Topical tacalcitol as neoadjuvant for photodynamic therapy of acral actinic keratoses: An intra-patient randomized study.

Abstract

BACKGROUND:

photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is a well described and widely practiced treatment for actinic keratoses (AKs) on the head and face. Less is known about its use for AKs on upper extremities, which can be challenging for the dermatologist. The aim of our study was to compare the combination of topical tacalcitol before 5-ALA-PDT vs conventional 5-ALA-PDT for acral AKs in a prospective, randomized, intra-individual clinical study.

METHODS:

patients with AKs of both upper extremities underwent keratolytic pretreatment with topical tacalcitol on the back of one hand and/or forearm (right vs left), randomly selected, for fifteen consecutive days before PDT. All patients underwent one session of 5-ALA-PDT. Visual analog scale for pain was assessed immediately after PDT session and any side effects were recorded after 3 days. Efficacy was evaluated with lesion count (LC) prior to treatment (V0) and 90 days (V1) after PDT.

RESULTS:

twenty-one patients with multiple acral AKs were enrolled and completed the study. At V1, neoadjuvant combination of topical tacalcitol plus PDT was significantly more effective than PDT alone (percentage reduction in total lesion count was 44.4 %. There was no significant difference in VAS pain score between the two treatment modalities. Mild erythema was the only local side effect reported for both treatment regimens (52.4 %, tacalcitol plus PDT vs 42.9 %, PDT alone).

CONCLUSIONS:

neoadjuvant use of topical tacalcitol might be useful to improve PDT efficacy, especially in hard-to-treat AKs on extremities.

• Authors: Francesco Borgia, Gabriella Riso, Fabio Catalano, Marialorena Coppola, Roberta Giuffrida, Serafinella Patrizia Cannavò
• Journal: Photodiagnosis and photodynamic therapy (Photodiagnosis Photodyn Ther) Vol. 31 Pg. 101803 (Sep 2020) ISSN: 1873-1597 [Electronic] Netherlands
• PMID: 32389738 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Chemical References

• Dihydroxycholecalciferols
• Photosensitizing Agents
• 1 alpha,24-dihydroxyvitamin D3
• Aminolevulinic Acid

Topics

• Aminolevulinic Acid (therapeutic use)
• Dihydroxycholecalciferols
• Humans
• Keratosis, Actinic (drug therapy)
• Neoadjuvant Therapy
• Photochemotherapy (methods)
• Photosensitizing Agents (therapeutic use)
• Prospective Studies
• Treatment Outcome