CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany.
Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany; Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany.
Photodiagnosis Photodyn Ther. 2021 Jun;34:102249. doi: 10.1016/j.pdpdt.2021.102249. Epub 2021 Mar 9.
A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment.
28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm, power 30 W, beam size 4-18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS).
Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0-2.4]) compared to baseline (5.3 [4-7.75]). Median reduction rate was 75.5 % (61.3 %-100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0-0), 0 (0-2) and 0 (0-2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]).
S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.
最近提出的协同光动力疗法方案（s-PDT）结合了常规光动力疗法和日光光动力疗法的优势，已被证明是治疗光化性角化病（AK）患者的有效且几乎无痛的治疗方法。本研究调查了额外的消融性分数 CO2 激光（AFXL）预处理的安全性和有效性。
28 例头部 AK 患者接受 5-氨基酮戊酸 s-PDT。AFXL 预处理采用以下参数：脉冲能量 8mJ，光斑密度 50 个/cm，功率 30W，光束尺寸 4-18mm。通过 AK 面积和严重程度指数（AKASI）和病变计数（LC）在治疗前和治疗后 3 个月进行评估。通过血压和脉搏测量监测安全性。通过使用视觉模拟量表（VAS）确定疼痛强度。
大多数患者（96.4%）在 PDT 后 3 个月（中位数 AKASI 1.6[0-2.4]）与基线（5.3[4-7.75]）相比，AKASI 显著降低（P<0.0001）。中位数降低率为 75.5%（61.3%-100%）。11 例患者（39.3%）达到 AKASI 100，3 例（10.7%）达到 AKASI 75，10 例（35.7%）达到 AKASI 50。治疗过程中血压和脉搏无明显变化。照射过程中疼痛的中位数 VAS 分别为 0（0-0）、0（0-2）和 0（0-2）。与无 AFXL 预处理的数据相比，本研究显示 AKASI 和 LC 降低率显著更高（75.5%比 63.7%[P=0.023]和 91.3%比 80.4%[P=0.043]）。
头部 AK 患者的 s-PDT 联合 AFXL 预处理代表了一种安全且几乎无痛的治疗方法，可提高治疗效果。
