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J Am Acad Dermatol. 2019 Sep 13. pii: S0190-9622(19)32747-1. doi: 10.1016/j.jaad.2019.09.010. [Epub ahead of print]

A regimen to minimize pain during blue light photodynamic therapy of actinic keratoses: Bilaterally controlled, randomized trial of simultaneous versus conventional illumination.

Author information

1
Department of Dermatology.
2
Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
3
Department of Dermatology. Electronic address: maytine@ccf.org.

Abstract

BACKGROUND:

Blue light photodynamic therapy (PDT) is effective for actinic keratosis (AK), but many patients experience stinging pain during illumination.

OBJECTIVE:

Compare a conventional regimen (1 h ALA preincubation, followed by blue light), to a new modified regimen in which blue light is started immediately after ALA application.

METHODS:

A clinical trial with a bilaterally controlled, intrapatient study design was conducted in 23 patients. Topical 20% ALA was applied to the entire face and/or scalp. On one side of the body, blue light was started immediately and continued for either 30, 45, or 60 min ("simultaneous PDT"). On the contralateral side, blue light began 1 h after ALA application and lasted 1000 sec ("conventional PDT"). Pain was evaluated on a 0-10 scale. AK lesion counts were determined by clinical exam and photography.

RESULTS:

All patients experienced significantly less pain during simultaneous illumination than during the conventional regimen. At 3 months post-treatment, lesion clearance was nearly identical on the two sides, as determined by statistical testing of non-inferiority ± 15% margin.

LIMITATIONS:

Although bilaterally controlled, the study was relatively small. Additional studies are recommended.

CONCLUSION:

The modified PDT regimen is essentially painless, yet provides treatment efficacy similar to a conventional regimen.

KEYWORDS:

clinical research; oncology; phototherapy; skin cancer; therapeutics

PMID:
31525441
DOI:
10.1016/j.jaad.2019.09.010

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