A Randomized, Blinded, Bilateral Intraindividual, Vehicle-Controlled Trial of the Use of Photodynamic Therapy With 5-Aminolevulinic Acid and Blue Light for the Treatment of Actinic Keratoses of the Upper Extremities

September 2011 | Volume 10 | Issue 9 | Original Article | 1049 | Copyright © 2011

Abstract

Background/Objective: Actinic keratoses (AKs) on the upper extremities are difficult to treat. This study compares the efficacy and tolerability of photodynamic therapy (PDT) using 20% 5-aminolevulinic acid solution (ALA) and blue light versus ALA vehicle and blue light for the treatment of AKs of the dorsal hand and forearm.
Methods: Subjects were treated twice at an eight-week interval by ALA with blue light on one hand and forearm and with ALA vehicle and blue light on the contralateral hand and forearm. ALA incubation time was two hours under occlusion. Efficacy and tolerability were compared.
Results: The mean lesion count reductions (58.4±22.2% and 24.8±20.6% four weeks after the second treatment for the ALA and vehicle-treated sides, respectively) differed significantly (P=0.0004). Eleven of 15 subjects (73%) in the ALA-treated side achieved at least 50 percent reduction in lesion count compared to only two subjects (13%) in the vehicle-treated side four weeks after the second treatment. The difference was significant (P=0.0143). Photodamage grade reduction was also significant (P=0.0309) after the second treatment. Subject satisfaction was moderate to very satisfied (86.7%) on the ALA-treated side. Transient adverse events were significantly greater on the ALA-treated side for erythema (P=0.0011), edema (P=0.0199) and stinging and burning (P=0.0016) 48 hours after the first treatment.
Conclusions: Two sessions of PDT using ALA with blue light is a moderately effective, well-tolerated treatment of actinic keratoses of the dorsal hand and forearm.

J Drugs Dermatol. 2011;10(9):1049-1056.

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INTRODUCTION

Actinic keratoses (AKs) are common cutaneous lesions associated with chronic sun exposure. Fair skin, advancing age and immunosuppression are other risk factors.1,2 AK lesions are most often found on the head, face, neck, forearms and dorsal surfaces of the hands. AKs may be considered precursors to invasive squamous cell carcinoma (SCC), as approximately eight percent of AK lesions progress to invasive SCC.3 AK lesions may also affect large areas of skin (field cancerization).4 Since it is not yet possible to identify which AK lesions will progress to SCC, some advocate that all AK lesions should be identified and treated early. AK lesions often occur on cosmetically sensitive areas, so a procedure that provides a favorable cosmetic outcome is preferred.5,6

Therapies for AK lesions include surgical excision, curettage, cryotherapy, chemical peeling, dermabrasion, electrodessication, laser ablation, topical 5-fluorouracil, diclofenac (3%) gel and imiquimod cream.5,6These modalities may be inconvenient, yield unsatisfactory results and are associated with erythema, pain, blister formation, dyspigmentation and prolonged social downtime.7,8 The choice of therapy depends on

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