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Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Online ISSN 1827-1820
Rossi R., Mavilia L., Ghersetich I., Lotti T.
Unit of Dermatological Physiotherapy Department of Dermatological Sciences University of Florence, Florence, Italy
Aim. Actinic keratoses (AKs) are considered one of the most common cutaneous intraepithelial neoplastic disorders. Some authors have recently proposed to define AK as a keratinocyte intraepithelial neoplasia with 3 possible steps of evolution towards squamous cell carcinoma. According to others, AK is a true neoplasia from the very beginning. It has been calculated that 60% of subjects with skin from I to III phototype over 40s present at least one AK. This diffuse and progressing condition requires a prompt diagnosis and an adequate treatment. The prevalence of AKs increases with age, with sun exposure and is regulated by different factors, including immunosurveillance and low phototype. The more risk factors there are, the more diffuse the lesions which required multiple therapies. Up to now both medical (5-FU cream, imiquimod cream, retinoids etc.) and surgical (cryosurgery, laser surgery, diclofenac gel, etc.) treatments have been used to treat AK with variable results. Photodynamic therapy (PDT) seems to represent a new, effective and well tolerated therapy for the treatment of AKs with excellent cosmetic results and long term follow up in terms of efficacy. In this paper the efficacy of PDT treatment has been evaluated with special attention to the employment of methyl-ester of aminolevulinic acid (MAL), which is a prodrug recently introduced in our country.
Methods. We have treated 100 Caucasian patients (70 males, 30 females) with a skin phototype ranging from 1 to 3 according to the Fitzpatrick classification, for a total of 170 AKs of the face and scalp.
Results. 15 days after the treatment showed complete healing in 114 lesions of the face (82.4%) and in 44 lesions of the scalp (78%). 84% of the more superficial and less squamous keratosis (grade I) presented a complete response against 80% of grade II lesions. The general response to the first treatment was 77%. We showed 90% of complete healing with excellent compliance and cosmetic results.
Conclusion. This study has shown that metylaminolevulinate PDT is an effective, safe and well tolerated treatment for AKs, which could probably be considered the treatment of choice for this very common and emerging cutaneous disorder. PDT is also a promising treatment modality with a good potential for future development in different fields, such as T cell lymphoma, acne, localized eczema, and human papillomavirus infection.