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Dany Touma, MD; Mina Yaar, MD; Sara Whitehead, MD; Nellie Konnikov, MD; Barbara A. Gilchrest, MD

Arch Dermatol. 2004;140:33-40.

Background  There is no completely satisfactory treatment for multiple actinic keratoses (AKs).

Objective  To evaluate the efficacy of short incubation, broad-area application of -aminolevulinic acid followed by exposure to activating light–photodynamic therapy (-ALA/PDT) for treatment of AKs and background photodamage. The benefit of pretreatment with 40% urea cream to enhance penetration and the use of topical 3% lidocaine hydrochloride to decrease discomfort were also evaluated.

Methods  Eighteen patients with at least 4 nonhypertrophic facial AKs and mild to moderate diffuse facial photodamage were enrolled in the study. For 7 days, 40% urea cream or vehicle was applied to half of the treatment area, and then -ALA was applied to the entire area for 1, 2, or 3 hours. Lidocaine hydrochloride (3%) or vehicle cream was also applied to the entire area 45 minutes before exposure to 10 J/cm² of blue light. Pain,phototoxic reactions, AK counts, and photodamage improvement were evaluated 1 day, 1 week, and 1 month after treatment in all patients and after 5 months in 10 patients.

Results  All patients experienced mild to moderate discomfort during treatment and moderate phototoxic effects for 1 week. At 1 and 5 months there was significant reduction in AKs in all groups and significant improvement of several photodamage parameters. Different -ALA application times and pretreament with urea cream or lidocaine had no significant effect on the results.

Conclusions  This -ALA/PDT protocol is safe and effective for AK treatment as well as for improving photodamage. Further studies with a larger cohort, longer follow-up, and histologic confirmation of the clinical data would be of value.

From the Department of Dermatology, Boston University School of Medicine, Boston, Mass. The authors have no relevant financial interest in this article.

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