George Martin, MD
Eggert Stockfleth, MD
Ted Rosen, MD
Brian Berman, MD, PhD
ALA PDT can be made “painless” by incubating ALA for 15 mins on the skin followed by 1-hour of blue light activation (BLU-U). AK clearance rates appear to be equivalent to conventional (but off-label) 1-hour ALA incubation PDT in a small scale split face study and clinical experience in over 120 patients.
AKs are a chronic disease. Consider a chemoprevention strategy that includes not only sunscreens, topical retinoids and Vitamin B3 (nicotinamide 500 bid) and the use of 3.75% imiquimod daily for 1 week, 2 weeks off then once weekly indefinitely. Immune stimulation over time limits AK recurrences during a pilot study.
Field therapy is an essential component of the treatment of patients with actinic keratoses (AKs), and the presence of these lesions is a biomarker for field cancerization (the combination of visible AKs and subclinical lesions).