Department of Dermatology, The First People's Hospital of Lianyungang, Affiliated to Xuzhou Medical University, Lianyungang, China.
Department of Orthopedics, The First People's Hospital of Lianyungang, Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, China.
J Dermatolog Treat. 2022 Sep;33(6):2853-2857. doi: 10.1080/09546634.2022.2089325. Epub 2022 Jun 20.
The aim of this study was to accurately evaluate the efficacy of photodynamic therapy (PDT) on actinic keratosis (AK) in the Asian population and its relationship with preconditioning and dermoscopy grading, and to determine whether some dermoscopic features of AK can independently predict the response to PDT to optimize the choice of clinical treatment.
From January 2017 to January 2020, patients who were diagnosed as AK with only one lesion in our hospital were included in our study. PDT was performed after pretreatment with ablative fractional CO2 laser or cryotherapy. Logistic regression analysis was used to evaluate the characteristics of dermoscopy to determine the independent predictors of efficacy.
A total of 95 patients were enrolled in the study, and the final clinical evaluation was 92 cases (96.8%) as complete remission and 3 cases (3.2%) as partial remission/no response. Dermoscopy showed complete remission in 77 cases (81.1%) and partial remission/no response in 18 cases (18.9%). No significant difference was observed in the complete remission rate of dermoscopy grade 1 lesion after laser or cryotherapy pretreatment ( > 0.05), but for dermoscopy grade 2 and grade 3 lesions, the complete remission rate (dermoscopy evaluation) of the cryotherapy pretreatment group was higher than that of laser group ( < 0.05). The probability of complete remission with red pseudonetwork at the T0 time point increased by 3.8 times (odds ratio [OR] = 3.870,95%confidence interval [CI]:1.077-13.912, = 0.048), while the probability of complete response for lesions with slight erosion at the baseline decreased by 85% (OR = 0.150,95%CI:0.033-0.671, = 0.013).
For dermoscopy grade 2 and 3 lesions, PDT after pretreatment with cryotherapy is more effective. Dermoscopy pseudo-reticular structure and microscopic erosions were independent predictors of PDT efficacy. These findings may help clinicians to better select patients with AK for PDT.
本研究旨在准确评估光动力疗法（PDT）在亚洲人群中对光化性角化病（AK）的疗效及其与预处理和皮肤镜分级的关系，并确定 AK 的某些皮肤镜特征是否可以独立预测 PDT 的反应，从而优化临床治疗选择。
本研究纳入 2017 年 1 月至 2020 年 1 月期间在我院就诊的仅患有 1 处 AK 的患者。在使用消融性 CO2 激光或冷冻疗法进行预处理后，进行 PDT。使用逻辑回归分析评估皮肤镜特征，以确定疗效的独立预测因素。
共纳入 95 例患者，最终有 92 例（96.8%）患者获得完全缓解，3 例（3.2%）患者获得部分缓解/无反应。皮肤镜显示 77 例（81.1%）患者完全缓解，18 例（18.9%）患者部分缓解/无反应。激光或冷冻预处理后，1 级病变皮肤镜完全缓解率无显著差异（ > 0.05），但 2 级和 3 级病变中，冷冻预处理组的完全缓解率（皮肤镜评估）高于激光组（ < 0.05）。T0 时间点红色假性网络存在时完全缓解的概率增加了 3.8 倍（优势比[OR] = 3.870，95%置信区间[CI]：1.077-13.912， = 0.048），而基线时有轻微侵蚀的病变完全缓解的概率降低了 85%（OR = 0.150，95%CI：0.033-0.671， = 0.013）。
对于 2 级和 3 级病变，冷冻预处理后 PDT 更有效。皮肤镜伪网状结构和微小侵蚀是 PDT 疗效的独立预测因素。这些发现可能有助于临床医生更好地为 AK 患者选择 PDT。
