D Y Ko1, K H Kim, K H Song. 1. Skin Cancer Center, Department of Dermatology, College of Medicine, Dong-A University, Dong dae sin-dong, Seo-gu, Busan, 602-715, Korea.
Abstract
BACKGROUND:Methyl aminolaevulinate photodynamic therapy (MAL-PDT) is an effective treatment for Bowen disease (BD) of the lower extremities. Er:YAG (erbium:yttrium-aluminium-garnet) ablative fractional laser (AFL) treatment removes the stratum corneum to increase MAL uptake and may improve efficacy. However, no studies have directly compared the efficacy of MAL-PDT with and without Er:YAG AFL therapy in treating BD of the lower extremities in Asians. OBJECTIVES: To compare the efficacy, recurrence rate, cosmetic outcomes and safety between Er:YAG AFL-assisted MAL-PDT (Er:YAG AFL-PDT) and standard MAL-PDT. METHODS:Twenty-one patients with a total of 58 BD lesions randomly received either one session of Er:YAG AFL-PDT or two sessions of MAL-PDT in two symmetrical areas. Er:YAG AFL therapy was performed with 550-600 μm ablation depth, level 1 coagulation, 22% treatment density and a single pulse. MAL cream was then applied under occlusion for 3 h and illuminated with a red light-emitting diode lamp at 37 J cm(-2) . A second session of MAL-PDT was administered 7 days later. Overall response rate, recurrence rate, cosmetic outcomes and safety were assessed at 1 week, 3 and 12 months after treatment. RESULTS: After 3 months, Er:YAG AFL-PDT was significantly more effective (93.8%) than MAL-PDT (73.1%; P = 0.031), and the recurrence rate was significantly lower for Er:YAG AFL-PDT (6.7%) than MAL-PDT (31.6%) at 12 months (P = 0.022). No significant difference was found between Er:YAG AFL-PDT and MAL-PDT in terms of cosmetic outcomes or safety. CONCLUSIONS:Er:YAG AFL-PDT showed significantly higher efficacy and lower recurrence rate than did standard MAL-PDT for treating lower extremity BD in an Asian population.
RCT Entities:
BACKGROUND:Methyl aminolaevulinate photodynamic therapy (MAL-PDT) is an effective treatment for Bowen disease (BD) of the lower extremities. Er:YAG (erbium:yttrium-aluminium-garnet) ablative fractional laser (AFL) treatment removes the stratum corneum to increase MAL uptake and may improve efficacy. However, no studies have directly compared the efficacy of MAL-PDT with and without Er:YAG AFL therapy in treating BD of the lower extremities in Asians. OBJECTIVES: To compare the efficacy, recurrence rate, cosmetic outcomes and safety between Er:YAG AFL-assisted MAL-PDT (Er:YAG AFL-PDT) and standard MAL-PDT. METHODS: Twenty-one patients with a total of 58 BD lesions randomly received either one session of Er:YAG AFL-PDT or two sessions of MAL-PDT in two symmetrical areas. Er:YAG AFL therapy was performed with 550-600 μm ablation depth, level 1 coagulation, 22% treatment density and a single pulse. MAL cream was then applied under occlusion for 3 h and illuminated with a red light-emitting diode lamp at 37 J cm(-2) . A second session of MAL-PDT was administered 7 days later. Overall response rate, recurrence rate, cosmetic outcomes and safety were assessed at 1 week, 3 and 12 months after treatment. RESULTS: After 3 months, Er:YAG AFL-PDT was significantly more effective (93.8%) than MAL-PDT (73.1%; P = 0.031), and the recurrence rate was significantly lower for Er:YAG AFL-PDT (6.7%) than MAL-PDT (31.6%) at 12 months (P = 0.022). No significant difference was found between Er:YAG AFL-PDT and MAL-PDT in terms of cosmetic outcomes or safety. CONCLUSIONS: Er:YAG AFL-PDT showed significantly higher efficacy and lower recurrence rate than did standard MAL-PDT for treating lower extremity BD in an Asian population.