Daylight versus conventional photodynamic therapy for the treatment of actinic keratosis: A meta-analysis of randomized controlled trials.

Daylight photodynamic therapy (dPDT) is suggested to be effective for actinic keratosis (AK). We performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of dPDT versus conventional photodynamic therapy (cPDT) in patients with AK. Relevant studies were identified through a systematic search of PubMed, Embase, and the Cochrane Library. A fixed or random effect model was applied, depending on the heterogeneity. Six RCTs with 369 patients with 5,556 AK lesions that were undergoing dPDT or cPDT with red light and methyl aminolevulinate (MAL) were included. Overall, the incidence of complete response (CR) was not significantly different between the two groups (risk ratio [RR]: 0.93, p = 0.07). Subgroup analyses indicated that dPDT was non-inferior to cPDT for CR in studies only included grade III AK lesions (RR: 0.97, p = 0.41), but less effective for CR in studies which also included grade III lesions (RR = 0.87, p < 0.001). Subsequent meta-analyses showed that dPDT was associated with a significantly reduced maximal pain score (mean difference = -4.51, p < 0.001) and a lower risk of adverse events (RR = 0.70, p < 0.001) as compared with cPDT. These results suggested although dPDT was better tolerated, the treatment efficacy of dPDT is non-inferior to cPDT with red light and MAL only in grade III AK lesions. The relative therapeutic efficacy of dPDT in AK of grade III lesions in comparison with cPDT should be further evaluated.