Photodynamic treatment, aminolevulinic acid 20% shows benefit in actinic keratoses

Combination therapy with photodynamic treatment and aminolevulinic acid 20% solution has shown strong outcomes with minimal adverse events in actinic keratoses, according to results of a meta-analysis.

“Actinic keratoses (AK) are lesions with potential to transform into nonmelanoma skin cancers,” Joseph Gorelick, MSN, FNP-C, of the California Skin Institute in San Jose, and Scott Freeman, MCMS, PC-A, of Advanced Dermatology in St. Petersburg, Florida, wrote.

Among the various treatments available for AK is combination therapy involving photodynamic treatment and the sensitizing agent aminolevulinic acid 20% solution (ALA-PDT). In the current meta-analysis, Gorelick and Freeman reviewed clinical trial data for this combination, particularly in patients with AKs on the face, scalp and upper extremities.

Clinical trials investigating the efficacy and safety of ALA-PDT have demonstrated similar outcomes compared with other therapeutic options for AK even though treatment guidelines for this condition have variability. For example, British guidelines suggest that treatment of AK may not be absolutely necessary, while those in Canada advocate for treatment.

Data have shown that ALA-PDT may perform better than some options and has demonstrated superiority versus placebo, with a strong long-term adverse event profile. One study showed that ALA-PDT yielded a complete response rate of 66% compared with 11% for vehicle. In high-risk patients, ALA-PDT was associated with a complete response rate of 36% and 37.5%, compared with just 18.9% for vehicle.

Patients with multiple AKs, in particular, may benefit from ALA-PDT, according to the authors. Cosmetic outcomes for this approach may be superior to those reported for cryotherapy.

The researchers noted that thorough education about the risk-benefit profile of ALA-PDT is a necessary component of the approach. This education should include information about the regimen itself, along with the importance of treatment adherence, management of local reactions and symptoms that require ongoing intervention.