Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) is effective for treating multiple actinic keratoses (AKs). Ablative fractional laser (FL) creates vertical channels that may facilitate MAL delivery and improve PDT response.


To evaluate the efficacy of FL-assisted PDT (FL-PDT) in treating facial AKs in Korean patients.


A prospective randomized non-blinded trial initially evaluated 271 facial AKs in 45 patients. All patients underwent one session of MAL-PDT using a red light-emitting diode lamp at 37 J/cm2, and 23 patients with 135 AK lesions were randomly assigned to pre-treatment with a 2940-nm ablative fractional erbium:Yag laser. Patients were followed up at 1, 2 and 4 weeks and every month until 6 and 12 months post-treatment. Response, adverse events, cosmetic outcome and patient satisfaction were documented. Finally, a total of 236 facial AKs in 40 patients were enrolled and analysed in this study.


FL-PDT was significantly more effective than MAL-PDT at treating all AK grades (86.9% vs. 61.2%; < 0.001). The efficacy of FL-PDT was most pronounced in treating Olsen grade III AKs (69.4% vs. 32.5%; = 0.001). FL-PDT also showed a lower lesion recurrence rate than MAL-PDT (9.7% vs. 26.6%; = 0.004). Excellent or good cosmetic outcome was reported in >90% cases. Erythema and hyperpigmentation intensities were higher in the FL-PDT group (> 0.05). Side-effects were more frequent in the FL-PDT group, but these were mild and well tolerated (> 0.05).


FL-PDT is effective for treating AKs, especially moderate-to-thick lesions.