Alexiades-Armenakas Macrene R, Geronemus Roy G
Laser & Skin Surgery Center of New York, New York 10016, USA.
Arch Dermatol. 2003 Oct;139(10):1313-20. doi: 10.1001/archderm.139.10.1313.
To assess the safety and efficacy of the long-pulsed pulsed dye laser (LP PDL) (595 nm) with photodynamic therapy (PDT) for treatment of actinic keratoses (AKs).
Prospective, controlled study with 10-day and 2-, 4-,6-, and 8-month follow-ups.
Clinical research center. PATIENTS Volunteer sample of 41 patients (age range, 35-91 years; skin types I-III) with AKs.
Single treatment with application of topical 20% 5-aminolevulinic acid for 3 hours or 14 to 18 hours, followed by LP PDL irradiation at 595 nm. Controls received LP PDL irradiation alone.
Safety assessments, treatment and recovery times, and efficacy assessments, including patient mean percentage of lesions cleared and distribution of patients by percentage of lesions cleared for different anatomic sites.
We observed no to slight pain; slight to moderate erythema; no purpura, crusting, or scarring; treatment time of 1 lesion per second; and resolution of erythema by 7 to 14 days. The patient mean (95% confidence interval) percentage of head lesions (2620 lesions) cleared after 1 treatment was 99.47% (99.44%-99.50%) at 10 days, 98.19% (98.15%-98.23%) at 2 months, 92.94% (92.73%-93.14%) at 4 months, 91.65% (91.15%-92.15%) at 6 months, and 90.32% (78.10%-100%) at 8 months. For extremities (949 lesions), these were 83.1% (81.4%-84.9%) at 10 days, 75.5% (73.4-77.6) at 2 months, 70.9% (68.9%-72.8%) at 4 months, 92.0% (84.0%-100%) at 6 months, and 100% at 8 months. For trunk (53 lesions), these were 85% (74%-100%) at 10 days, 85% (74%-100%), and 65% (50%-80%) at 4 months. No difference in safety or efficacy was found between the 3-hour and 14- to 18-hour incubation times. In the laser-only control group, no decrease in lesions was observed. Among 31 patients with head lesions, 28 (90%) at 10 days, 19 (70%) at 2 months, 9 (47%) at 4 months, 5 (42%) at 6 months, and 5 (56%) at 8 months were completely (100%) clear following a single treatment. Skin biopsy specimens of nonresponding lesions demonstrated a high rate of squamous cell carcinoma and other non-AK neoplasms.
Treatment of AKs using LP PDL (595 nm) at nonpurpuric parameters following topical application of 5-aminolevulinic acid is safe and effective. The advantages may include minimal discomfort, rapid incubation treatment and recovery times, excellent posttreatment cosmesis, high efficacy rates with respect to head lesions, and practical applicability to large body surface areas.
评估长脉冲染料激光（LP PDL，595nm）联合光动力疗法（PDT）治疗光化性角化病（AK）的安全性和有效性。
前瞻性对照研究，随访10天以及2、4、6和8个月。
临床研究中心。
41例患有AK的患者（年龄范围35 - 91岁；皮肤类型I - III）的志愿者样本。
单次治疗，外用20%的5 - 氨基酮戊酸3小时或14至18小时，随后进行595nm的LP PDL照射。对照组仅接受LP PDL照射。
安全性评估、治疗和恢复时间以及有效性评估，包括患者病变清除的平均百分比以及不同解剖部位病变清除百分比的患者分布情况。
我们观察到无痛至轻微疼痛；轻微至中度红斑；无紫癜、结痂或瘢痕形成；每秒治疗1个病变；红斑在7至14天消退。单次治疗后，10天时头部病变（2620个病变）的患者平均（95%置信区间）清除百分比为99.47%（99.44% - 99.50%），2个月时为98.19%（98.15% - 98.23%），4个月时为92.94%（92.73% - 93.14%），6个月时为91.65%（91.15% - 92.15%），8个月时为90.32%（78.10% - 100%）。对于四肢（949个病变），这些百分比分别为10天时83.1%（81.4% - 84.9%），2个月时75.5%（73.4 - 77.6），4个月时70.9%（68.9% - 72.8%），6个月时92.0%（84.0% - 100%），8个月时100%。对于躯干（53个病变），10天时为85%（74% - 100%），4个月时为85%（74% - 100%），65%（50% - 80%）。3小时和14至18小时的孵育时间在安全性或有效性方面未发现差异。在仅接受激光治疗的对照组中，未观察到病变减少。在31例头部病变患者中，单次治疗后10天时28例（90%）、2个月时19例（70%）、4个月时9例（47%）、6个月时5例（42%）、8个月时5例（56%）完全（100%）清除。未反应病变的皮肤活检标本显示鳞状细胞癌和其他非AK肿瘤的发生率很高。
外用5 - 氨基酮戊酸后，以非紫癜参数使用LP PDL（595nm）治疗AK是安全有效的。其优点可能包括不适最小、孵育治疗和恢复时间短、治疗后美容效果好、头部病变的有效率高以及对大面积体表的实际适用性。
