‘Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT
Background: Between 2003 and 2016, 546 patients in our clinic discontinued outpatient treatment for actinic keratoses (AKs) using conventional photodynamic therapy (PDT) because of intolerable pain, thereby necessitating the use of a less painful procedure. Therefore, we developed a novel off-label...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
|
| Series: | Photodiagnosis and Photodynamic Therapy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1572100024004095 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background: Between 2003 and 2016, 546 patients in our clinic discontinued outpatient treatment for actinic keratoses (AKs) using conventional photodynamic therapy (PDT) because of intolerable pain, thereby necessitating the use of a less painful procedure. Therefore, we developed a novel off-label PDT protocol: ‘PDT light’. Methods: Laser-assisted low irradiance PDT (li-PDT) was performed beginning in 2014. The dosage was gradually lowered to 8–12 J/cm² in 2018, so that we achieved considerable pain reduction while maintaining comparable therapeutic efficacy. A further considerable reduction in pain was achieved from 2018 onwards by combining the advantages of li-PDT with daylight PDT (DLPDT), thereby resulting in 2018 in the new technique ‘PDT light’. Patients with AK Olsen grades 1 or 2 and field cancerization initially received a mild-fractionated CO2 laser pretreatment prior to MAL-incubation (methyl aminolaevulinate, Metvix ®) under occlusion for 1.5–3 h. Then, patients were illuminated on average for 1.02 min with the Aktilite-LED and, after application of an UV-screen on the illuminated area, sent out into daylight for 1 h. Results: Between March and November 2019, we successfully treated 152 cases using the enhanced ‘PDT light’ procedure, with 137 cases achieving at follow-up 1 (on average after 8.14 months) good-to-excellent clearance rates (CLA and CLB together 90 %) and minimal adverse effects. Conclusions: The novel ‘PDT light’ protocol proved to be an excellent and nearly painless method with an average visual-analogue scale (VAS) score of 1.19. Additional advantages included reduced illumination time, shorter outpatient stays in the clinic, fewer adverse effects, and better patient compliance than with DLPDT alone. |
|---|---|
| ISSN: | 1572-1000 |