title: Comparative Study of Photodynamic Therapy with Topical Methyl Aminolevulinate versus 5-Aminolevulinic Acid for Facial Actinic Keratosis with Long-Term Follow-Up.
abstract: BACKGROUND
  Few studies have compared the efficacy, cosmetic outcomes, and adverse events between 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate-PDT (MAL-PDT) for actinic keratoses (AKs) in Asian ethnic populations with dark-skin.
  
  
  OBJECTIVE
  We retrospectively compared the long-term efficacy, recurrence rates, cosmetic outcomes, and safety of ALA-PDT versus MAL-PDT for facial AKs in Koreans.
  
  
  METHODS
  A total of 222 facial AKs in 58 patients were included in this study. A total of 153 lesions (29 patients) were treated with 5-ALA, and 69 lesions (29 patients) with MAL. ALA and MAL creams were applied for 6 hours and 3 hours, respectively; the lesions were then illuminated with a halogen lamp at 150 J/cm(2) for ALA-PDT and a diode lamp at 37 J/cm(2) for MAL-PDT.
  
  
  RESULTS
  The complete response rates of ALA-PDT and MAL-PDT were 56.9% and 50.7%, respectively, with no significant difference at 12 months after treatment. No significant difference in recurrence rates was observed between the 2 PDT modalities at either 6 or 12 months after treatment. There was no significant difference in the cosmetic outcomes between the 2 treatment modalities at 12 months after PDT. However, ALA-PDT caused significantly more painful than MAL-PDT (p=0.005). The adverse events were mild to moderate, transient, and self-limiting for both modalities.
  
  
  CONCLUSIONS
  MAL-PDT was similar to ALA-PDT in terms of long-term efficacy, recurrence rates, cosmetic outcomes, and adverse events; however, it was a significantly less painful procedure than ALA-PDT in our study.
authors: Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea.
authors: Dong-Yeob
authors: DY
authors: Ko
authors: Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea.
authors: Ki-Ho
authors: KH
authors: Kim
authors: Department of Dermatology, College of Medicine, Dong-A University, Busan, Korea.
authors: Ki-Hoon
authors: KH
authors: Song
keywords: 5-aminolevulinic acid; Long-term efficacy; Methyl aminolevulinate; Multiple actinic keratoses; Photodynamic therapy