A randomized controlled clinical trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients.

Abstract

BACKGROUND:

Transplant recipients have an increased propensity to develop multiple actinic keratoses, which demonstrate an increased transformation rate into invasive squamous cell carcinoma.

OBJECTIVE:

To evaluate the efficacy and tolerability of topical photodynamic therapy with the new highly tumour-selective photosensitizer methyl aminolaevulinate vs. placebo in the treatment of actinic keratoses in transplant recipients.

METHODS:

Seventeen transplant recipients with a total number of 129 mild to moderate actinic keratoses were enrolled in a prospective, randomized, double-blind, placebo-controlled study. Two lesional areas within a patient were randomized for two consecutive treatments of topical photodynamic therapy 1 week apart using either methyl aminolaevulinate or placebo cream. Sites were illuminated with 75 J cm(-2) of visible light delivered at 80 mW cm(-2) by a noncoherent light source. Complete resolution and reduction in the number or size of actinic keratoses within the lesional area relative to the initial findings were evaluated at weeks 4, 8 and 16 after treatment.

RESULTS:

The lesional areas treated with methyl aminolaevulinate were clinically cleared in 13 of 17 patients at 16 weeks. A partial response was recorded in a further three. No reduction in the size or number of actinic keratoses was observed in one area treated with methyl aminolaevulinate and in all placebo-treated areas. Adverse events, such as erythema, oedema and crust formation, were mild to moderate, and treatment was well tolerated by all patients.

CONCLUSION:

Photodynamic therapy using methyl aminolaevulinate is a safe and effective treatment for actinic keratoses in transplant recipients. It may also reduce the risk of transformation of actinic keratoses to invasive, potentially fatal, squamous cell carcinoma.

• Authors: G Dragieva, B M Prinz, J Hafner, R Dummer, G Burg, U Binswanger, W Kempf
• Journal: The British journal of dermatology (Br J Dermatol) Vol. 151 Issue 1 Pg. 196-200 (Jul 2004) ISSN: 0007-0963 [Print] England
• PMID: 15270891 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Photosensitizing Agents
• methyl 5-aminolevulinate
• Aminolevulinic Acid

Topics

• Adult
• Aged
• Aminolevulinic Acid (analogs & derivatives)
• Carcinoma, Basal Cell (prevention & control)
• Female
• Follow-Up Studies
• Heart Transplantation
• Humans
• Keratosis (drug therapy)
• Kidney Transplantation
• Male
• Middle Aged
• Photochemotherapy (methods)
• Photosensitivity Disorders (drug therapy)
• Photosensitizing Agents (administration & dosage, therapeutic use)
• Postoperative Period
• Skin Neoplasms (prevention & control)
• Transplantation