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A randomized split‐scalp study comparing calcipotriol‐assisted methyl aminolaevulinate photodynamic therapy (MAL‐PDT) with conventional MAL‐PDT for the treatment of actinic keratosis.
- Source :
- British Journal of Dermatology; Oct2018, Vol. 179 Issue 4, p829-835, 7p
- Publication Year :
- 2018
-
Abstract
- Summary: Background: Topical photodynamic therapy (PDT) is an approved treatment for actinic keratosis (AK). To enhance the efficacy of PDT for AKs, physical and chemical pretreatments have been suggested. Objectives: To compare the efficacy and safety of the combination of topical calcipotriol (CAL) before methyl aminolaevulinate (MAL)‐PDT for AKs of the scalp vs. conventional MAL‐PDT in a randomized controlled clinical trial. Methods: Twenty patients with multiple AKs on the scalp were randomized to receive conventional MAL‐PDT with previous curettage on one side of the scalp and CAL‐assisted MAL‐PDT once a day for 15 days before illumination on the other side. After 3 months, patients were evaluated for clearance of AKs, side‐effects and histopathology before and after the procedure. Protoporphyrin IX (PpIX) fluorescence was measured before and after illumination on both sides. Results: All 20 patients completed the study. Overall AK clearance rates were 92·1% and 82·0% for CAL‐PDT and conventional PDT, respectively (P < 0·001). Grade 1 AKs showed similar response rates for both sides (P = 0·055). However, grade II AKs showed more improvement on the CAL‐PDT side (90%) than on the MAL‐PDT side (63%) (P < 0·001). Before illumination, PpIX fluorescence intensity was higher on the CAL‐assisted side (P = 0·048). The treatment was more painful on the CAL‐PDT side, although well tolerated. The mean visual analogue scale score was 5·4 ± 1·4 on the CAL‐PDT side and 4·0 ± 0·69 on the conventional MAL‐PDT side (P = 0·001). Side‐effects such as erythema (P = 0·019), oedema (P = 0·002) and crusts (P < 0·001) were more pronounced on the CAL‐assisted side. Histopathological analyses were obtained from five patients and both sides showed improved keratinocyte atypia following PDT, with slightly more improvement on the CAL‐assisted side. Conclusions: CAL‐assisted PDT proved to be safe and more effective than conventional MAL‐PDT for the treatment of AKs on the scalp. CAL pretreatment increased PpIX accumulation within the skin and may have enhanced the efficacy in this first human trial. What's already known about this topic? Topical vitamin D pretreatment enhances methyl aminolaevulinate (MAL)‐induced protoporphyrin IX (PpIX) in hairless mice.Topical vitamin D prior to aminolaevulinic acid photodynamic therapy (PDT) enhances treatment efficacy of nonmelanoma skin cancers in mouse skin models. What does this study add? In human skin, calcipotriol (CAL)‐assisted MAL‐PDT proved to be superior to MAL‐PDT alone and was well tolerated.Topical preconditioning of actinic keratoses with CAL‐assisted MAL induced PpIX formation to a greater extent compared with the side that was not pretreated. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00070963
- Volume :
- 179
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- British Journal of Dermatology
- Publication Type :
- Academic Journal
- Accession number :
- 132394306
- Full Text :
- https://doi.org/10.1111/bjd.16473