A randomized, half-side comparative study of aminolaevulinate photodynamic therapy vs. CO(2)  laser ablation in immunocompetent patients with multiple actinic keratoses.
BACKGROUND
Photodynamic therapy (PDT) and laser ablation (LA) are frequently used treatment options for multiple actinic keratoses (AK), yet they have not been compared head to head.


OBJECTIVE
To compare PDT and carbon dioxide (CO(2) ) LA in the management of multiple AK using objective and subjective outcome measures.


METHODS
A single-centre, randomized, two-treatment half-side comparative study of PDT vs. CO(2) LA was performed. Patients with at least four bilateral (e.g., scalp, forearms) AK were included. The primary outcome measure was the reduction of AK 3 months (v3) after therapy. Secondary outcome measures included the reduction of AK 4 weeks (v2) after therapy, decrease of epidermal p53 and Ki-67 protein expression, micromorphological changes as assessed by optical coherence tomography (OCT) in vivo, and investigators' and patients' satisfaction scoring.


RESULTS
In total, 20 patients (18 men and 2 women) completed the study. Both treatments reduced AK quantity significantly. On v3, relative reduction of AK quantity was significantly higher following PDT (P = 0·0362). Ki-67 and p53 protein expression was reduced significantly from baseline (Ki-67, median 49·5%; p53, median 64·8%) to v2 by both procedures (PDT, median 18·5%, P < 0·0001; LA, median 16·2%, P < 0·0001). AK features as assessed by OCT imaging were also significantly reduced by both procedures. The investigators and patients rated the side-effects and inconveniences of PDT as more severe, but both overall preferred PDT due to the superior clinical outcome.


CONCLUSIONS
CO(2) LA and PDT are both effective therapy options for multiple AK, yet PDT seems to be superior in terms of AK reduction and participants' and investigators' overall satisfaction.
Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany. n.scola@klinikum-bochum.de
N
N
Scola
S
S
Terras
D
D
Georgas
N
N
Othlinghaus
R
R
Matip
I
I
Pantelaki
K
K
Möllenhoff
M
M
Stücker
P
P
Altmeyer
A
A
Kreuter
T
T
Gambichler
D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D004817:Epidermis / Q000378:metabolism; D005260:Female; D006801:Humans; D055623:Keratosis, Actinic / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D019394:Ki-67 Antigen / Q000378:metabolism; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
D019394:Ki-67 Antigen; D017319:Photosensitizing Agents; D016159:Tumor Suppressor Protein p53; D000622:Aminolevulinic Acid