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Microneedling Pre-Treatment Shortens PDT Time For Actinic Keratosis
Pre-treating actinic keratosis with microneedling can shorten photodynamic therapy time and reduce pain, according to a recent study published in JAMA Dermatology.
In a randomised trial, researchers found that treating actinic keratosis with microneedling followed by photodynamic therapy at 20-minute aminolevulinic acid incubation time was effective in producing comparable results to conventional photodynamic therapy treatment alone. The combined therapy also reduced treatment time and was less painful.
Photodynamic therapy with one-hour aminolevulinic acid incubation is a conventional approach in actinic keratosis field therapy. Other treatments include topical 5-fluorouracil, imiquimod, ingenol mebutate, diclofenac, chemical peels, and ablative laser resurfacing.
There are great variations in the long-term outcomes of these field therapies, and severe pain is a common side effect for patients undergoing photodynamic therapy. The study found that this can cause patients to interrupt or stop treatment, or refuse to undergo further treatments in the future.
The study’s authors wrote that enhancing treatment modalities leads to improved efficacy, duration, convenience and patient adherence to treatment.
They reported on 32 actinic keratosis patients, each with at least three grade 2 facial actinic keratoses. Patients were randomised to pre-treatment with either a 200 um microneedle roller or sham roller. Then, they were randomised to photodynamic therapy with either a 20-minute or 10-minute incubation time. Post-incubation, patients were exposed to blue light, for 1,000 seconds or a total 10 J/cm2fluence. The results were evaluated after four weeks.
Microneedle-assisted photodynamic therapy with a 20-minute aminolevulinic acid incubation resulted in a 76 percent clearance of actinic keratosis, versus 58 percent on the sham side. Three patients achieved complete clearance compared to zero in the sham side.
The improved actinic keratosis counts with this treatment were superior to sham and similar to the 78.6 percent reported outcome with traditional photodynamic therapy treatment with one-hour aminolevulinic acid incubation.
Pain on the microneedle pre-treated side was an average 1.3 on the 10-point visual analogue scale, compared to 0.3 on the sham side. Pain during blue light exposure was not significantly different between the microneedle and sham sides.
In the 10-minute incubation group, average actinic keratosis clearance was 43 percent on the microneedle pre-treated side compared to 38 percent with sham. Pain was greater in the microneedle pre-treated side, at an average 1.4 on the visual analogue scale, versus 0.3 on the sham side, but pain during blue light exposure was not significantly different between the sides.
While pain levels for the microneedle groups were higher than for sham sides, pain with the shorter therapies is still less than with the conventional approach. In research looking at photodynamic therapy with aminolevulinic acid incubation times of one to three hours, 60 percent of patients reported moderate to severe pain. None of the patients in this study reported moderate to severe pain.
The authors concluded that the findings are promising for shortening treatment time and achieving greater patient satisfaction.
Petukhova, T.A., Hassoun, L.A., Foolad, N., et al. (July 2017.) Effect of Expedited Microneedle-Assisted Photodynamic Therapy for Field Treatment of Actinic Keratoses: A Randomized Clinical Trial. JAMA Dermatology. DOI: 10.1001/jamadermatol.2017.0849.
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