title: A trial of short incubation, broad-area photodynamic therapy for facial actinic keratoses and diffuse photodamage.
abstract: 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.
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, MA 02118-2394, USA.
authors.forename: Dany
authors.initials: D
authors.lastname: Touma
authors.forename: Mina
authors.initials: M
authors.lastname: Yaar
authors.forename: Sara
authors.initials: S
authors.lastname: Whitehead
authors.forename: Nellie
authors.initials: N
authors.lastname: Konnikov
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gilchrest
mesh_terms: 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
chemical_list: D000779:Anesthetics, Local; D009824:Ointments; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; D014508:Urea; D008012:Lidocaine