Treatment of actinic keratoses with sequential use of photodynamic therapy; and imiquimod 5% cream.
BACKGROUND
Field-directed therapies for actinic keratosis include photodynamic therapy and imiquimod.


OBJECTIVE
The author designed a randomized, vehicle-controlled, split-face study to explore the safety and efficacy of photodynamic therapy followed by imiquimod.


METHODS
The entire face of adults with > or =10 facial actinic keratoses were treated with photodynamic therapy with aminolevulinic acid 20% at baseline and at month 1. At month 2, imiquimod 5% cream was applied to one-half of the face and vehicle to the other half, 2-times-per-week for 16 weeks. Lesion counts were performed at baseline and months 1, 2, 3, 4, 6, and 12; and local skin reactions assessments at months 2, 3, 4, and 6.


RESULTS
Of 25 participants enrolled, 24 completed the study. Baseline median lesions were 23.5 and 21.5 for the imiquimod- and vehicle-treated sides, respectively. At month 12, median lesion reductions was 89.9% versus 74.5% (P=.0023), respectively. No subject discontinued for an adverse event. Severe local skin reactions occurring in the most participants were erythema (17%) and flaking/scaling/dryness (13%).


CONCLUSIONS
Photodynamic therapy followed by imiquimod was well tolerated and improved reduction of actinic keratoses.
Shaffelburg
Michael
M
Valley Professional Center, Kentville, Nova Scotia, Canada. mshaffelburg@accesswave.ca
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use*; D000287:Administration, Topical; D000368:Aged; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000077271:Imiquimod; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D010865:Pilot Projects
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D017319:Photosensitizing Agents; D000077271:Imiquimod