A trial of short incubation, broad-area photodynamic therapy for facial actinic keratoses and diffuse photodamage.
BACKGROUND
There is no completely satisfactory treatment for multiple actinic keratoses (AKs).


OBJECTIVE
To evaluate the efficacy of short incubation, broad-area application of delta-aminolevulinic acid followed by exposure to activating light-photodynamic therapy (delta-ALA/PDT) for treatment of AKs and background photodamage. The benefit of pretreatment with 40% urea cream to enhance penetration and the use of topical 3% lidocaine hydrochloride to decrease discomfort were also evaluated.


METHODS
Eighteen patients with at least 4 nonhypertrophic facial AKs and mild to moderate diffuse facial photodamage were enrolled in the study. For 7 days, 40% urea cream or vehicle was applied to half of the treatment area, and then delta-ALA was applied to the entire area for 1, 2, or 3 hours. Lidocaine hydrochloride (3%) or vehicle cream was also applied to the entire area 45 minutes before exposure to 10 J/cm(2) of blue light. Pain,phototoxic reactions, AK counts, and photodamage improvement were evaluated 1 day, 1 week, and 1 month after treatment in all patients and after 5 months in 10 patients.


RESULTS
All patients experienced mild to moderate discomfort during treatment and moderate phototoxic effects for 1 week. At 1 and 5 months there was significant reduction in AKs in all groups and significant improvement of several photodamage parameters. Different delta-ALA application times and pretreatment with urea cream or lidocaine had no significant effect on the results.


CONCLUSIONS
This delta-ALA/PDT protocol is safe and effective for AK treatment as well as for improving photodamage. Further studies with a larger cohort, longer follow-up, and histologic confirmation of the clinical data would be of value.
Touma
Dany
D
Department of Dermatology, Boston University School of Medicine, Boston, MA 02118-2394, USA.
Yaar
Mina
M
Whitehead
Sara
S
Konnikov
Nellie
N
Gilchrest
Barbara A
BA
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage; D005148:Facial Dermatoses / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007642:Keratosis / Q000188:drug therapy* / Q000209:etiology; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009824:Ointments; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D015595:Skin Aging / Q000187:drug effects*; D013472:Sunlight / Q000009:adverse effects*; D014508:Urea / Q000008:administration & dosage
D000779:Anesthetics, Local; D009824:Ointments; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; D014508:Urea; D008012:Lidocaine