A randomized pilot comparative study of topical methyl aminolevulinate photodynamic therapy versus imiquimod 5% versus sequential application of both therapies in immunocompetent patients with actinic keratosis: clinical and histologic outcomes.
BACKGROUND
Photodynamic therapy (PDT) and imiquimod are the treatments of choice for actinic keratosis (AK). As they have different mechanisms of action, it seems reasonable to assume that applying both treatments sequentially would be efficacious.


OBJECTIVE
We sought to determine which of these therapeutic modalities provides a better clinical and histologic response in patients with AK and whether sequential use of both was more efficacious than each separately.


METHODS
Patients were randomly assigned to one treatment group: group 1, PDT only; group 2, imiquimod only; or group 3, sequential use of PDT and imiquimod. The primary outcome measure was complete clinical response. Partial clinical response was defined as a reduction of more than 75% in the initial number of lesions. A complete clinicopathologic response was defined as lack of evidence of AK in the biopsy specimen.


RESULTS
In all, 105 patients completed the study (group 1, 40 patients; group 2, 33 patients; group 3, 32 patients). Sequential application of PDT and imiquimod was more efficacious in all the outcome measures. More patients were satisfied with PDT than with the other two modalities (P = .003). No significant differences were observed among the 3 modalities and tolerance to treatment.


CONCLUSIONS
Only one cycle of imiquimod was administered. The follow-up period was brief.


CONCLUSIONS
Sequential application of PDT and imiquimod provides a significantly better clinical and histologic response in the treatment of AK than PDT or imiquimod monotherapy. It also produces less intense local reactions and better tolerance and satisfaction than imiquimod monotherapy.
Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain. cserraguillen@gmail.com
Carlos
C
Serra-Guillén
Eduardo
E
Nagore
Luis
L
Hueso
Victor
V
Traves
Francesc
F
Messeguer
Onofre
O
Sanmartín
Beatriz
B
Llombart
Celia
C
Requena
Rafael
R
Botella-Estrada
Carlos
C
Guillén
D000287:Administration, Topical; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000634:Aminoquinolines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D000077271:Imiquimod; D007121:Immunocompetence; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
D000634:Aminoquinolines; D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid; D000077271:Imiquimod