Wennberg Ann-Marie, Stenquist Bo, Stockfleth Eggert, Keohane Stephen, Lear John T, Jemec Gregor, Mork Cato, Christensen Eidi, Kapp Alexander, Solvsten Henrik, Talme Toomas, Berne Berit, Forschner Tobias
Department of Dermatology, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden.
Transplantation. 2008 Aug 15;86(3):423-9. doi: 10.1097/TP.0b013e318180731e.
Organ transplant recipients on long-term immunosuppressive therapy are at increased risk of non-melanoma skin lesions. Repeated field photodynamic therapy using topical methyl aminolevulinate (MAL) may have potential as a preventive treatment.
This open randomized, intrapatient, comparative, multicenter study included 81 transplant recipients with 889 lesions (90% actinic keratoses (AK)]. In each patient, the study treatment was initially administered to one 50 cm area on the face, scalp, neck, trunk, or extremities (n=476 lesions) twice (1 week apart), with additional single treatments at 3, 9, and 15 months. On each occasion, the area was debrided gently and MAL cream (160 mg/g) applied for 3 hr, before illumination with noncoherent red light (630 nm, 37 J/cm2). The control, 50 cm2 area (n=413 lesions) received lesion-specific treatment (83% cryotherapy) at baseline and 3, 9, and 15 months. Additionally, all visible lesions were given lesion-specific treatment 21 and 27 months in both treatment and control areas.
At 3 months, MAL photodynamic therapy significantly reduced the occurrence of new lesions (65 vs. 103 lesions in the control area; P=0.01), mainly AK (46% reduction; 43 vs. 80; P=0.006). This effect was not significant at 27 months (253 vs. 312; P=0.06). Hypopigmentation, as assessed by the investigator, was less evident in the treatment than control areas (16% vs. 51% of patients; P<0.001) at 27 months.
Our results suggest that repeated field photodynamic therapy using topical MAL may prevent new AK in transplant recipients although further studies are needed.
接受长期免疫抑制治疗的器官移植受者发生非黑色素瘤皮肤病变的风险增加。使用外用甲基氨基乙酰丙酸（MAL）进行重复的局部光动力疗法可能具有作为预防性治疗的潜力。
这项开放随机、患者内、比较、多中心研究纳入了81名移植受者，有889处病变（90%为光化性角化病（AK））。在每位患者中，研究治疗最初在面部、头皮、颈部、躯干或四肢的一个50平方厘米区域（n = 476处病变）进行两次（间隔1周），并在3、9和15个月时进行额外的单次治疗。每次治疗时，轻轻清创该区域，涂抹MAL乳膏（160 mg/g）3小时，然后用非相干红光（630 nm，37 J/cm²）照射。对照的50平方厘米区域（n = 413处病变）在基线以及3、9和15个月时接受针对病变的治疗（83%为冷冻疗法）。此外，在治疗区和对照区，所有可见病变在21和27个月时均接受针对病变的治疗。
在3个月时，MAL光动力疗法显著减少了新病变的发生（治疗区65处病变，对照区103处病变；P = 0.01）主要是AK（减少46%；43处对80处；P = 0.006）。在27个月时这种效果不显著（253处对312处；P = 0.06）。根据研究者评估，在27个月时，治疗区色素减退比对照区不明显（患者比例分别为16%和51%；P < 0.001）。
我们的结果表明，使用外用MAL进行重复的局部光动力疗法可能预防移植受者出现新的AK，尽管还需要进一步研究。
