title: Spanish-Portuguese consensus statement on use of daylight-mediated photodynamic therapy with methyl aminolevulinate in the treatment of actinic keratosis.
abstract: BACKGROUND
  Daylight-mediated photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in grade 1 and 2 actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol.
  
  
  OBJECTIVE
  We describe a protocol for the treatment of grade 1 and 2 actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries.
  
  
  METHODS
  Twelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol.
  
  
  RESULTS
  According to the recommendations adopted, patients with multiple grade 1 and 2 lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight-mediated PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours.
  
  
  CONCLUSIONS
  This consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight-mediated PDT with MAL in Spain and Portugal with minimal adverse effects.
authors.affiliation: Unidad de Dermatología, Hospital San Jorge, Huesca, España. Electronic address: ygilaberte@salud.aragon.es.
authors.forename: Y
authors.initials: Y
authors.lastname: Gilaberte
authors.affiliation: Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España.
authors.forename: M
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Servicio de Dermatología, Complejo Hospitalario Universitario, La Coruña, España.
authors.forename: M
authors.initials: M
authors.lastname: Almagro
authors.affiliation: Centro de Dermatología Epidermis, Instituto CUF, Oporto y Facultad de Medicina, Universidad de Oporto, Oporto, Portugal.
authors.forename: O
authors.initials: O
authors.lastname: Correia
authors.affiliation: Servicio de Dermatología, Instituto Valencia de Oncología, Valencia, España.
authors.forename: C
authors.initials: C
authors.lastname: Guillén
authors.affiliation: Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Harto
authors.affiliation: Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: Pérez-García
authors.affiliation: Servicio de Dermatología, Estructura Organizativa de Gestión Integrada (EOXI) de Vigo, Clínica Pérez & Gavín dermatólogos, Vigo, España.
authors.forename: L
authors.initials: L
authors.lastname: Pérez-Pérez
authors.affiliation: Servicio de Dermatología, Clínica Universitaria de Navarra, Pamplona, España.
authors.forename: P
authors.initials: P
authors.lastname: Redondo
authors.affiliation: Clínica Ruber y Clínica Dermatológica Internacional, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Sánchez-Carpintero
authors.affiliation: Servicio de Dermatología, Instituto Valencia de Oncología, Valencia, España.
authors.forename: C
authors.initials: C
authors.lastname: Serra-Guillén
authors.affiliation: Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España.
authors.forename: L M
authors.initials: LM
authors.lastname: Valladares
mesh_terms: D000622:Aminolevulinic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002985:Clinical Protocols; D006801:Humans; D055623:Keratosis, Actinic / Q000188:drug therapy*; D018579:Patient Selection; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011174:Portugal; D013030:Spain; D013472:Sunlight / Q000009:adverse effects; D013473:Sunscreening Agents / Q000627:therapeutic use; D013696:Temperature; D016896:Treatment Outcome
chemical_list: D017319:Photosensitizing Agents; D013473:Sunscreening Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid
keywords: Actinic keratosis; Daylight; Luz de día; Methyl aminolevulinate; Metil-aminolevulinato; Photodynamic therapy; Queratosis actínicas; Terapia fotodinámica