 nm) irradiation at 37 J/cm(2) . Primary end-point was complete lesion-response (CR) 3 months post-treatment.RESULTS: 16 patients with 542 AK (grade I-III) in field-cancerized skin of the scalp, chest and extremities were treated August and September. After 3 months, CR (AK I-III) were 74% after AFL-dPDT, 46% after dPDT, 50% after cPDT and 5% after AFL (p<0.001). CR in AFL-dPDT, dPDT and cPDT were also significant different (p=0.004). Median maximal pain scores differed significantly during AFL-dPDT (0), dPDT (0), AFL (0) and cPDT (5) (p<0.001). Erythema and crusting were more intense following AFL-dPDT than dPDT and cPDT, but only transient hypopigmentation was observed.CONCLUSIONS: AFL-dPDT is a novel PDT modality that enhances CR with excellent tolerability compared to dPDT and cPDT in difficult-to-treat AK in OTR. This article is protected by copyright. All rights reserved.
AB - BACKGROUND: Topical photodynamic therapy (PDT) for actinic keratoses (AK) is hampered by pain during illumination and inferior efficacy in organ-transplant recipients (OTR). We assessed ablative fractional laser (AFL)-assisted daylight photodynamic therapy (PDT) (AFL-dPDT) compared to daylight PDT (dPDT), conventional PDT (cPDT) and AFL alone (AFL) in field treatment of AK in OTR.MATERIALS AND METHODS: In each patient, four areas in the same region were randomized to one treatment with AFL-dPDT, dPDT, cPDT and AFL. AFL was delivered with a 2,940 nm ablative fractional laser at 2.3 mJ/pulse, 1.15W, two stacks, 50 microsecond pulse-duration, 2.4% density. In dPDT and AFL-dPDT, MAL was applied for 2½ hours without occlusion during daylight exposure. For cPDT, MAL occluded for 3 hours followed by red light (630 nm) irradiation at 37 J/cm(2) . Primary end-point was complete lesion-response (CR) 3 months post-treatment.RESULTS: 16 patients with 542 AK (grade I-III) in field-cancerized skin of the scalp, chest and extremities were treated August and September. After 3 months, CR (AK I-III) were 74% after AFL-dPDT, 46% after dPDT, 50% after cPDT and 5% after AFL (p<0.001). CR in AFL-dPDT, dPDT and cPDT were also significant different (p=0.004). Median maximal pain scores differed significantly during AFL-dPDT (0), dPDT (0), AFL (0) and cPDT (5) (p<0.001). Erythema and crusting were more intense following AFL-dPDT than dPDT and cPDT, but only transient hypopigmentation was observed.CONCLUSIONS: AFL-dPDT is a novel PDT modality that enhances CR with excellent tolerability compared to dPDT and cPDT in difficult-to-treat AK in OTR. This article is protected by copyright. All rights reserved.
U2 - 10.1111/bjd.13222
DO - 10.1111/bjd.13222
M3 - Journal article
C2 - 24975199
SN - 0007-0963
VL - 172
SP - 467
EP - 474
JO - British Journal of Dermatology
JF - British Journal of Dermatology
IS - 2
ER -