Ablative Fractional Laser Enhances Artificial or Natural Daylight Photodynamic Therapy of Actinic Field Cancerization: A Randomized and Investigator-initiated Half-side Comparative Study
DOI:
https://doi.org/10.2340/actadv.v103.6579Keywords:
actinic keratosis, laser therapy, photochemotherapyAbstract
Artificial daylight photodynamic therapy is a near-painless treatment for actinic keratoses, which can be performed indoors using a controlled light dose. Daylight photodynamic therapy is approved only for treatment of grade I–II actinic keratoses. The aim of this study was to evaluate whether fractional laser pre-treatment improves the outcomes of daylight photodynamic therapy for actinic keratoses of all grades. In addition, the study compared the outcomes of artificial and natural daylight photodynamic therapy. This randomized single-blinded split-side comparative study included 60 patients with ≥ 2 actinic keratoses of the head. Fractional laser pre-treatment was assigned randomly for actinic keratoses on 1 side of the head and, subsequently, the entire treatment area was treated with artificial or natural daylight photodynamic therapy. Fractional laser-mediated daylight photodynamic therapy achieved significantly higher complete clearance (50.0% vs 30.3%, p = 0.04), partial clearance (78.6% vs 50.0%, p < 0.01) and lesion-specific clearance (86.2% vs 70.2%, p < 0.01) than daylight photodynamic therapy alone at the 6-month follow-up. No significant differences were found in the outcomes of artificial vs natural daylight photodynamic therapy or grade I lesions vs grade II–III lesions. Thus, fractional laser pre-treatment appears to significantly increase the efficacy of artificial and natural daylight photodynamic therapy, and to be suitable for treatment of actinic keratoses of all grades.
Downloads
References
Werner RN, Jacobs A, Rosumeck S, Erdmann R, Sporbeck B, Nast A. Methods and results report - evidence and consensus-based (s3) guidelines for the treatment of actinic keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum. J Eur Acad Dermatol Venereol 2015; 29: 1-66.
https://doi.org/10.1111/jdv.13179 DOI: https://doi.org/10.1111/jdv.13179
Morton CA, Wulf HC, Szeimies RM, Basset-Seguin N, Sotiriou E, Piaserico S, et al. Practical approach to the use of daylight photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: a European consensus. J Eur Acad Dermatol Venereol 2015; 29: 1718-1723.
https://doi.org/10.1111/jdv.12974 DOI: https://doi.org/10.1111/jdv.12974
Wiegell SR, Fabricius S, Gniadecka M, Stender IM, Berne B, Kroon S, et al. Daylight-mediated photodynamic therapy of moderate to thick actinic keratoses of the face and scalp: a randomized multicentre study: daylight-mediated PDT of moderate to thick actinic keratoses. Br J Dermatol 2012; 166: 1327-1332.
https://doi.org/10.1111/j.1365-2133.2012.10833.x DOI: https://doi.org/10.1111/j.1365-2133.2012.10833.x
Mordon S, Vignion-Dewalle AS, Thecua E, Vicentini C, Maire C, Deleporte P, et al. Can daylight-PDT be performed indoor? G Ital Dermatol E Venereol Organo Uff Soc Ital Dermatol E Sifilogr 2018; 153: 811-816.
https://doi.org/10.23736/S0392-0488.18.05907-2 DOI: https://doi.org/10.23736/S0392-0488.18.05907-2
Kellner C BS Hollstein S, Renhold U. Simulated-daylight photodynamic therapy with BF-200 aminolaevulinic acid for actinic keratosis: assessment of the efficacy and tolerability in a retrospective study. Br J Dermatol 2015; 172: 1132-1164.
https://doi.org/10.1111/bjd.13420 DOI: https://doi.org/10.1111/bjd.13420
O'Gorman SM, Clowry J, Manley M, McCavana J, Gray L, Kavanagh A, et al. Artificial white light vs daylight photodynamic therapy for actinic keratoses: a randomized clinical trial. JAMA Dermatol 2016; 152: 638.
https://doi.org/10.1001/jamadermatol.2015.5436 DOI: https://doi.org/10.1001/jamadermatol.2015.5436
von Dobbeler C, Schmitz L, Dicke K, Szeimies RM, Dirschka T. PDT with PPIX absorption peaks adjusted wavelengths: safety and efficacy of a new irradiation procedure for actinic keratoses on the head. Photodiagnosis Photodyn Ther 2019; 27: 198-202.
https://doi.org/10.1016/j.pdpdt.2019.05.015 DOI: https://doi.org/10.1016/j.pdpdt.2019.05.015
Maire C, Vignion-Dewalle AS, Cartier H, Mordon S. Artificial white light photodynamic therapy for actinic keratosis: a study of 38 patients in private office practice. J Eur Acad Dermatol Venereol 2020; 34: 165-167.
https://doi.org/10.1111/jdv.16112 DOI: https://doi.org/10.1111/jdv.16112
Haedersdal M, Sakamoto FH, Farinelli WA, Doukas AG, Tam J, Anderson RR. Pretreatment with ablative fractional laser changes kinetics and biodistribution of topical 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL). Lasers Surg Med 2014; 46: 462-469.
