A Regimen to Minimize Pain during Blue Light Photodynamic Therapy of Actinic Keratoses: Bilaterally Controlled, Randomized Trial of Simultaneous versus Conventional Illumination
Open accessAbstract
Background Blue light photodynamic therapy (PDT) is effective for actinic keratosis, but many patients experience stinging pain during illumination.Objective To compare a conventional regimen (1 hour of 5-aminolevulinic acid [ALA] preincubation, followed by blue light) versus a new modified regimen in which blue light is started immediately after ALA application.Methods A clinical trial with a bilaterally controlled, intrapatient study design was conducted with 23 patients. Topical 20% ALA was applied to the entire face and/or scalp. On 1 side of the body, blue light was started immediately and continued for either 30, 45, or 60 minutes (simultaneous PDT). On the contralateral side, the blue light began 1 hour after ALA application and lasted 1000 seconds (conventional PDT). Pain was evaluated on a scale from 0 to 10. Actinic keratosis lesion counts were determined by clinical examination and photography.Results All patients experienced significantly less pain during simultaneous illumination than during the conventional regimen. At 3 months after treatment, lesion clearance was nearly identical on the 2 sides, as determined by statistical testing of noninferiority ± 15% margin.Limitations Although bilaterally controlled, the study was relatively small. Additional studies are recommended.Conclusion The modified PDT regimen is essentially painless, yet it provides treatment efficacy similar to a conventional regimen.
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Blue light illumination immediately after ALA application results in significantly less pain, without losing much efficacy evaluated at 3 months after treatment, than the conventional protocol where ALA is applied hours before light treatment.
“Furthermore, blue light illumination immediately after ALA application results in significantly less pain, without losing much efficacy evaluated at 3 months after treatment, than the conventional protocol where ALA is applied hours before light treatment [64].”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [64]
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- Authors
- Kaw, U., Ilyas, M., Bullock, T., Rittwage, L., Riha, M., Vidimos, A., Hu, B., Warren, C. B., & Maytin, E. V.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Maytin, Edward V.
- ORCID
- Venue
- Journal of the American Academy of Dermatology
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 82
- Issue
- 4
- Pages
- 862-868
- ISSN
- 0190-9622 (ISSN-L)
- PMC
- PMC8036906
- OpenAlex
- W2972986938
- Cited by
- 53
- References
- 23
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 9 · 2023: 13 · 2022: 8 · 2021: 3 · 2020: 6
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Dermatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Sun Pharma
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Photodynamic Therapy Research Studies
- Health Sciences › Medicine › Dermatology › Skin Protection and Aging
- Keywords
- actinic keratosis, 5-aminolevulinic acid, lesion clearance, non-inferiority
- MeSH terms
- Aged, Aged, 80 and over, Aminolevulinic Acid, Drug Administration Schedule, Facial Dermatoses, Female, Humans, Male, Middle Aged, Pain, Photochemotherapy, Scalp Dermatoses, Treatment Outcome, Photosensitizing Agents, Keratosis, Actinic
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