title: Polypodium leucotomos supplementation in the treatment of scalp actinic keratosis: could it improve the efficacy of photodynamic therapy?
abstract: BACKGROUND
  Actinic keratoses (AKs) are a common premalignant skin condition. Many treatments are available for AKs. Photodynamic therapy (PDT) is one of the most effective treatments. However, major concerns exist on the possibility of PDT-induced DNA-mutagenesis/immunosuppression, leading to AKs recurrence/treatment failure. An extract (PLE) from the fern polypodium leucotomos reduces UV-induced immunosuppression and mutagenesis.
  
  
  OBJECTIVE
  To assess the ability of PLE to enhance the efficacy of PDT treatment, reducing AKs recurrence on the scalp.
  
  
  METHODS
  Thirty-four bald patients presenting at least two AKs on the scalp were alternatively assigned to two groups. Both groups underwent two PDT-sessions one-week apart. The first group began oral PLE supplementation one week after the last PDT session. Evaluation of the effect of PLE supplementation was performed by direct inspection of the bald areas, lesions count, and photodynamic diagnosis assessment at 2 and 6 months.
  
  
  RESULTS
  Both groups were homogeneous in terms of skin phototype and previous UV exposure. Mean age was 75.7 ± 7.8 years and 76.5 ± 5.5 years, respectively. Both treatment modalities were successful in reducing AKs number (p < .001). However, PLE supplementation increased clearance rate compared with PDT alone (p = .040).
  
  
  CONCLUSIONS
  Polypodium leucotomos improves PDT clearance and decreases AK recurrence rate at 6 months, suggesting its use as a complementary agent in the treatment of field cancerization.
authors.affiliation: *Department of Medicine and Aging Science, Dermatologic Clinic, University "G. d'Annunzio," Chieti-Pescara, Italy; †Department of Experimental and Clinical Science, University "G. d'Annunzio," Chieti-Pescara, Italy; ‡Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; §Dermatology Service, Ramon y Cajal Hospital, Madrid, Spain; ‖Dermatologic Department, University of Padua, Padua, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Auriemma
authors.forename: Marta
authors.initials: M
authors.lastname: Di Nicola
authors.forename: Salvador
authors.initials: S
authors.lastname: Gonzalez
authors.forename: Stefano
authors.initials: S
authors.lastname: Piaserico
authors.forename: Alessandra
authors.initials: A
authors.lastname: Capo
authors.forename: Paolo
authors.initials: P
authors.lastname: Amerio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D032494:Polypodium / Q000737:chemistry*; D012008:Recurrence; D012536:Scalp Dermatoses / Q000188:drug therapy*
chemical_list: D017319:Photosensitizing Agents; D010936:Plant Extracts; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid