Randomized controlled trial comparing 35% trichloroacetic acid peel and 5-aminolevulinic acid photodynamic therapy for the treatment of multiple actinic keratosis

Summary

Background

Photodynamic therapy (PDT) and chemical peels with trichloroacetic acid (TCA) can be applied to larger skin areas and thus are suitable treatment options for patients with multiple actinic keratosis (AK). Despite its long use TCA has, however, only been investigated rarely in this indication.

Objectives

This randomized, observer-blinded, intrapatient comparison study sought to investigate the efficacy and safety of 35% TCA versus 20% aminolevulinic acid PDT (ALA PDT) in patients with extensive field cancerisation and multiple AK in the face or on the scalp.

Methods

28 patients with at least 5 AK in two comparable anatomical areas on the head were treated with 35% TCA and ALA PDT randomly assigned to each area. Therapeutic efficacy, adverse events and cosmetic outcome were assessed by a blinded investigator at 1, 3, 6 and 12 months after treatment.

Results

After 12-months follow up TCA and ALA PDT reduced the total lesion count, the primary outcome, by 31,9% and 58,0%, respectively (p=0,006). Complete clearance of preexisting AK were 48,8% for TCA and 73,7% for ALA PDT (p=0,011). Treatment failure (Number of AK greater than 50% of the baseline count) was observed in 7 patients (25%) after TCA and in 2 patients (7,1%) after PDT treatment. Treatment-related pain was significantly higher for ALA PDT (VAS 7,5±2,3 vs TCA: 5,1±2,6; p=0,04) whereas scarring (n=6, 21,4%) was only seen in TCA treated patients.

Conclusions

ALA PDT provided better clinical results than TCA in the treatment of patients with extensive field cancerisation and multiple AK.

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