Wiegell Stine Regin, Fredman Gabriella, Andersen Flemming, Bjerring Peter, Paasch Uwe, Haedersdal Merete
Department of Dermatology, Copenhagen University Hospital Bispebjerg, Nielsine Nielsens Vej 9, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen NV, Denmark; Department of Dermatology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
Department of Dermatology, Copenhagen University Hospital Bispebjerg, Nielsine Nielsens Vej 9, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen NV, Denmark.
Photodiagnosis Photodyn Ther. 2025 Feb;51:104445. doi: 10.1016/j.pdpdt.2024.104445. Epub 2024 Dec 16.
Since recurrences and new AKs commonly are observed after treatment long-term effects of field-directed therapies for AKs are crucial. Thus, we evaluated the 6- and 12-month efficacy and satisfaction of sequential topical 5-fluorouracil (5-FU) and daylight PDT (dPDT) with dPDT alone.
In a randomized intra-individual study patients with multiple AKs in the face and scalp were treated with 4 % 5-fluorouracil cream twice daily for 7 days on one side of the scalp/face, followed by dPDT on both sides. Lesion clearance rate, lesion recurrence rate and number of new lesions were evaluated at 6- and 12-month after treatment.
58/60 completed 6-month and 55/60 completed 12-month follow-up. Pre-treatment with topical 5-FU improved the long-term efficacy of dPDT, especially for moderately thick AKs, with a lesion clearance of 72 % at 12-month compared to 48 % after dPDT alone (p = 0.017). The recurrence rate at 12-month was 15 % for combination treatment and 20 % for dPDT alone (0.042). Most patients were highly satisfied with both treatments.
Sequential treatment with short-term topical 5-FU followed by dPDT maintained a higher complete lesion clearance than dPDT alone at both 6- and 12-month follow-ups, with fewer new AKs developing after combination therapy.
由于在治疗后常观察到复发和新的光化性角化病（AK），因此光化性角化病的区域定向疗法的长期效果至关重要。因此，我们评估了序贯外用5-氟尿嘧啶（5-FU）和日光光动力疗法（dPDT）与单独使用dPDT的6个月和12个月疗效及满意度。
在一项随机个体内研究中，对面部和头皮有多个AK的患者，在头皮/面部一侧每日两次外用4% 5-氟尿嘧啶乳膏，共7天，然后双侧进行dPDT治疗。在治疗后6个月和12个月评估皮损清除率、皮损复发率和新皮损数量。
60例中有58例完成了6个月随访，60例中有55例完成了12个月随访。外用5-FU预处理提高了dPDT的长期疗效，尤其是对于中度厚度的AK，12个月时皮损清除率为72%，而单独使用dPDT后为48%（p = 0.017）。联合治疗12个月时的复发率为15%，单独使用dPDT为20%（p = 0.042）。大多数患者对两种治疗都高度满意。
在6个月和12个月随访时，短期外用5-FU后序贯dPDT治疗比单独使用dPDT能维持更高的皮损完全清除率，联合治疗后新发生的AK较少。
