Combination-Based Strategies for the Treatment of Actinic Keratoses with Photodynamic Therapy: An Evidence-Based Review

Author:

Piaserico StefanoORCID,Mazzetto RobertoORCID,Sartor Emma,Bortoletti Carlotta

Abstract

Photodynamic therapy (PDT) is a highly effective and widely adopted treatment strategy for many skin diseases, particularly for multiple actinic keratoses (AKs). However, PDT is ineffective in some cases, especially if AKs occur in the acral part of the body. Several methods to improve the efficacy of PDT without significantly increasing the risks of side effects have been proposed. In this study, we reviewed the combination-based PDT treatments described in the literature for treating AKs; both post-treatment and pretreatment were considered including topical (i.e., diclofenac, imiquimod, adapalene, 5-fluorouracil, and calcitriol), systemic (i.e., acitretin, methotrexate, and polypodium leucotomos), and mechanical–physical (i.e., radiofrequency, thermomechanical fractional injury, microneedling, microdermabrasion, and laser) treatment strategies. Topical pretreatments with imiquimod, adapalene, 5-fluorouracil, and calcipotriol were more successful than PDT alone in treating AKs, while the effect of diclofenac gel was less clear. Both mechanical laser treatment with CO2 and Er:YAG (Erbium:Yttrium–Aluminum–Garnet) as well as systemic treatment with Polypodium leucotomos were also effective. Different approaches were relatively more effective in particular situations such as in immunosuppressed patients, AKs in the extremities, or thicker AKs. Conclusions: Several studies showed that a combination-based approach enhanced the effectiveness of PDT. However, more studies are needed to further understand the effectiveness of combination therapy in clinical practice and to investigate the role of acitretin, methotrexate, vitamin D, thermomechanical fractional injury, and microdermabrasion in humans.

Publisher

MDPI AG

Subject

Pharmaceutical Science

Cited by 10 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Effective treatment of actinic keratosis on the hands with red light photodynamic therapy using BF-200 ALA;Photodiagnosis and Photodynamic Therapy;2024-10

2. Conventional PDT versus one PDT session plus 3% diclofenac gel for severe skin field cancerization of the face and scalp: Randomized controlled trial assessing clinical and histological response;Journal of the European Academy of Dermatology and Venereology;2024-07-29

3. Diagnose und Therapie aktinischer Keratosen;JDDG: Journal der Deutschen Dermatologischen Gesellschaft;2024-05

4. Diagnosis and therapy of actinic keratosis;JDDG: Journal der Deutschen Dermatologischen Gesellschaft;2024-03-08

5. Quoi de neuf en dermatologie interventionnelle ?;Annales de Dermatologie et de Vénéréologie - FMC;2023-12

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