Daylight photodynamic therapy for actinic keratosis: an international consensus

Photodynamic therapy (PDT) is an attractive therapy for non‐melanoma skin cancers including actinic keratoses (AKs) because it allows treatment of large areas; it has a high response rate and results in an excellent cosmesis. However, conventional PDT for AKs is associated with inconveniently long clinic visits and discomfort during therapy. In this article, we critically review daylight‐mediated PDT, which is a simpler and more tolerable treatment procedure for PDT. We review the effective light dose, efficacy and safety, the need for prior application of sunscreen, and potential clinical scope of daylight‐PDT. Three randomized controlled studies have shown that daylight‐mediated PDT is an effective treatment of thin AKs. Daylight‐mediated PDT is nearly pain‐free and more convenient for both the clinics and patients. Daylight‐mediated PDT is especially suited for patients with large field‐cancerized areas, which can easily be exposed to daylight. Further investigations are necessary to determine at which time of the year and in which weather conditions daylight‐mediated PDT will be possible in different geographical locations.

[1]  R. Botella-Estrada,et al.  Comparative study between cold air analgesia and supraorbital and supratrochlear nerve block for the management of pain during photodynamic therapy for actinic keratoses of the frontotemporal zone , 2009, The British journal of dermatology.

[2]  Even Angell-Petersen,et al.  Porphyrin formation in actinic keratosis and basal cell carcinoma after topical application of methyl 5-aminolevulinate. , 2006, The Journal of investigative dermatology.

[3]  B. L. Andersen,et al.  A randomized, multicentre study of directed daylight exposure times of 1½ vs. 2½ h in daylight‐mediated photodynamic therapy with methyl aminolaevulinate in patients with multiple thin actinic keratoses of the face and scalp , 2011, The British journal of dermatology.

[4]  H. Wulf,et al.  Topical photodynamic therapy for prevention of new skin lesions in renal transplant recipients. , 2006, Acta dermato-venereologica.

[5]  Cynthia C. Morton,et al.  Intraindividual, right–left comparison of topical methyl aminolaevulinate‐photodynamic therapy and cryotherapy in subjects with actinic keratoses: a multicentre, randomized controlled study , 2006, The British journal of dermatology.

[6]  H. Wulf,et al.  The wrist is a reliable body site for personal dosimetry of ultraviolet radiation , 2000, Photodermatology, photoimmunology & photomedicine.

[7]  S. Salasche,et al.  Epidemiology of actinic keratoses and squamous cell carcinoma. , 2000, Journal of the American Academy of Dermatology.

[8]  M A Weinstock,et al.  Nonmelanoma skin cancer in the United States: incidence. , 1994, Journal of the American Academy of Dermatology.

[9]  P. Foley,et al.  Solar keratosis: Epidemiology, pathogenesis, presentation and treatment , 2007, The Australasian journal of dermatology.

[10]  J. Moan,et al.  Temperature Effect on Accumulation of Protoporphyrin IX After Topical Application of 5-Aminolevulinic Acid and its Methylester and Hexylester Derivatives in Normal Mouse Skin¶ , 2002, Photochemistry and photobiology.

[11]  S. Esmann,et al.  Management of actinic keratosis patients: A qualitative study , 2007, The Journal of dermatological treatment.

[12]  M. Ericson,et al.  Pain caused by photodynamic therapy of skin cancer , 2002, Clinical and experimental dermatology.

[13]  J. Lang.  Pain during photodynamic therapy is associated with protoporphyrin IX fluorescence and fluence rate , 2009 .

[14]  J C Kennedy,et al.  Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy. , 1992, Journal of photochemistry and photobiology. B, Biology.

[15]  G. Martin.  A randomized, multicentre study of directed daylight exposure times of 1½ vs. 2½h in daylight-mediated photodynamic therapy with methyl aminolaevulinate in patients with multiple thin actinic keratoses of the face and scalp , 2012 .

[16]  R. Stern,et al.  Incidence of skin cancer in 5356 patients following organ transplantation , 2000, The British journal of dermatology.

[17]  J. Q. Rosso,et al.  Photodynamic therapy of actinic keratoses with 8% and 16% methyl aminolaevulinate and home-based daylight exposure: a double-blinded randomized clinical trial , 2010 .

[18]  H. Wulf,et al.  Photodynamic therapy of actinic keratoses with 8% and 16% methyl aminolaevulinate and home‐based daylight exposure: a double‐blinded randomized clinical trial , 2009, The British journal of dermatology.

[19]  Ann-Marie Wennberg,et al.  Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus. International Society for Photodynamic Therapy in Dermatology, 2005. , 2007, Journal of the American Academy of Dermatology.

[20]  I. Bronshtein,et al.  The influence of temperature on photodynamic cell killing in vitro with 5-aminolevulinic acid. , 2006, Journal of photochemistry and photobiology. B, Biology.

[21]  H. Pehamberger,et al.  Development of a treatment algorithm for actinic keratoses: a European Consensus. , 2008, European journal of dermatology : EJD.

[22]  H. Wulf,et al.  Continuous activation of PpIX by daylight is as effective as and less painful than conventional photodynamic therapy for actinic keratoses; a randomized, controlled, single‐blinded study , 2008, The British journal of dermatology.

[23]  Jakob Heydenreich,et al.  Miniature Personal Electronic UVR Dosimeter with Erythema Response and Time-stamped Readings in a Wristwatch , 2005, Photochemistry and photobiology.

[24]  H Moseley,et al.  Guidelines for topical photodynamic therapy: report of a workshop of the British Photodermatology Group , 2002, The British journal of dermatology.