Topical Steroids Reduce Erythema from Photodynamic Therapy

Summary and Comment |
August 28, 2014

Topical Steroids Reduce Erythema from Photodynamic Therapy

  1. Craig A. Elmets, MD

A 39% increase in erythema with standard PDT was reduced to 18% with the addition of a potent steroid cream.

  1. Craig A. Elmets, MD

Photodynamic therapy (PDT) — in which delta aminolevulinate or methyl aminolevulinate (MAL) is applied to the skin and activated by exposure to visible light — effectively treats actinic keratoses (AKs). However, its use is associated with pain and erythema at the treatment site. In this randomized trial, investigators assessed the efficacy of a potent topical steroid to reduce these adverse effects.

In 22 patients, two areas of skin were treated with MAL and red light; one of the areas was pretreated with clobetasol cream before MAL application and again immediately after the compound was illuminated.

Immediately after illumination, erythemal response was similar in the two treatment sites. At 24 hours, erythema had increased significantly more in the MAL-only area than in the clobetasol-treated area (38.7% vs. 18.2%). Milder erythema was not caused by differences in photosensitizer use; similar amounts of activated compound were used in both areas. Application of the topical steroid did not impair the efficacy of MAL-PDT; both sites had equivalent declines in AKs. Topical steroids had no effect on procedure-associated pain.


Topical PDT is increasingly used as field therapy for nonhypertrophic AKs. Case reports and small series suggest that PDT may also be useful for other benign skin diseases (e.g., acne) and cosmetic rejuvenation. Two applications of a topical steroid are easy to do and might increase patients' acceptance of the procedure without reducing efficacy. However, the main complaint with PDT is the associated pain, and at this time, no procedures effectively reduce the pain. In this study, MAL was employed as the photosensitizing compound, and red light was used to activate it, but topical steroids are likely to have a similar effect on delta-aminolevulinic acid and blue-light PDT — the PDT type primarily used in the U.S.

Editor Disclosures at Time of Publication

  • Disclosures for Craig A. Elmets, MD at time of publication Consultant / Advisory board Astellas Pharmaceuticals Grant / Research support NIH; NIH/NCI; Veteran’s Administration; Ferndale Laboratories; Abbvie Editorial boards Cancer Prevention Research; Photodermatology, Photoimmunology, & Photomedicine; UpToDate; eMedicine; Journal of Dermatological Sciences Leadership positions in professional societies American Academy of Dermatology (Chair, Clinical Guidelines and Research Committee); Photomedicine Society (Board of Directors)


Reader Comments (1)

PhD Other Healthcare Professional, Allergy/Immunology, RETAIRED

We are going to treat patias after rediotherapy with those medicine. Thanks, Lucyr

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.