title: Intraindividual, right-left comparison of topical 5-aminolevulinic acid photodynamic therapy vs. 5% imiquimod cream for actinic keratoses on the upper extremities.
abstract: BACKGROUND
  Actinic keratoses (AKs) are considered as in situ squamous cell carcinoma. Early and effective treatment is important. Objective To compare the efficacy, cosmetic outcome and patient preference of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) with that of 5% imiquimod (IMIQ) cream in patients with AKs on the dorsa of hands and forearms.
  
  
  METHODS
  Subjects received two ALA-PDT treatment sessions and one or two courses of imiquimod (three times per week for 4 weeks each). Treatments were randomly allocated to alternate upper extremities. Assessments included lesion response one and six months after treatment, cosmetic outcome evaluated by the investigators and patients' preference 6 months after treatment. Efficacy end point included the individual AK lesion clearance rate.
  
  
  RESULTS
  Thirty patients with 256 lesions were included in the study. At the first follow-up, treatment with ALA-PDT resulted in significantly larger rate of cured lesions relative to 5% IMIQ cream (70.16% vs. 18.26%). At the second follow-up both treatments showed a high rate of cured lesions (65.32% for PDT vs. 55.65% for IMIQ cream). Response rates obtained in grade I lesions were higher for both treatments (71.64% for PDT vs. 72.13% for IMIQ), while treatment with PDT resulted in a significant larger rate of cured grade II lesions (57.89% for PDT vs. 37.03 for IMIQ). Difference in cosmetic outcome was not statistically significant. Results for subject preference favoured ALA-PDT.
  
  
  CONCLUSIONS
  Our study shows that ALA-PDT and 5% IMIQ cream are both attractive treatment options for upper extremities AKs with comparable efficacy and cosmetic outcomes.
authors.affiliation: 1st Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. elenasotiriou@yahoo.gr
authors.forename: E
authors.initials: E
authors.lastname: Sotiriou
authors.forename: Z
authors.initials: Z
authors.lastname: Apalla
authors.forename: F
authors.initials: F
authors.lastname: Maliamani
authors.forename: N
authors.initials: N
authors.lastname: Zaparas
authors.forename: D
authors.initials: D
authors.lastname: Panagiotidou
authors.forename: D
authors.initials: D
authors.lastname: Ioannides
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000634:Aminoquinolines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D000077271:Imiquimod; D007369:Interferon Inducers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D017060:Patient Satisfaction; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D034941:Upper Extremity
chemical_list: D000634:Aminoquinolines; D007369:Interferon Inducers; D009824:Ointments; D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid; D000077271:Imiquimod