背景:光化性角化病(AK)的光动力疗法(PDT)受到治疗深度的限制。微针或分数CO2激光可以促进光敏剂的穿透,虽然冷冻疗法可以治疗较深的组织,但不适合野外癌变。
目的:为了研究微针的疗效,分数CO2激光,冷冻治疗联合PDT治疗AK。
方法:AK患者随机分为4组,包括A组用微针+PDT,B组采用点阵CO2激光+PDT,C组采用冷冻疗法+PDT,和D组PDT。12周后,临床,皮肤镜,和反射共聚焦显微镜(RCM)结果进行评估。
结果:本研究共纳入129例患者,每组有31、30、35和31名患者,产生90.3%的临床反应率,93.3%,97.1%,74.2%,分别为(P=0.026)。RCM反应率为71.0%,80.0%,85.7%,和54.8%,分别为(P=0.030)。皮肤镜反应率为77.4%,83.3%,88.6%,和60.0%,分别为(P=0.039)。C组在临床上表现出最好的疗效,皮肤镜,和RCM结果。
结论:三种治疗方法均能提高PDT的疗效,且耐受性良好,冷冻疗法+PDT显示最佳疗效。
BACKGROUND: Photodynamic therapy (PDT) for actinic keratosis (AK) is limited by the depth of treatment.
Microneedling or fractional CO2 laser can facilitate the penetration of photosensitizer, while cryotherapy can treat deeper tissues but is not suitable for field cancerization.
OBJECTIVE: To investigate the efficacy of
microneedling, fractional CO2 laser, and cryotherapy in combination with PDT for AK.
METHODS: Patients with AK were randomized into 4 groups, including group A with
microneedling + PDT, group B with fractional CO2 laser + PDT, group C with cryotherapy + PDT, and group D with PDT. After 12 weeks, the clinical, dermoscopic, and reflectance confocal microscopy (RCM) outcomes were assessed.
RESULTS: A total of 129 patients were included in this study, with 31, 30, 35, and 31 patients in each group, yielding clinical response rates of 90.3%, 93.3%, 97.1%, and 74.2%, respectively (P=0.026). The RCM response rates were 71.0%, 80.0%, 85.7%, and 54.8%, respectively (P=0.030). The dermoscopic response rates were 77.4%, 83.3%, 88.6%, and 60.0%, respectively (P=0.039). Group C showed the best efficacy in terms of clinical, dermoscopic, and RCM outcomes.
CONCLUSIONS: All three treatments improved the efficacy of PDT and were well tolerated, with cryotherapy + PDT showing the best efficacy.