https://doi.org/10.1002/lsm.22259 DOI: https://doi.org/10.1002/lsm.22259
Bay C, Lerche CM, Ferrick B, Philipsen PA, Togsverd-Bo K, Haedersdal M. Comparison of physical pretreatment regimens to enhance protoporphyrin ix uptake in photodynamic therapy: a randomized clinical trial. JAMA Dermatol 2017; 153: 270.
https://doi.org/10.1001/jamadermatol.2016.5268 DOI: https://doi.org/10.1001/jamadermatol.2016.5268
Steeb T, Schlager JG, Kohl C, Ruzicka T, Heppt MV, Berking C. Laser-assisted photodynamic therapy for actinic keratosis: a systematic review and meta-analysis. J Am Acad Dermatol 2019; 80: 947-956.
https://doi.org/10.1016/j.jaad.2018.09.021 DOI: https://doi.org/10.1016/j.jaad.2018.09.021
Yoon J, Kim YC. Daylight photodynamic therapy with ablative carbon dioxide fractional laser for treating actinic keratosis in Asians: a case series. Photodiagnosis Photodyn Ther 2020; 31: 101905.
https://doi.org/10.1016/j.pdpdt.2020.101905 DOI: https://doi.org/10.1016/j.pdpdt.2020.101905
Paasch U, Said T. Treating field cancerization by ablative fractional laser and indoor daylight: assessment of efficacy and tolerability. J Drugs Dermatol 2020; 19: 425-427.
https://doi.org/10.36849/JDD.2020.4589 DOI: https://doi.org/10.36849/JDD.2020.4589
Wenande E, Phothong W, Bay C, Karmisholt KE, Haedersdal M, Togsverd-Bo K. Efficacy and safety of daylight photodynamic therapy after tailored pretreatment with ablative fractional laser or microdermabrasion: a randomized, side-by-side, single-blind trial in patients with actinic keratosis and large-area field cancerization. Br J Dermatol 2019; 180: 756-764.
https://doi.org/10.1111/bjd.17096 DOI: https://doi.org/10.1111/bjd.17096
Rizvi S, Veierød M, Mørk G, Helsing P, Gjersvik P. Ablative fractional laser-assisted daylight photodynamic therapy for actinic keratoses of the scalp and forehead in organ transplant recipients: a pilot study. Acta Derm Venereol 2019; 99: 1047-1048.
https://doi.org/10.2340/00015555-3274 DOI: https://doi.org/10.2340/00015555-3274
Togsverd-Bo K, Lei U, Erlendsson AM, Taudorf EH, Philipsen PA, Wulf HC, et al. Combination of ablative fractional laser and daylight-mediated photodynamic therapy for actinic keratosis in organ transplant recipients - a randomized controlled trial. Br J Dermatol 2015; 172: 467-474.
https://doi.org/10.1111/bjd.13222 DOI: https://doi.org/10.1111/bjd.13222
Lindholm V, Pitkänen S, Schröder M, Hahtola S, Sahi H, Halme H, et al. Pulsed dye laser-mediated photodynamic therapy is less effective than conventional photodynamic therapy for actinic field cancerization: a randomized half-side comparative study. Acta Derm Venereol 2021; 101: adv00404.
https://doi.org/10.2340/00015555-3754 DOI: https://doi.org/10.2340/00015555-3754
Olsen EA, Lisa Abernethy M, Kulp-Shorten C, Callen JP, Glazer SD, Huntley A, et al. A double-blind, vehicle-controlled study evaluating masoprocol cream in the treatment of actinic keratoses on the head and neck. J Am Acad Dermatol 1991; 24: 738-743.
https://doi.org/10.1016/0190-9622(91)70113-G DOI: https://doi.org/10.1016/0190-9622(91)70113-G
Braathen LR, Morton CA, Basset-Seguin N, Bissonnette R, Gerritsen MJP, Gilaberte Y, et al. Photodynamic therapy for skin field cancerization: an international consensus. International Society for Photodynamic Therapy in Dermatology: PDT for skin field cancerization. J Eur Acad Dermatol Venereol 2012; 26: 1063-1066.
https://doi.org/10.1111/j.1468-3083.2011.04432.x DOI: https://doi.org/10.1111/j.1468-3083.2011.04432.x
Dragieva G, Hafner J, Dummer R, Schmid-Grendelmeier P, Roos M, Prinz BM, et al. Topical photodynamic therapy in the treatment of actinic keratoses and Bowen's disease in transplant recipients. Transplantation 2004; 77: 115-21.
https://doi.org/10.1097/01.TP.0000107284.04969.5C DOI: https://doi.org/10.1097/01.TP.0000107284.04969.5C
Ibrahim O, Wenande E, Hogan S, Arndt KA, Haedersdal M, Dover JS. Challenges to laser-assisted drug delivery: applying theory to clinical practice. Lasers Surg Med 2018; 50: 20-27.
https://doi.org/10.1002/lsm.22769 DOI: https://doi.org/10.1002/lsm.22769
Published
How to Cite
License
Copyright (c) 2023 Vivian Lindholm, Mari Salmivuori, Sonja Hahtola, Kerttu Mäkelä, Sari Pitkänen, Kirsi Isoherranen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
