title: Effective combination of photodynamic therapy and imiquimod 5% cream in the treatment of actinic keratoses: three cases.
abstract: BACKGROUND
  The therapy for actinic keratoses includes photodynamic therapy (PDT) and imiquimod 5% cream. The sequential use of both could result in better clinical outcomes.
  
  
  OBJECTIVE
  To enhance efficacy of therapies while improving tolerability, convenience, and patient adherence with a scheme combining two concomitant or sequential AK treatments.
  
  
  METHODS
  All patients underwent one session of conventional PDT. Two weeks after, the PDT imiquimod 5% cream was applied to the treatment area once daily for three days per week. One course continued for four weeks followed by a clinical evaluation and decision about further treatment. Patients who had not cleared all of their AK lesions in the treatment area in course 1 participated in a second 4-week course of treatment. Limitations. Small size of population.
  
  
  RESULTS
  Three participants were enrolled. Two patients showed complete clinical clearance of AKs. The effect was also noted after long-term followup, at months seven and eleven. No subject discontinued for an adverse event. There were severe local skin reactions in two participants which were severe erythema, scaling, and crusting. One patient showed no response to the therapy.
  
  
  CONCLUSIONS
  Photodynamic therapy followed by imiquimod was well tolerated and improved reduction of actinic keratoses. This initial proof-of-concept should be studied in larger clinical trials.
authors.affiliation: Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, 72076 Tübingen, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Held
authors.forename: Thomas Kurt
authors.initials: TK
authors.lastname: Eigentler
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
authors.forename: Mark-Jürgen
authors.initials: MJ
authors.lastname: Berneburg
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D000077271:Imiquimod; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009824:Ointments; D012867:Skin / Q000473:pathology*; D013997:Time Factors
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D009824:Ointments; D000077271:Imiquimod