Journal of Clinical and Aesthetic Dermatology

Psoriasis and Cutaneous Supplement 2016

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: http://jcadonline.epubxp.com/i/729153

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S 2 0 S U P P L E M E N T T O T H E J O U R N A L O F C L I N I C A L A N D A E S T H E T I C D E R M AT O L O G Y [ S E P T E M B E R 2 0 1 6 • V O L U M E 9 • N U M B E R 9 ] patient applied sunscreen and was asked to walk outside for 1.5 or 2.5 hours (two treatment groups). Daylight exposure was monitored using a wristwatch- type dosimeter calibrated to 412nm. A total of 120 patients with 1,572 thin AKs on the face and/or scalp participated in the study. The mean lesion response rate at three months was about 75 percent for both treatment groups with grade 1 AKs. The mean overall effective light dose was 9.4J/cm 2 (range 0.2–28.3), and the response rate was not associated with the effective daylight dose, exposure duration (1.5 or 2.5 hours), time of day, or time of year. Patients were asked to rate their pain on an 11-point numeric scale with 0 representing no pain at all and 10 being the worst pain imaginable. Ninety-two percent of patients rated their pain 0 to 3, meaning they experienced little to no pain with treatment. Moderate pain was reported by 7.5 percent of patients (pain score 4–7), and only one patient (0.8%) reported severe pain (range 8–10). Intriguingly, in this study there was no correlation between pain and efficacy. While "daylight mediated" PDT could be a game- changing therapeutic option for field AK therapy, there are some limitations to its use. Since it relies on daylight, weather represents a confounding and uncontrollable variable and there is no standardized way to dose light exposure. There may be times of year or locations in which this treatment is simply not possible. Furthermore, the therapy requires the patient to spend some time outdoors in an environment that is not clinically supervised or controlled. Perhaps most restricting is the fact that this new painless PDT protocol is not yet covered by insurance; reimbursement for PDT-ALA requires exposure to blue light in a clinical setting. A novel iteration to painless PDT evolved in the form Figures 3A and 3B. Clearance rates for PDT-ALA using a 14-hour incubation protocol (n=110) and results at one year Figures 4A and 4B. A fluorokinetic analysis carried out after ALA application predicts ALA accumulation patterns

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