Ablative Fractional Laser With 22% Laser Density Improves Complete Response Rate in Actinic Keratosis

actinic keratosis
actinic keratosis
Treatment for actinic keratosis with AFL-PDT with higher laser density showed a better complete response rate with reduced recurrence, especially for actinic keratosis with higher Olsen grade.

In patients with actinic keratosis (AK), ablative fractional laser (AFL) photodynamic therapy (PDT) with higher laser density (22%) and with methyl aminolevulinate is associated with a better complete response (CR) rate and a potentially reduced recurrence rate compared with AFL-PDT with lower laser densities. This is according to study data published in the Journal of the American Academy of Dermatology.

A total of 47 patients from Korea who had AK lesions were randomly assigned to 3 different AFL density groups: 5.5% (n=16), 11% (n=15), and 22% (n=16). Lesions were photographed and graded. Protoporphyrin IX accumulation was assessed by measuring fluorescence intensity approximately 3 hours after application of methyl aminolevulinate. Each area was then irradiated with red light-emitting diode lamp, with a peak emission of 630 and a total light dose of 37 J/cm2.

There was no difference among groups with regard to sex, age, Fitzpatrick score, number of lesions, or Olsen grade. At month 3, patients who received AFL-PDT with a 22% density had a significantly higher CR rate compared with patients who received the 5.5% density (88.7% vs 80.0%, respectively; P =.037). An even higher proportion of patients in the 22% density group achieved a CR at 12 months compared with the 5.5% density group (81.1% vs 60.9%, respectively; P =.003). In Olsen grade 3 AK lesions, the CR rate was higher in the 22% vs the 5.5% density group at 3 months (81.3% vs 55.9%, respectively) and 12 months (68.8% vs 38.2%, respectively; P =.043).

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Limitations of the study included its small sample size and the single ethnic group, which may reduce the findings’ generalizability.

Taken together, these findings “recommend pretreatment with AFL at a higher laser density when AFL-PDT is used to treat AK with severe hyperkeratosis.”

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Cho YR, Seo JW, Kim HJ, Song KH. A comparison of the efficacy of ablative fractional laser-assisted photodynamic therapy according to the density of ablative laser channel in the treatment of actinic keratosis: a prospective, randomized, controlled trial [published online October 25, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.10.037