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. 2014 Jun;26(3):321-31.
doi: 10.5021/ad.2014.26.3.321. Epub 2014 Jun 12.

Comparative Study of Photodynamic Therapy with Topical Methyl Aminolevulinate versus 5-Aminolevulinic Acid for Facial Actinic Keratosis with Long-Term Follow-Up

Dong-Yeob Ko  1 , Ki-Ho Kim  1 , Ki-Hoon Song  1
Affiliations

Comparative Study of Photodynamic Therapy with Topical Methyl Aminolevulinate versus 5-Aminolevulinic Acid for Facial Actinic Keratosis with Long-Term Follow-Up

Dong-Yeob Ko et al. Ann Dermatol. 2014 Jun.

Abstract

Background: Few studies have compared the efficacy, cosmetic outcomes, and adverse events between 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate-PDT (MAL-PDT) for actinic keratoses (AKs) in Asian ethnic populations with dark-skin.

Objective: We retrospectively compared the long-term efficacy, recurrence rates, cosmetic outcomes, and safety of ALA-PDT versus MAL-PDT for facial AKs in Koreans.

Methods: A total of 222 facial AKs in 58 patients were included in this study. A total of 153 lesions (29 patients) were treated with 5-ALA, and 69 lesions (29 patients) with MAL. ALA and MAL creams were applied for 6 hours and 3 hours, respectively; the lesions were then illuminated with a halogen lamp at 150 J/cm(2) for ALA-PDT and a diode lamp at 37 J/cm(2) for MAL-PDT.

Results: The complete response rates of ALA-PDT and MAL-PDT were 56.9% and 50.7%, respectively, with no significant difference at 12 months after treatment. No significant difference in recurrence rates was observed between the 2 PDT modalities at either 6 or 12 months after treatment. There was no significant difference in the cosmetic outcomes between the 2 treatment modalities at 12 months after PDT. However, ALA-PDT caused significantly more painful than MAL-PDT (p=0.005). The adverse events were mild to moderate, transient, and self-limiting for both modalities.

Conclusion: MAL-PDT was similar to ALA-PDT in terms of long-term efficacy, recurrence rates, cosmetic outcomes, and adverse events; however, it was a significantly less painful procedure than ALA-PDT in our study.

Keywords: 5-aminolevulinic acid; Long-term efficacy; Methyl aminolevulinate; Multiple actinic keratoses; Photodynamic therapy.

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Figures

Fig. 1
Fig. 1
Complete response rates at 3, 6, and 12 months after methyl aminolevulinate-photodynamic therapy (MAL-PDT) and 5-aminolevulinic acid (ALA)-PDT. *Statistically significant, p<0.05.
Fig. 2
Fig. 2
Clinical and histopathological images of the representative cases treated for Olsen grade 2 (moderate) actinic keratosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) (A~C) and methyl aminolevulinate (MAL)-PDT (D~F). (A, D) Clinical images at baseline before treatment with ALA-PDT and MAL-PDT. (B, E) Histopathological images after treatment with both PDT modalities (H&E, ×80). (C, F) Follow-up at 12 months.
Fig. 3
Fig. 3
Clinical and histopathological images of the representative cases treated for Olsen grade 3 (severe) actinic keratosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) (A~C) and methyl aminolevulinate (MAL)-PDT (D~F). (A, D) Clinical images at baseline before treatment with ALA-PDT and MAL-PDT. (B, E) Histopathological images after treatment with both PDT modalities (H&E, ×80). (C, F) Follow-up at 12 months.
Fig. 4
Fig. 4
Recurrence rates at 6 and 12 months after methyl aminolevulinate photodynamic therapy (MAL-PDT) and 5-aminolevulinic acid (ALA)-PDT. *Statistically significant, p<0.05.
Fig. 5
Fig. 5
Cosmetic outcomes at 12 months after 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate (MAL)-PDT.
Fig. 6
Fig. 6
Pain severity (visual analogue scale [VAS] score) during lesion illumination in the 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate (MAL)-PDT groups. *Statistically significant, p<0.05.
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