Borgia Francesco, Riso Gabriella, Catalano Fabio, Coppola Marialorena, Giuffrida Roberta, Cannavò Serafinella Patrizia
Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, 98125, Italy.
Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, 98125, Italy.
Photodiagnosis Photodyn Ther. 2020 Sep;31:101803. doi: 10.1016/j.pdpdt.2020.101803. Epub 2020 May 8.
photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is a well described and widely practiced treatment for actinic keratoses (AKs) on the head and face. Less is known about its use for AKs on upper extremities, which can be challenging for the dermatologist. The aim of our study was to compare the combination of topical tacalcitol before 5-ALA-PDT vs conventional 5-ALA-PDT for acral AKs in a prospective, randomized, intra-individual clinical study.
patients with AKs of both upper extremities underwent keratolytic pretreatment with topical tacalcitol on the back of one hand and/or forearm (right vs left), randomly selected, for fifteen consecutive days before PDT. All patients underwent one session of 5-ALA-PDT. Visual analog scale for pain was assessed immediately after PDT session and any side effects were recorded after 3 days. Efficacy was evaluated with lesion count (LC) prior to treatment (V0) and 90 days (V1) after PDT.
twenty-one patients with multiple acral AKs were enrolled and completed the study. At V1, neoadjuvant combination of topical tacalcitol plus PDT was significantly more effective than PDT alone (percentage reduction in total lesion count was 44.4 %. There was no significant difference in VAS pain score between the two treatment modalities. Mild erythema was the only local side effect reported for both treatment regimens (52.4 %, tacalcitol plus PDT vs 42.9 %, PDT alone).
neoadjuvant use of topical tacalcitol might be useful to improve PDT efficacy, especially in hard-to-treat AKs on extremities.
外用5-氨基酮戊酸（ALA）进行光动力疗法（PDT）是一种针对头面部光化性角化病（AK）的已被充分描述且广泛应用的治疗方法。对于上肢AK的治疗，人们了解较少，这对皮肤科医生来说可能具有挑战性。我们研究的目的是在一项前瞻性、随机、个体内临床研究中，比较5-ALA-PDT前外用他卡西醇与传统5-ALA-PDT治疗肢端AK的效果。
双上肢患有AK的患者在PDT前连续15天，随机选择一只手的背部和/或前臂（右手或左手）外用他卡西醇进行角质溶解预处理。所有患者均接受一次5-ALA-PDT治疗。在PDT治疗后立即评估疼痛视觉模拟量表，并在3天后记录任何副作用。在治疗前（V0）和PDT后90天（V1）用病损计数（LC）评估疗效。
21例患有多处肢端AK的患者入组并完成研究。在V1时，外用他卡西醇加PDT的新辅助联合治疗比单独使用PDT显著更有效（总病损计数减少百分比为44.4%）。两种治疗方式在VAS疼痛评分上无显著差异。两种治疗方案报告的唯一局部副作用均为轻度红斑（他卡西醇加PDT为52.4%，单独使用PDT为42.9%）。
外用他卡西醇的新辅助使用可能有助于提高PDT疗效，尤其是在治疗四肢难治性AK时。
