Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei 230022, Anhui, China; Department of Dermatology, Anhui Provincial Corps Hospital of Chinese People's Armed Police Forces, Hefei 230001, Anhui, China.
Department of Dermatology, Anhui Provincial Corps Hospital of Chinese People's Armed Police Forces, Hefei 230001, Anhui, China.
Photodiagnosis Photodyn Ther. 2023 Dec;44:103797. doi: 10.1016/j.pdpdt.2023.103797. Epub 2023 Sep 28.
Numerous clinical studies have demonstrated the effectiveness of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) in treating actinic keratosis (AK). This therapy has achieved an average lesion clearance rate of approximately 80 % and has also shown to produce satisfactory cosmetic outcomes. However, in our clinical practice, the utilization and adherence to ALA-PDT treatment among AK patients has been lower than anticipated, possibly due to various factors.
The objectives of this study are twofold: (1) To analyze the actual therapeutic effects of ALA-PDT treatment on AK lesions in clinical practice; and (2) To identify the factors that hinder acceptance of ALA-PDT therapy among AK patients with large area or multiple lesions situated on the head and face.
This study included a group of 20 AK patients, comprising 15 females and 5 males, with an age range of 57-87 years. All patients received a complete course of ALA-PDT therapy, consisting of 3-6 treatments. The study analyzed various factors, including the cure rate, recurrence rate, cosmetic effects, and adverse reactions following treatment. To investigate the factors affecting the acceptance of ALA-PDT treatment among AK patients with large or multiple lesions on the head and face, we also examined a separate group of 43 AK patients. This group included individuals who either had incomplete courses of ALA-PDT treatment or declined the therapy for the first time. The factors potentially influencing patients' acceptance of PDT were analyzed based on the outcomes of these investigations.
Among the 20 patients who completed the full course of ALA-PDT treatment, the cure rate was 95 % (19/20). The recurrence rates at 1 month, 3 months, and 6 months were 0 %, 5 %, and 10 %, respectively. Out of the 19 cured patients, only 2 experienced heavy pigmentation, and no scarring was reported 1-3 months post-treatment. Based on the survey of 43 patients who either had an incomplete course of ALA-PDT treatment or declined the therapy initially, several factors were identified as limiting their choice of PDT therapy. These factors include: (1) Intolerable adverse effects of treatment. (2) Higher treatment cost than expected. (3) Inconvenient transportation. (4) Coexistence of other senile diseases. (5) Unsatisfactory clinical efficacy observed. (6) Inadequate understanding of AK. (7) Lost to follow-up.
The study concludes that ALA-PDT is a beneficial and aesthetically pleasing treatment for AK patients, particularly those with extensive or multiple lesions on the head and face. However, various factors can impede the selection of ALA-PDT therapy, potentially depriving patients of the most suitable option. The study aims to assist dermatologists and AK patients in considering treatment plans and exploring alternative options. Overall, the findings of this study may provide valuable guidance for improving treatment outcomes and patient satisfaction.
许多临床研究已经证明 5-氨基酮戊酸（ALA）介导的光动力疗法（PDT）在治疗光化性角化病（AK）方面的有效性。这种疗法的平均病灶清除率约为 80%，并且已显示出令人满意的美容效果。然而，在我们的临床实践中，AK 患者对 ALA-PDT 治疗的应用和坚持率低于预期，这可能是由于多种因素造成的。
本研究的目的有两个：（1）分析 ALA-PDT 治疗 AK 病变的实际治疗效果；（2）确定阻碍 AK 患者接受大面积或头面部多发性病变的 ALA-PDT 治疗的因素。
本研究纳入了 20 例 AK 患者，其中女性 15 例，男性 5 例，年龄 57-87 岁。所有患者均接受了完整的 ALA-PDT 治疗疗程，包括 3-6 次治疗。研究分析了各种因素，包括治愈率、复发率、美容效果和治疗后的不良反应。为了研究影响头面部大面积或多发性 AK 患者接受 ALA-PDT 治疗的因素，我们还检查了另外 43 例 AK 患者。这些患者要么未完成 ALA-PDT 治疗疗程，要么首次拒绝治疗。根据这些调查结果，分析了可能影响患者接受 PDT 治疗的因素。
20 例完成完整 ALA-PDT 治疗疗程的患者中，治愈率为 95%（19/20）。1 个月、3 个月和 6 个月的复发率分别为 0%、5%和 10%。19 例治愈患者中仅有 2 例出现重度色素沉着，治疗后 1-3 个月无瘢痕形成。根据对 43 例未完成 ALA-PDT 治疗疗程或首次拒绝治疗的患者的调查，发现了一些限制他们选择 PDT 治疗的因素。这些因素包括：（1）治疗的不可耐受的不良反应；（2）治疗费用高于预期；（3）交通不便；（4）同时患有其他老年疾病；（5）临床疗效不佳；（6）对 AK 的认识不足；（7）失访。
本研究表明，ALA-PDT 是治疗 AK 患者的一种有益且美容效果良好的治疗方法，特别是头面部有广泛或多发性病变的患者。然而，各种因素可能会阻碍 ALA-PDT 治疗的选择，使患者可能无法选择最合适的治疗方案。本研究旨在帮助皮肤科医生和 AK 患者考虑治疗方案，并探索替代方案。总的来说，本研究的结果可能为改善治疗效果和患者满意度提供有价值的指导。
