Daylight photodynamic therapy for severe facial and scalp actinic keratosis: a prospective non-sponsored single-centre study employing the actinic keratosis area and severity index (AKASI).

Daylight photodynamic therapy (DL-PDT) is an effective and convenient treatment for multiple actinic keratosis (AKs). There are limited tools to evaluate the outcome of AK treatment. Recently, the actinic keratosis area and severity index (AKASI) has been proposed as a quantitative tool for assessing AK severity. To investigate patient satisfaction and efficacy of DL-PDT for severe AKs and to validate AKASI scoring as a quantitative tool for assessing the outcome of DL-PDT treatment. In this prospective single-centre study, we analysed the results of patients treated with one or two cycles of DL-PDT for severe AKs in the facial or scalp area. Forty patients (37 male and three female) with a mean age of 74 years (range: 56-87 years) were included and received either one (n = 20) or two (n = 20) cycles of DL-PDT. At baseline, most patients (95%) had 20 or more lesions. Patients treated with one cycle of DL-PDT showed a mean AKASI reduction of 45.5% (p < 0.001). Patients eligible for two cycles of DL-PDT demonstrated a mean AKASI reduction of 23.7% (p < 0.05) after one and 48.2% (p < 0.001) after two cycles. Patients participating in this study were either very satisfied (67.5%) or satisfied (32.5%). Almost all patients (97.5%) would recommend DL-PDT to other patients. DL-PDT is a well-tolerated, safe and efficient treatment option for field cancerisation in the facial and scalp area with high patient satisfaction. AKASI scoring has proven useful as a quantitative tool for assessing the outcome of DL-PDT treatment.