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Use of 5-Aminolevulinic Acid and Daylight Photodynamic Therapy for the Treatment of Actinic Keratoses

Shive, Melissa L., MD, MPH*; Coakley, Brandon J., MD; Bierman, Dina F., MD; Serowka Lane, Kathryn L., MD§; Wiegell, Stine R., MD, PhD, DMSc; Haedersdal, Merete, MD, PhD, DMSc; Zachary, Christopher B., MBBS, FRCP*

doi: 10.1097/DSS.0000000000001771
Original Article

BACKGROUND Photodynamic therapy (PDT) is an effective modality for the treatment of actinic keratoses (AKs). The use of methyl aminolevulinate with daylight PDT (D-PDT) has quickly gained popularity internationally because of its tolerability and high levels of safety and efficacy. However, there is a paucity of studies on the use of D-PDT with 5-aminolevulinic acid (ALA).

OBJECTIVE To study the safety and efficacy of D-PDT in treating AKs on the face and scalp using ALA.

MATERIALS AND METHODS Thirty patients were recruited for this prospective, uncontrolled study. Patients were treated with topical ALA on either the scalp or face, incubated for 30 minutes, and then sat at home in a shady area for 2 hours. Weather conditions, lux measurements, and AK counts at 3 and 6 months were measured.

RESULTS Daylight PDT led to a median of 75% reduction in AK count at 6 months, with no significant adverse effects. Ninety-six percentage of patients were either moderately or very satisfied with the treatment, and the median peak pain score during treatment was 1. There was no correlation between weather or average lux received during treatment and 6-month outcomes.

CONCLUSION Daylight PDT with ALA is a safe and effective treatment modality for AKs on the head.

*Department of Dermatology, University of California, Irvine, California;

Dermatology and Laser Center of Charleston, Charleston, South Carolina;

Division of Dermatology, University of California, Los Angeles, California;

§Division of Dermatology, Kaiser Permanente, Riverside, California;

Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

Address correspondence and reprint requests to: Christopher Zachary, FRCP, Department of Dermatology, 118 Medical Surge I, Irvine, CA 92697-2400, or e-mail:

Supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery.

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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