Repetitive Daylight Photodynamic Therapy versus Cryosurgery for Prevention of Actinic Keratoses in Photodamaged Facial Skin: A Prospective, Randomized Controlled Multicentre Two-armed Study

• Main Authors: Sigrid Karrer, Rolf-Markus Szeimies, Wolfgang G. Philipp-Dormston, Peter A. Gerber, Welf Prager, Elisabeth Datz, Florian Zeman, Karolina Müller, Michael Koller
• Format: Article
• Language: English
• Published: Society for Publication of Acta Dermato-Venereologica 2021-01-01
• Series: Acta Dermato-Venereologica
• Subjects: actinic keratoses; daylight photodynamic therapy; methyl aminolevulinate; photo-rejuvenation; skin cancer prevention; skin ageing
• Online Access: https://www.medicaljournals.se/acta/content/html/10.2340/00015555-3717
• ISSN: 0001-5555; 1651-2057

Actinic keratoses are a chronic condition in ultraviolet-damaged skin, with a risk of progressing to invasive skin cancer. The aim of this study was to investigate the preventive potential of field-directed repetitive daylight photodynamic therapy for actinic keratoses. A randomized trial was performed, including 58 patients with ≥5 actinic keratoses on photodamaged facial skin, who received either 5 full-face sessions of daylight photodynamic therapy within a period of 2 years or lesion-directed cryosurgery. Primary outcome was the mean cumulative number of new actinic keratoses developed between visits 2 and 6 (visit 6 being a follow-up). This outcome was lower after daylight photo­dynamic therapy (7.7) compared with cryosurgery (10.2), but the difference did not reach significance (–2.5, 95% confidence interval –6.2 to 1.2; p=0.18). Several signs of photoageing (fine lines, pigmentation, roughness, erythema, sebaceous gland hyperplasia) were significantly reduced after daylight photodynamic therapy, but not after cryosurgery. Significantly less pain and fewer side-effects were reported during daylight photodynamic therapy than during cryosurgery. This study found that repetitive daylight photodynamic therapy had photo-rejuvenating effects. However, the prevention of actinic keratoses by this therapy could not be proven in a statistically reliable manner.