Dermatology Department, Hospital Ramón y Cajal, Madrid, Spain.
J Eur Acad Dermatol Venereol. 2019 Aug;33(8):1529-1534. doi: 10.1111/jdv.15566. Epub 2019 Apr 15.
Conventional photodynamic therapy (PDT) with methylaminolevulinic acid (MAL) and daylight PDT have demonstrated similar efficacy in the treatment of actinic keratosis (AK). The reason for the use of daylight is to reduce pain during illumination but daylight has the limitation of the weather conditions. The difference in the doses of red light applied between these two methods suggests that an intermediate dose with red light conventional illumination could be effective in PDT of AK.
To compare the efficiency of conventional MAL-PDT with half-time conventional red light illumination in patients with multiple AK.
Adult patients with more than five symmetrically distributed AK were selected. After randomization, one area was treated with conventional PDT (Aktilite , 630 nm, 37 J/cm , 8 min), while the contralateral was illuminated half time (Aktilite , 630 nm, 37 J/cm , 4 min). Patients evaluated pain in each different side. Patients were evaluated at baseline, 3 and 6 months after PDT treatment by a blinded dermatologist. A questionnaire to be done at home 24 h after completing treatment was deliver to the patients to evaluate any side-effects.
A total of 774 lesions were treated, 385 with conventional PDT and 389 with half-time PDT (P > 0.05). Conventional PDT was 85% of complete response of AK (327/385) at 3 months, and half-time PDT was 82% (319/389). At 6 months, conventional PDT was 70% (268/385) of complete response and half-time PDT was 65% (252/389). Pain during illumination was significantly lower in the VAS with the half-time protocol with a mean of 5.59 (SD 1.48) vs. 6.41 (SD 1.66) in conventional PDT. No difference in adverse effects was found between protocols.
Conventional PDT with half-time illumination in multiple actinic keratosis is as effective as complete time illumination and decreased pain significantly.
传统的光动力疗法（PDT）使用 5-氨基酮戊酸（MAL）和日光 PDT 已被证明在治疗光化性角化病（AK）方面具有相似的疗效。使用日光的原因是为了减轻光照时的疼痛，但日光有天气条件的限制。这两种方法应用的红光剂量不同，这表明中剂量的红光常规照射可能对 AK 的 PDT 有效。
比较传统 MAL-PDT 与半时间常规红光照射在多发性 AK 患者中的疗效。
选择超过 5 个对称分布的 AK 的成年患者。随机分组后，一侧用传统 PDT（Aktilite，630nm，37J/cm，8min）治疗，对侧用半时间光照（Aktilite，630nm，37J/cm，4min）。患者评估不同侧的疼痛。治疗后 3 个月和 6 个月由一位盲法皮肤科医生对患者进行评估。在完成治疗后 24 小时内，患者会收到一份在家完成的调查问卷，以评估任何副作用。
共治疗 774 个病变，385 个用传统 PDT，389 个用半时间 PDT（P＞0.05）。传统 PDT 在 3 个月时 AK 的完全缓解率为 85%（327/385），半时间 PDT 为 82%（319/389）。6 个月时，传统 PDT 的完全缓解率为 70%（268/385），半时间 PDT 为 65%（252/389）。半时间方案的 VAS 疼痛评分明显低于传统 PDT，平均为 5.59（SD 1.48）比 6.41（SD 1.66）。两种方案的不良反应无差异。
多发性光化性角化病的半时间传统 PDT 与全时间光照一样有效，且显著减轻疼痛。
