Intensified photodynamic therapy of actinic keratoses with fractional CO2 laser: a randomized clinical trial



This article is corrected by:

  1. Errata: Errata Volume 167, Issue 2, 461, Article first published online: 26 July 2012

  • Funding sources
    The study was funded by Department of Dermatology, Bispebjerg Hospital, University of Copenhagen and A.P. Møller Foundation for the Advancement of Medical Science. Lumenis Inc. (Santa Clara, CA, U.S.A.) lent the ablative fractional CO2 laser but had no role in the design or conduct of the trial and had no access to study data nor the preparation of the manuscript.

  • Conflicts of interest
    K.T.-B. has received a travelling grant from Galderma. C.S.H. and D.T.-P. have no disclosures. H.C.W. has received fees for speaking and a travelling grant from Galderma. R.R.A. is a consultant for Galderma (unrelated to this study). M.H. has received fees from Galderma for speaking and is on the advisory board for Galderma International regarding photodynamic therapy of organ transplant recipients.

Katrine Togsverd-Bo.


Background  Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is effective for thin actinic keratoses (AKs) in field-cancerized skin. Ablative fractional laser resurfacing (AFXL) creates vertical channels that facilitate MAL uptake and may improve PDT efficacy.

Objectives  To evaluate efficacy and safety of AFXL-assisted PDT (AFXL-PDT) compared with conventional PDT in field-directed treatment of AK.

Methods  Fifteen patients with a total of 212 AKs (severity grade I–III) in field-cancerized skin of the face and scalp were randomized to one treatment with PDT and one treatment with AFXL-PDT in two symmetrical areas. Following curettage of both treatment areas, AFXL was applied to one area using 10 mJ per pulse, 0·12 mm spot, 5% density, single pulse (UltraPulse®, DeepFx handpiece; Lumenis Inc., Santa Clara, CA, U.S.A.). MAL cream was then applied under occlusion for 3 h and illuminated with red light-emitting diode light at 37 J cm−2. Fluorescence photography quantified protoporphyrin IX (PpIX) before and after illumination.

Results  At 3-month follow-up, AFXL-PDT was significantly more effective than PDT for all AK grades. Complete lesion response of grade II–III AK was 88% after AFXL-PDT compared with 59% after PDT (= 0·02). In grade I AK, 100% of lesions cleared after AFXL-PDT compared with 80% after PDT (= 0·04). AFXL-PDT-treated skin responded with significantly fewer new AK lesions (AFXL-PDT = 3, PDT = 11; = 0·04) and more improved photoageing (moderate vs. minor improvement, = 0·007) than PDT-treated skin. Pain scores during illumination (6·5 vs. 5·4; = 0·02), erythema and crusting were more intense, and long-term pigmentary changes more frequent from AFXL-PDT than PDT (= not significant). PpIX fluorescence was higher in AFXL-pretreated skin [7528 vs. 12 816 arbitrary units (AU); = 0·003] and photobleached to equal intensities after illumination (AFXL-PDT 595 AU, PDT 454 AU; = 0·59).

Conclusions  AFXL-PDT is more effective than conventional PDT for treatment of AK in field-cancerized skin.