Kurwa H A, Yong-Gee S A, Seed P T, Markey A C, Barlow R J
Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, United Kingdom.
J Am Acad Dermatol. 1999 Sep;41(3 Pt 1):414-8. doi: 10.1016/s0190-9622(99)70114-3.
Photodynamic therapy (PDT) has not been compared with topical 5-fluorouracil (5-FU) in the treatment of epidermal dysplasia.
The purpose of this study was to assess the efficacy and tolerability of these two treatment modalities in 17 patients with actinic keratoses on the backs of the hands.
Each patient's right and left hands were randomized to receive either a 3-week course of topical 5-FU applied twice per day or PDT using topical 5-aminolevulinic acid (5-ALA) and then, after 4 hours, irradiation with an incoherent light source consisting of a 1200 W metal halogen lamp emitting red light (580 to 740 nm). Each hand randomized for PDT received 150 J/cm(2). The observed median fluence rate was 86 mW/cm(2) (interquartile range, 53 to 100 mW/cm(2)). All patients were reviewed at 1, 4, and 24 weeks after starting treatment.
Fourteen of 17 patients (82%) completed the study. The mean lesional area treated with topical 5-FU decreased from 1390 mm(2) (standard deviation [SD], 1130) to 297 mm(2) (SD, 209). This represents a mean reduction in lesional area of 70% (confidence interval [CI], 61%-80%). The mean lesional area treated with topical PDT decreased from 1322 mm(2) (SD, 1280) to 291 mm(2) (SD, 274), representing a mean reduction in lesional area of 73% (CI, 61%-84%). The reduction in lesional area elicited by the two treatment methods was similar (CI, -25% to 17%). There was no statistically significant difference between the treatment methods in overall symptom scores for pain and redness.
One treatment with PDT using topical 5-ALA appears to be as effective and well tolerated as 3 weeks of twice-daily topical 5-FU, a cheap and widely available alternative.
光动力疗法（PDT）尚未与外用5-氟尿嘧啶（5-FU）在治疗表皮发育异常方面进行比较。
本研究旨在评估这两种治疗方式对17例手部背部光化性角化病患者的疗效和耐受性。
将每位患者的右手和左手随机分组，分别接受为期3周、每天两次外用5-FU的治疗，或使用外用5-氨基酮戊酸（5-ALA）进行光动力疗法，然后在4小时后，用由发射红光（580至740nm）的1200W金属卤化物灯组成的非相干光源进行照射。随机接受光动力疗法的每只手接受150J/cm²的照射。观察到的中位光通量率为86mW/cm²（四分位间距，53至100mW/cm²）。所有患者在开始治疗后的1、4和24周接受复查。
17例患者中有14例（82%）完成了研究。外用5-FU治疗的平均皮损面积从1390mm²（标准差[SD]，1130）降至297mm²（SD，209）。这代表皮损面积平均减少了70%（置信区间[CI]，61%-80%）。外用光动力疗法治疗的平均皮损面积从1322mm²（SD，1280）降至291mm²（SD，274），代表皮损面积平均减少了73%（CI，61%-84%）。两种治疗方法引起的皮损面积减少相似（CI，-25%至17%）。在疼痛和发红的总体症状评分方面，两种治疗方法之间没有统计学上的显著差异。
使用外用5-ALA进行一次光动力疗法似乎与每日两次外用5-FU治疗3周一样有效且耐受性良好，后者是一种便宜且广泛可用的替代方法。
