Abstract:
BACKGROUND:Photodynamic therapy (PDT) and imiquimod are the treatments of choice for actinic keratosis (AK). As they have different mechanisms of action, it seems reasonable to assume that applying both treatments sequentially would be efficacious. OBJECTIVES:We sought to determine which of these therapeutic modalities provides a better clinical and histologic response in patients with AK and whether sequential use of both was more efficacious than each separately. METHODS:Patients were randomly assigned to one treatment group: group 1, PDT only; group 2, imiquimod only; or group 3, sequential use of PDT and imiquimod. The primary outcome measure was complete clinical response. Partial clinical response was defined as a reduction of more than 75% in the initial number of lesions. A complete clinicopathologic response was defined as lack of evidence of AK in the biopsy specimen. RESULTS:In all, 105 patients completed the study (group 1, 40 patients; group 2, 33 patients; group 3, 32 patients). Sequential application of PDT and imiquimod was more efficacious in all the outcome measures. More patients were satisfied with PDT than with the other two modalities (P = .003). No significant differences were observed among the 3 modalities and tolerance to treatment. LIMITATIONS:Only one cycle of imiquimod was administered. The follow-up period was brief. CONCLUSIONS:Sequential application of PDT and imiquimod provides a significantly better clinical and histologic response in the treatment of AK than PDT or imiquimod monotherapy. It also produces less intense local reactions and better tolerance and satisfaction than imiquimod monotherapy.
journal_name
J Am Acad Dermatoljournal_title
Journal of the American Academy of Dermatologyauthors
Serra-Guillén C,Nagore E,Hueso L,Traves V,Messeguer F,Sanmartín O,Llombart B,Requena C,Botella-Estrada R,Guillén Cdoi
10.1016/j.jaad.2011.11.933subject
Has Abstractpub_date
2012-04-01 00:00:00pages
e131-7issue
4eissn
0190-9622issn
1097-6787pii
S0190-9622(11)02242-0journal_volume
66pub_type
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