title: Results of an investigator-initiated single-blind split-face comparison of photodynamic therapy and 5% imiquimod cream for the treatment of actinic keratoses.
abstract: BACKGROUND
  Topical photodynamic therapy (PDT) with aminolevulinic acid (ALA) and 5% imiquimod cream are effective therapies for the treatment of actinic keratoses (AKs), but no split-face studies directly comparing these treatment options are available in the literature.
  
  
  OBJECTIVE
  To compare the efficacy and tolerability of ALA-PDT and imiquimod 5% cream for the treatment of AKs.
  
  
  RESULTS
  Sixty-one patients were enrolled from the Salt Lake City Veterans Affairs Hospital; 51 completed the study and were included in the analysis. All patients were randomized to receive half of a sachet of imiquimod 5% cream twice weekly on half of their face and two sessions of PDT with 20% solution of ALA applied for 1 hour to the other side of the face. The 75% AK clearance rate was 34.6% for ALA-PDT and 25% for imiquimod 5% cream (p = .30). The mean reduction in AK count was 59.2% for ALA-PDT and 41.4% for imiquimod 5% cream (p = .002). Dermatology Life Quality Index (DLQI) scores were assessed for each treatment modality at week 4 and were 1.95 and 1.38, respectively (p = .20).
  
  
  CONCLUSIONS
  The sample size was small, and patients applied a small amount of imiquimod 5% cream (half a sachet) to a large surface area.
  
  
  CONCLUSIONS
  There was no statistically significant difference in treatment response when the 100% or 75% clearance rate cutoff was used, but our secondary outcome suggests that two sessions of ALA-PDT is superior to imiquimod 5% cream for the treatment of AKs. There was no statistically significant difference in effect on quality of life as assessed using the DLQI.
authors.affiliation: McKay-Dee Dermatology, Ogden, Utah, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Hadley
authors.forename: Payam
authors.initials: P
authors.lastname: Tristani-Firouzi
authors.forename: Christopher
authors.initials: C
authors.lastname: Hull
authors.forename: Scott
authors.initials: S
authors.lastname: Florell
authors.forename: Murray
authors.initials: M
authors.lastname: Cotter
authors.forename: Michael
authors.initials: M
authors.lastname: Hadley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000627:therapeutic use; D000634:Aminoquinolines / Q000627:therapeutic use*; D005148:Facial Dermatoses / Q000188:drug therapy*; D006801:Humans; D000077271:Imiquimod; D007369:Interferon Inducers / Q000627:therapeutic use*; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D007369:Interferon Inducers; D000622:Aminolevulinic Acid; D000077271:Imiquimod