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    Off-label PDT protocols show promise in AK treatment


    Protocol in point

    At the University of Illinois at Chicago, Dr. Tsoukas and colleagues have implemented a protocol that seems to reduce the need for repeat sessions. It uses topical 5- fluorouracil (5-FU) as pretreatment, beginning seven to 10 days prior to standard PDT.

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    “Results from several studies indicate that using the FDA-approved protocol, two or three serial PDT sessions are needed to eradicate 70% to 95% of AKs, and these serial PDT sessions have also been shown to provide longer ‘lesion-free’ intervals than a single treatment,” she says.

    “Analyses of outcomes using our approach using a short pre-treatment course of topical 5-FU indicate we are achieving an AK eradication rate of up to 95% and better control of AK recurrences with just a single PDT session.”

    Side effects

    Dr. Tsoukas adds that when the skin is treated first with 5-FU, patients may develop a brisker local response with greater discomfort likely during the light treatment and increased redness and peeling after.

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    “Discomfort during the light treatment is mostly dependent on the severity of actinic damage and becomes manageable through topical cooling with spray mist, handheld mini fans, or iced towels. Care is needed to avoid excessive cooling, however, because that may decrease PDT efficacy,” she says, adding that other protocols implement local anesthetics or nerve blocks.

    Other strategies that have been reported for enhancing the benefit of PDT for treating AKs include:

    • mild curettage of hyperkeratotic lesions prior to treatment;
    • occlusion during ALA incubation;
    • application of heating, particularly when treating AKs on the extremities;
    • fractional laser resurfacing or microneedling prior to PDT;
    • application of longer and/or multiple wavelengths during light exposure;
    • fractionated PDT, and application of other topical agents prior to PDT or for a short course after, such as imiquimod, ingenol mebutate, diclofenac, or retinoids. 

    In addition, daylight PDT is being widely used in Europe and is beginning to be adopted in the United States.

    “Substituting the conventional light irradiation with exposure to ambient visible light, may provide a safe, effective, well-tolerated and cost-effective method for medical and cosmetic dermatology PDT applications. By utilizing natural light, PDT may ultimately be used in reversing photoaging,” Dr. Tsoukas says.

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