title: Daylight methyl-aminolevulinate photodynamic therapy versus ingenol mebutate for the treatment of actinic keratoses: an intraindividual comparative analysis.
abstract: Daylight-photodynamic therapy (D-PDT) and ingenol mebutate (IM) are novel therapies directed to actinic keratoses (AK). The purpose of our study was to compare effectiveness, tolerability, cosmetic outcome and patient preference of D-PDT versus IM in the treatment of grade I and II AK. Twenty-seven patients with AK on the face or scalp were enrolled. Each patient received, in a 25 cm(2) target area, D-PDT on right side and IM on left side. Overall 323 AK were treated. Both target areas achieved complete response in 40.47% of the cases and average AK clearance rate was similar for D-PDT and IM (p=0.74). In D-PDT areas mean grade II AK clearance rate was lower compared with that of grade I AK (p=0.015). In IM areas grade I and II AK average clearance rates were similar (p=0.28). At week 1 and month 1, mean local skin responses (LSR) score were higher in areas treated with IM. IM areas showed more severe pain and cosmetic sequelae. D-PDT had similar effectiveness to IM, even if IM demonstrated higher grade II AK clearance rate. Tolerability profile was superior for D-PDT in terms of LSR and pain. D-PDT was more cosmetically acceptable. Patients preferred D-PDT to IM in most cases.
authors.affiliation: Unit of Dermatology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Genovese
authors.affiliation: Dermatology Service, AUSL Lecce, Gagliano del Capo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Fai
authors.affiliation: Dermatology Service, AUSL Lecce, Gagliano del Capo, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Fai
authors.affiliation: Unit of Dermatology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Mavilia
authors.affiliation: Unit of Dermatology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Santo R
authors.initials: SR
authors.lastname: Mercuri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000622:Aminolevulinic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004224:Diterpenes / Q000009:adverse effects / Q000627:therapeutic use*; D005148:Facial Dermatoses / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D055623:Keratosis, Actinic / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010778:Photochemotherapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction; D012536:Scalp Dermatoses / Q000175:diagnosis / Q000188:drug therapy*; D013472:Sunlight / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C486592:3-ingenyl angelate; D003879:Dermatologic Agents; D004224:Diterpenes; D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid
keywords: actinic keratosis; daylight photodynamic therapy; field cancerization; ingenol mebutate; methyl-aminolevulinate