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• W1971424264 abstract "Sir: Intense pulsed light systems have been shown to be effective in the treatment of features of photodamage, including actinic keratoses. The use of intense pulsed light with methyl-aminolevulinic acid on extensive areas of actinic changes, unsuitable with conventional treatment modalities, has not been reported. This prospective controlled study assessed the treatment of large areas of actinic keratoses using intense pulsed light with and without the use of methyl-aminolevulinic acid. Eight patients with 20 treatment sites on the scalp, trunk, and limbs were recruited. One site with actinic keratoses was treated with methyl-aminolevulinic acid (applied 1 hour earlier) and intense pulsed light; the contralateral, control site was treated with intense pulsed light alone. All patients were treated with the Lumina intense pulsed light system (Lynton Laser, Cheshire, United Kingdom) with cryospray. A maximum of five treatments were given at 4-week intervals. Results were assessed with patient questionnaires, and pretreatment and posttreatment photographs were compared by two independent, blinded assessors. All patients had Fitzpatrick skin types I or II, with a mean age of 75 years (range, 65 to 86 years). Treatment sites included the hands, legs, trunk, and scalp. There was good correlation of assessment of improvement by the independent clinicians and patients. There was a 60 percent improvement at the intense pulsed light/methyl- aminolevulinic acid treatment site, compared with 55 percent at the intense pulsed light–only site. Fifty-six percent of patients preferred intense pulsed light to other treatment modalities experienced previously. Sixty-three percent of patients were satisfied with the treatment. Most patients rated the discomfort during treatment as mild or moderate. Side effects, which were temporary, included swelling, crusting, and blistering (75 percent of patients). The photosensitizers aminolevulinic acid and its methyl ester have been shown to be effective in treating actinic keratoses. Methyl-aminolevulinic acid was used in this study, as its better skin penetration and greater selectivity for neoplastic cells may make treating large areas of skin more efficient.1 Compared with conventional photodynamic therapy, which requires overnight application of a photosensitizer (14 to 18 hours) and a light exposure time of 15 minutes, the intense pulsed light system is much easier to use. Its large spot sizes mean that the treatment of large body areas can be achieved in a significantly shorter time; for example, treatment of the whole trunk can be achieved in about 30 minutes. Studies performed so far on intense pulsed light with aminolevulinic acid have concentrated on the face, as part of photorejuvenation procedures.2–5 So far, no study has concentrated on large, cumbersome areas on the limbs, scalp, and trunk. In this study, improvement in actinic keratoses was noted in 60 percent of patients (Fig. 1). Patients with thick keratotic lesions (40 percent) failed to improve. Poor aminolevulinic acid absorption and use of a lower fluence in areas with thin skin (e.g., limbs) may have resulted in less ideal response rates. The patients tolerated the treatment well, with no significant side effects.Fig. 1.: (Left) A 78-year-old man with extensive actinic keratoses on his left hand. (Right) The site treated with intense pulsed light only responded well to treatment.Intense pulsed light, with or without methyl-aminolevulinic acid, is effective in treating extensive areas of actinic keratoses and should be considered when other treatment modalities have failed or are not practical. However, it is not suitable for treating hyperkeratotic lesions. S. Tadiparthi, M.R.C.S. S. Falder, F.R.C.S.(Plast.) S. Saour, M.R.C.S. Department of Plastic and Reconstructive Surgery Whiston Hospital Liverpool, United Kingdom S. J. Hills, B.Sc., Ph.D. Lynton Lasers Cheshire, United Kingdom S. Liew, F.R.C.S.(Plast.) Department of Plastic and Reconstructive Surgery Whiston Hospital Liverpool, United Kingdom ACKNOWLEDGMENTS The authors thank Lynton Lasers, Cheshire, United Kingdom, and S. J. Hills (of Lynton Lasers) for provision of the Lumina intense pulsed light system and the Cryo-5 skin cooling device. They merely provided supervision and guidance on the technical aspects of the study but were not involved in patient selection or assessment. DISCLOSURES None of the authors has any commercial associations that might pose or create a conflict of interest with information presented in any submitted communication. These associations include consultancies, stock ownership, or other equity interests, patent licensing arrangements, and payments for conducting or publicizing the study." @default.
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• W1971424264 date "2008-05-01" @default.
• W1971424264 modified "2023-09-27" @default.
• W1971424264 title "Intense Pulsed Light with Methyl-Aminolevulinic Acid for the Treatment of Actinic Keratoses" @default.
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• W1971424264 doi "https://doi.org/10.1097/prs.0b013e31816b1300" @default.
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