Photodynamic therapy for actinic keratosis followed by 5-fluorouracil reaction.
BACKGROUND
Actinic or solar keratoses are the earliest form of cancerous lesions that are found in sun-exposed areas of the body. Treatment involves eliminating the lesions before they have a chance to progress. Mainstay therapies include curettage, cryosurgery, and topical 5-fluorouracil. A recently Food and Drug Administration-approved regime using photodynamic therapy has also been employed since 2000.


OBJECTIVE
To inform physicians of the efficacy and potential inefficiency of this procedure, enabling the assessment of proper placement in the armamentarium.


METHODS
This patient underwent photodynamic therapy. She was challenged with 5-fluorouracil 5 weeks after photodynamic treatment.


RESULTS
The patient responded well to the photodynamic therapy and also to the challenge with the 5-fluorouracil.


CONCLUSIONS
Did the photodynamic treatment really destroy lesions significantly? What is the mechanism for the response to 5-fluorouracil after such a short period between treatment modalities? If 33% of patients treated with photodynamic therapy require retreatment in 8 weeks, is this modality cost-effective, and what is its place in treating patients? How should this new treatment be implemented in practice? These questions must be seriously assessed.
Marcus
LindaSusan
L
physderm@aol.com
D000622:Aminolevulinic Acid / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D004643:Emollients; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D007642:Keratosis / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000209:etiology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D014466:Ultraviolet Rays / Q000009:adverse effects*
D000964:Antimetabolites, Antineoplastic; D004643:Emollients; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; D005472:Fluorouracil