A randomized trial comparing methyl aminolaevulinate photodynamic therapy with and without Er:YAG ablative fractional laser treatment in Asian patients with lower extremity Bowen disease: results from a 12-month follow-up.

Abstract

BACKGROUND:

Methyl aminolaevulinate photodynamic therapy (MAL-PDT) is an effective treatment for Bowen disease (BD) of the lower extremities. Er:YAG (erbium:yttrium-aluminium-garnet) ablative fractional laser (AFL) treatment removes the stratum corneum to increase MAL uptake and may improve efficacy. However, no studies have directly compared the efficacy of MAL-PDT with and without Er:YAG AFL therapy in treating BD of the lower extremities in Asians.

OBJECTIVES:

To compare the efficacy, recurrence rate, cosmetic outcomes and safety between Er:YAG AFL-assisted MAL-PDT (Er:YAG AFL-PDT) and standard MAL-PDT.

METHODS:

Twenty-one patients with a total of 58 BD lesions randomly received either one session of Er:YAG AFL-PDT or two sessions of MAL-PDT in two symmetrical areas. Er:YAG AFL therapy was performed with 550-600 μm ablation depth, level 1 coagulation, 22% treatment density and a single pulse. MAL cream was then applied under occlusion for 3 h and illuminated with a red light-emitting diode lamp at 37 J cm(-2) . A second session of MAL-PDT was administered 7 days later. Overall response rate, recurrence rate, cosmetic outcomes and safety were assessed at 1 week, 3 and 12 months after treatment.

RESULTS:

After 3 months, Er:YAG AFL-PDT was significantly more effective (93.8%) than MAL-PDT (73.1%; P = 0.031), and the recurrence rate was significantly lower for Er:YAG AFL-PDT (6.7%) than MAL-PDT (31.6%) at 12 months (P = 0.022). No significant difference was found between Er:YAG AFL-PDT and MAL-PDT in terms of cosmetic outcomes or safety.

CONCLUSIONS:

Er:YAG AFL-PDT showed significantly higher efficacy and lower recurrence rate than did standard MAL-PDT for treating lower extremity BD in an Asian population.

• Authors: D Y Ko, K H Kim, K H Song
• Journal: The British journal of dermatology (Br J Dermatol) Vol. 170 Issue 1 Pg. 165-72 (Jan 2014) ISSN: 1365-2133 [Electronic] England
• PMID: 24102369 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 British Association of Dermatologists.

Chemical References

• Photosensitizing Agents
• methyl 5-aminolevulinate
• Aminolevulinic Acid

Topics

• Adult
• Aged
• Aged, 80 and over
• Aminolevulinic Acid (analogs & derivatives, therapeutic use)
• Asian People
• Bowen's Disease (ethnology, therapy)
• Female
• Follow-Up Studies
• Humans
• Laser Therapy (methods)
• Lasers, Solid-State (therapeutic use)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (ethnology, etiology)
• Photochemotherapy (adverse effects, methods)
• Photosensitizing Agents (therapeutic use)
• Prospective Studies
• Skin Neoplasms (therapy)
• Treatment Outcome