Although daylight photodynamic therapy (DLPTD) and conventional photodynamic therapy (CPDT) have demonstrated equivalent efficacy for the treatment of actinic keratoses (AKs) on the face and scalp, the use of DLPDT may improve patient adherence and address some unmet treatment needs, according to the results of a recent study published in the Journal of the European Academy of Dermatology and Venereology.
In this intraindividual right-left comparison study, the investigators sought to compare short- and long-term efficacy, safety, and tolerability of DLPDT vs CPDT for AKs on the face and scalp. Participants received either DLPDT or CPDT, which was randomly assigned to alternate sides of their face or scalp. Patient assessment occurred at baseline, 3 months, and 12 months. Evaluations involved lesion response at 3 and 12 months, PDT-associated pain during treatment, local skin reactions 3 days posttreatment, and patients’ therapy preferences 3 months posttreatment. Overall, 46 individuals age >18 completed the analysis. The 46 patients enrolled had a total of 453 lesions.
At 3 months posttreatment, overall lesion complete response rates were 77.9% with DLPDT (95% CI, 65.9-89.9) and 80.6% with CPDT (95% CI, 69.17-92.02). At the 12-month follow-up visit, the response rate decreased to 71.18% (95% CI, 65.4-76.96) and 73.73% (95% CI, 67.88-79.59) with DLPDT vs CPDT, respectively.
Regarding the response according to lesion grade, response rates from grade 1 (mild) lesions were higher with DLPDT vs CPDT (84.5% vs 83.8%, respectively). In contrast, CPDT vs DLPDT was associated with higher rates of cured grade 2 (moderate) lesions at both 3 months (77.68% vs 70%, respectively) and 12 months (66.07% vs 58.33%, respectively). All these results were not statistically significant.
Although both treatments had similar efficacy, DLPDT was associated with significantly less pain and reduced severity of local skin reactions compared with CPDT. Patients preferred DLPDT over CPDT (82.6% vs 17.3%, respectively). Regarding tolerance, 86.9% vs 13.0% of patients favored DLPDT over CPDT.
Since it is “effective, better tolerated, nearly painless, and less time-consuming, DLPDT may improve patient adherence, and address some of the unmet needs in AKs treatment, especially over large areas,” concluded the researchers.
Sotiriou E, Evagelou G, Papadavid E, et al. Conventional vs. daylight photodynamic therapy for patients with actinic keratosis on face and scalp: 12-month follow-up results of a randomized, intraindividual comparative analysis [published online October 3, 2017]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.14613