title: Efficacy of ablative fractional laser-assisted photodynamic therapy with short-incubation time for the treatment of facial and scalp actinic keratosis: 12-month follow-up results of a randomized, prospective, comparative trial.
abstract: BACKGROUND
  Photodynamic therapy (PDT) using methyl aminolevulinate (MAL) is an effective first-line treatment for actinic keratosis (AK). Erbium:yttrium-aluminium-garnet (Er:YAG) ablative fractional laser-assisted MAL-PDT (AFL-PDT) has shown significant benefit for the treatment of AK.
  
  
  OBJECTIVE
  The objectives of this study were to compare the efficacy, recurrence rate, cosmetic outcome and safety between AFL-PDT with 2 and 3 h of incubation vs. Conventional MAL-PDT in patients with facial and scalp AK.
  
  
  METHODS
  This prospective randomized trial initially enrolled 440 facial and scalp AK lesions in 93 patients. Patients were randomly assigned to AFL-PDT with a 2-h incubation time (2h-AFL-PDT), 3h-AFL-PDT and 3h-MAL-PDT. All patients underwent one session of MAL-PDT using a red light-emitting diode lamp at 37 J/cm(2) , and AFL-PDT groups were assigned to pretreatment with Er:YAG AFL. Patients were followed up at 1 week, 3 months and 12 months post treatment. Efficacy, cosmetic outcomes and adverse events were assessed. Finally, 427 facial AK lesions in 88 patients were analysed in this study.
  
  
  RESULTS
  Three months after the last treatment session, 3h-AFL-PDT (91.7%) was significantly more effective than 2h-AFL-PDT (76.8%) and 3h-MAL-PDT (65.6%, P < 0.001), and differences in efficacy remained significant at the 12-month follow-up. The recurrence rate was significantly lower for 3h-AFL-PDT (7.5%) than for 3h-MAL-PDT (22.1%) at 12 months (P = 0.002);however, no significant difference was found between 2h-AFL-PDT and 3h-MAL-PDT. No significant difference was found in cosmetic outcomes or safety between the three groups.
  
  
  CONCLUSIONS
  We recommend 3h-AFL-PDT rather than classic MAL-PDT or short-incubation AFL-PDT for treating AK.
authors: Department of Dermatology, College of Medicine, Dong-A University, Busan, South Korea.
authors: S H
authors: SH
authors: Choi
authors: Department of Dermatology, College of Medicine, Dong-A University, Busan, South Korea.
authors: K H
authors: KH
authors: Kim
authors: Department of Dermatology, College of Medicine, Dong-A University, Busan, South Korea.
authors: K H
authors: KH
authors: Song
mesh_terms: D055011:Ablation Techniques / Q000379:methods; D000368:Aged; D062109:Dermatologic Surgical Procedures / Q000379:methods; D005148:Facial Dermatoses / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D010778:Photochemotherapy; D011446:Prospective Studies; D012536:Scalp Dermatoses / Q000188:drug therapy* / Q000601:surgery*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome