Efficacy of 3 different light doses in the treatment of actinic keratosis with 5-aminolevulinic acid photodynamic therapy: a randomized, observer-blinded, intrapatient, comparison study.
BACKGROUND
Topical 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) has been established in recent years as an effective treatment for disseminated actinic keratosis (AK). As yet, however, data are lacking to define the optimal light dose for activation of ALA-induced protoporphyrin IX in AK.


OBJECTIVE
In the present study our purpose was to compare the efficacy and tolerability of 3 different doses of red light for ALA-PDT of AK.


METHODS
Twenty-seven patients with at least 3 clearly definable, mild or moderate AKs on the scalp or face entered the study. After occlusion for 4 hours with 20% ALA, one AK each was irradiated at random with a single dose of 70, 100, or 140 J/cm2. PDT-induced pain was assessed by the patients by means of a visual analog scale that graded pain intensity between 0 and 10. Follow-up examinations were performed 1 and 3 months after PDT.


RESULTS
One month after PDT, the rate of complete remission (CR) was 89% for 70 J/cm2, 92% for 100 J/cm2, and 81% for 140 J/cm2. The CR rates at 3 months were 81% for 70 J/cm2, 77% for 100 J/cm2, and 69% for 140 J/cm2. No significant difference in therapeutic efficacy was found among the 3 light doses at either 1 month (P = .36) or 3 months (P = .96) after PDT. The degree of PDT-induced pain during irradiation was substantial and not statistically different (P = .06) for all 3 light doses.


CONCLUSIONS
The conclusions from this study are limited by the small sample size and only apply to topical ALA-PDT.


CONCLUSIONS
Our results indicate that a red light dose of 70 J/cm2 may be sufficient for effective topical ALA-PDT of disseminated, mild to moderate AK on the face and scalp.
Radakovic-Fijan
Sonja
S
Division of Special and Environmental Dermatology, Medical University of Vienna, Vienna, Austria.
Blecha-Thalhammer
Ulrike
U
Kittler
Harald
H
Hönigsmann
Herbert
H
Tanew
Adrian
A
D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007642:Keratosis / Q000209:etiology*; D008297:Male; D010778:Photochemotherapy / Q000379:methods; D010787:Photosensitivity Disorders / Q000188:drug therapy*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D016037:Single-Blind Method
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid