Photodynamic therapy with methyl aminolevulinate for prevention of new skin lesions in transplant recipients: a randomized study.
BACKGROUND
Organ transplant recipients on long-term immunosuppressive therapy are at increased risk of non-melanoma skin lesions. Repeated field photodynamic therapy using topical methyl aminolevulinate (MAL) may have potential as a preventive treatment.


METHODS
This open randomized, intrapatient, comparative, multicenter study included 81 transplant recipients with 889 lesions (90% actinic keratoses (AK)]. In each patient, the study treatment was initially administered to one 50 cm area on the face, scalp, neck, trunk, or extremities (n=476 lesions) twice (1 week apart), with additional single treatments at 3, 9, and 15 months. On each occasion, the area was debrided gently and MAL cream (160 mg/g) applied for 3 hr, before illumination with noncoherent red light (630 nm, 37 J/cm2). The control, 50 cm2 area (n=413 lesions) received lesion-specific treatment (83% cryotherapy) at baseline and 3, 9, and 15 months. Additionally, all visible lesions were given lesion-specific treatment 21 and 27 months in both treatment and control areas.


RESULTS
At 3 months, MAL photodynamic therapy significantly reduced the occurrence of new lesions (65 vs. 103 lesions in the control area; P=0.01), mainly AK (46% reduction; 43 vs. 80; P=0.006). This effect was not significant at 27 months (253 vs. 312; P=0.06). Hypopigmentation, as assessed by the investigator, was less evident in the treatment than control areas (16% vs. 51% of patients; P<0.001) at 27 months.


CONCLUSIONS
Our results suggest that repeated field photodynamic therapy using topical MAL may prevent new AK in transplant recipients although further studies are needed.
Wennberg
Ann-Marie
AM
Department of Dermatology, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden. ann-marie.wennberg@vgregion.se
Stenquist
Bo
B
Stockfleth
Eggert
E
Keohane
Stephen
S
Lear
John T
JT
Jemec
Gregor
G
Mork
Cato
C
Christensen
Eidi
E
Kapp
Alexander
A
Solvsten
Henrik
H
Talme
Toomas
T
Berne
Berit
B
Forschner
Tobias
T
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017679:Cryotherapy; D005060:Europe; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007642:Keratosis / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D010778:Photochemotherapy / Q000009:adverse effects; D017319:Photosensitizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid