Dermatology Department, Ramón y Cajal Hospital, Madrid, Spain.
Department of Pathology, Hospital Clinico San Carlos, E-28040 Madrid, Spain.
Photodiagnosis Photodyn Ther. 2019 Mar;25:136-141. doi: 10.1016/j.pdpdt.2018.11.018. Epub 2018 Nov 30.
Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent.
In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test.
In all patients we observed a global reduction in the number of AK lesions (71%; p < 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment.
PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.
日光光动力疗法（dlPDT）是一种无痛且日益具有成本效益的治疗光化性角化病（AK）的方法。新方案避免了孵育，最大程度地减少了疼痛和不良事件。但是，它耗时且依赖于特定的天气条件。在头皮 AK 患者中，我们评估了使用可穿戴式低水平光疗（LLLT）设备进行室内光动力疗法（PDT）的疗效，而无需预先用光敏剂孵育。
在这项初步研究中，27 例 AK 患者（Olsen 分级 I-II）在涂抹完甲氨基酮戊酸（MAL）乳膏后立即使用可穿戴帽状设备进行单次 15 分钟 LLLT 治疗，无需预先准备受影响的区域。通过测量 AK 病变数量的减少和 AK 生活质量（AKQoL）评分来量化治疗效果。所有 AK 病变均在基线进行了映射，以进行 2 个月后的随访。对 5 例患者的头皮活检进行了组织学和免疫组织化学分析（p53、p27、细胞周期蛋白 D1、p63 和 Ki67 的表达）。使用 Wilcoxon 符号秩检验分析数据。
所有患者的 AK 病变数量（71%；p<0.0001）和 AKQoL 评分（从 5.6 降至 4.4；p=0.034）在治疗后 2 个月均有显著降低。5 例患者的皮肤活检组织学和免疫组化分析也显示 LLLT 后有明显改善。治疗过程中没有患者报告有任何疼痛。
使用 LLLT 的 PDT 是一种快速、无痛且有效的治疗 AK 的方法。
