cqvip:Photodynamic therapy (PDT) with topical methyl aminolevulinate (MAL) administered in two treatment sessions separated by 1 week is an effective treatment for actinic keratoses. This open prospective study compared the efficacy and safety of MAL- PDT given as a single treatment with two treatments of MAL- PDT 1 week apart. Two hundred and eleven patients with 413 thin to moderately thick actinic keratoses were randomized to either a single treatment with PDT using topical MAL (regimen I; n=105) or two treatments 1 week apart (regimen II; n=106). Each treatment involved surface debridement, application of Metvix(r) cream (160 mg/g) for 3 h, followed by illumination with red light using a light- emitting diode system (peak wave length 634± 3 nm, light dose 37 J/cm2). Thirtyseven lesions (19% ) with a non- complete response 3 months after a single treatment were re- treated. All patients were followed up 3 months after the last treatment. A total of 400 lesions, 198 initially treated once and 202 treated twice, were evaluable. Complete response rate for thin lesions after a single treatment was 93% (95% CI=87- 97% ), which was similar to 89% (82- 96% ) after repeated treatment. Response rates were lower after single treatment of thicker lesions (70% (60- 78% )- vs 84% (77- 91% )), but improved after repeated treatment (88% (82- 94% )). The conclusion of this study is that single treatment with topical MAL- PDT is effective for thin actinic keratosis lesions; however, repeated treatment is recommended for thicker or non- responding lesions.
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