title: Conventional vs. daylight methyl aminolevulinate photodynamic therapy for actinic keratosis of the face and scalp: an intra-patient, prospective, comparison study in Italy.
abstract: BACKGROUND
  Daylight photodynamic therapy (DL-PDT) with methyl aminolevulinate (MAL) is a simplified PDT procedure that was recently shown in a few trials to be effective for grade I actinic keratosis (AK), with improved tolerability and reduced time of clinical attendance as compared to conventional PDT (c-PDT).
  
  
  OBJECTIVE
  To evaluate the efficacy and tolerability of DL-PDT vs. c-PDT with MAL in the treatment of grade I AK on the face and scalp in Italy.
  
  
  METHODS
  Thirty-five patients with AKs on the face (n = 17) or scalp (n = 18) were prospectively enrolled in an intra-patient, left-right, prospective, comparison study between DL-PDT and c-PDT at a single centre between September and October 2013. Weather conditions and outdoor temperature during daylight exposure were recorded for each DL-PDT session. Pain was assessed after the PDT session and local adverse events 2 days after treatment. Lesion response rate was evaluated on both sides at 3 months. AKs with complete regression were followed until 6 months. Patient's preference for either treatment was recorded.
  
  
  RESULTS
  There was no difference in complete response (CR) rate of AK I at 3 months between DL-PDT and c-PDT (87% vs. 91%; RR = 0.96; P = 0.16). A lower CR rate was observed with DL-PDT than with c-PDT for AK II (36% vs. 61%; RR = 0.58, P = 0.06) and III (25% vs. 46%; RR = 0.50, P = 0.20). Recurrence rate at 6 months was slightly higher for cleared AK I after DL-PDT than after c-PDT (17% vs. 12%, RR = 1.50, P < 0.05). DL-PDT was associated with lower pain (ΔVAS = -2.2, P < 0.01) and reduced severity of local adverse events (ΔLSR = -1.4, P < 0.01) than c-PDT. Increasing outdoor temperature was associated with the efficacy of DL-PDT and the severity of adverse events. DL-PDT was preferred by 88% of the patients.
  
  
  CONCLUSIONS
  MAL DL-PDT showed similar efficacy to c-PDT in the treatment of AK I of the face/scalp but was less effective than c-PDT for AKs II and III. DL-PDT was better tolerated being associated with lower pain and occurrence of fewer adverse events. Clinical response to DL-PDT was significantly moderated by outdoor temperature, increasing at higher temperatures.
authors: Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
authors: M C
authors: MC
authors: Fargnoli
authors: Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
authors: A
authors: A
authors: Piccioni
authors: Department of Community and Clinical Sciences, University of Milan, Milan, Italy.
authors: L
authors: L
authors: Neri
authors: Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
authors: S
authors: S
authors: Tambone
authors: Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
authors: C
authors: C
authors: Pellegrini
authors: Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.
authors: K
authors: K
authors: Peris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005148:Facial Dermatoses / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007558:Italy; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012536:Scalp Dermatoses / Q000188:drug therapy*; D063465:Skin Cream; D013472:Sunlight; D013473:Sunscreening Agents / Q000008:administration & dosage; D013696:Temperature
chemical_list: D017319:Photosensitizing Agents; D013473:Sunscreening Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid