Methylaminolevulinic acid-based photodynamic therapy: the patient's view.
Topical photodynamic therapy (PDT) with methylaminolevulinate (MAL) for nonmelanomatous skin cancers (NMSC) has proven efficient and safe. Because pain and a phototoxic reaction (PTR) are frequent side effects, the ability to predict discomfort may improve the management of patient care. During a 3-month period, we enrolled 46 patients with a total of 120 precancerous actinic skin lesions or NMSCs. Patients were treated with MAL-PDT, and follow-up continued for 8 wk. PDT had no lasting side effects in 65% of the lesions, and nearly 90% healed. The most frequent adverse cosmetic effect was skin discoloration (26.7%). Scarring was observed more often on the nose (21%, 3 of 14 lesions). Women experienced erythema more often than men (24% vs. 6%). With approximately 80% of the lesions, the patient reported light or no PTR. The average patient-reported pain during irradiation was moderate (4.92 on a scale of 0 to 10). Pain was persistent in 45% of the cases, but it decreased rapidly thereafter (on average 1 d). Risk factors for a greater severity of pain were lesions on the scalp (average pain score: 6.62) and on the forehead (average: 7.00) and treatment over an extended area (average: 7.32). Treatment on the nose (average: 3.29) or on the thorax (average: 3.00) was less painful. The final level of satisfaction reported was good or very good by 90% of the patients. Based on our results, eligible patients can be individually identified and informed in advance about the likelihood of side effects, thereby improving their satisfaction.
Department of Dermatology, Bellinzona Regional Hospital, Bellinzona, Switzerland.
Michela Angela Maria
MA
Corti
Carlo
C
Mainetti
D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects*; D017060:Patient Satisfaction; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011230:Precancerous Conditions / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid