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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.

Comment

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.

  • 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)

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