Actinic Cheilitis Clinical Trial
Official title:
A Randomized, Prospective Study Comparing Methyl Aminolaevulinate Photodynamic Therapy With and Without Er:YAG Ablative Fractional Laser Treatment for Actinic Cheilitis
Methyl aminolaevulinate photodynamic therapy (MAL-PDT) is advantageous in that it has few cosmetic side effects and minimises patient discomfort. However, its relatively low efficacy prevents its application to the treatment of actinic cheilitis(AC). Er:YAG ablative fractional laser (AFL) treatment removes the stratum corneum to increase MAL uptake and may improve efficacy. However, no studies have directly compared the efficacy of MAL-PDT with and without Er:YAG AFL in treating AC
Actinic cheilitis (AC) is a keratinocytic neoplasm of the lip, especially the lower lip, is
confined to the epidermis, and results from chronic or excessive ultraviolet exposure. AC is
an early manifestation of lip squamous cell carcinoma (SCC), and SCC of the lip is usually
associated with an identifiable pre-existent AC. Furthermore, the likelihood that AC will
progress to SCC is higher than actinic keratosis (AK). Consequently, early identification
and treatment of AC is recommended. PDT involves the activation of a photosensitizer by
irradiation with 400- to 700-nm light to create cytotoxic oxygen and free radicals that kill
dysplastic cells.
Methyl aminolaevulinate photodynamic therapy (MAL-PDT) is advantageous in that it has few
cosmetic side effects and minimises patient discomfort. However, its relatively low efficacy
prevents its application to the treatment of actinic cheilitis(AC).
Erbium:yttrium-aluminium-garnet (Er:YAG) ablative fractional laser (AFL) therapy has been
used frequently to improve treatment efficacy of PDT. Er:YAG AFL can ablate stratum corneum
with minimal penetration depth and producing minimal thermal injury. This approach creates
microscopic vertical holes in the ablated tissue, surrounded by thin layers of coagulated
tissue. Er:YAG AFL does not injure the entire thickness of the epidermis; therefore, healing
times are minimised. Erbium:yttrium-aluminium-garnet (Er:YAG) ablative fractional laser
(AFL) has been proven in recent studies to facilitate the delivery and uptake of topical MAL
deep into the skin, enhancing porphyrin synthesis and photodynamic activation.
The aim of our study was to compare efficacy, recurrence rate, cosmetic outcome, and safety
between Er:YAG AFL-assisted MAL-PDT (Er:YAG AFL MAL-PDT) and standard MAL-PDT in patients
with AC.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Factorial Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment
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