背景:日光光动力疗法(DL-PDT)在治疗光化性角化病(AKs)方面具有与常规光动力疗法相似的功效。当与微针等物理方法相关时,已经报道了良好的临床结果,但是缺乏不同方法和组织学研究的比较。
目的:评估标准DL-PDT引起的临床和组织学改变,并与DL-PDT结合物理方法治疗面部皮肤区域癌变进行比较。
方法:将40例皮肤光损伤且面部至少有一个AK损伤的患者随机分为4组,每位10名患者(I:标准DL-PDT;II:DL-PDT微针;III:DL-PDTCO2激光;IV:DL-PDT微晶磨皮),并接受了两次使用氨基乙酰丙酸甲酯乳膏和2小时日光暴露的DL-PDT治疗。所有患者均在手术前和术后3个月进行皮肤活检。所有碎片都用苏木精-伊红染色,orcein,还有picrosirius.
结果:所有40例患者均完成研究。在1个月(p=0,002)和3个月(p=0,034)后,第III组的AK清除率更高,但6个月时每组相似(p=0,441)。第III组和第IV组在质地上有更好的临床整体改善,色素沉着和细纹。在与物理方法关联的组中,角质形成细胞的异型性和日光弹性增生的改善是显著的。治疗后,只有第III组显示日光弹性增生显着减少(p=0.034)和I型胶原蛋白增加(p=0.028)。
结论:与物理方法相关的DL-PDT具有更好的临床和组织学结果。预处理CO2激光1个月和3个月后,AK清除率显着提高。预处理CO2激光和微晶磨皮更明显。预处理-CO2激光显示日光弹性增生的显着减少和1型胶原蛋白的增加。这些结果表明,激光预处理可能是面部皮肤区域癌变的更好选择。
BACKGROUND: Daylight photodynamic therapy (DL-PDT) has similar efficacy to conventional photodynamic therapy in treating actinic keratosis (AKs). Good clinical outcomes have been reported when associated with physical methods such as microneedles, but a comparison of different methods and histologic studies is lacking.
OBJECTIVE: To evaluate clinical and histologic modifications induced by standard DL-PDT and compare with DL-PDT associated with physical methods in treating skin field cancerization of the face.
METHODS: Forty patients with photodamaged skin and at least one AK lesion on the face were randomly distributed into four groups, ten patients in each (I: Standard DL-PDT; II: DL-PDT + microneedles; III: DL-PDT + CO2 laser; IV: DL-PDT + microdermabrasion) and underwent two DL-PDT sessions with methyl aminolevulinate cream and 2-hour daylight exposure. Skin biopsies were performed on all patients before and 3 months after. All fragments were stained using the hematoxylin-eosin, orcein, and picrosirius.
RESULTS: All 40 patients completed the study. Group III had a higher AK-clearance after 1 (p = 0,002) and 3 (p = 0,034) months, but it was similar in every group at 6 months (p = 0,441). Group III and IV had better clinical global improvement on texture, pigmentation and fine lines. In the groups associated with physical methods, the improvement of the keratinocytes\' atypia and solar elastosis were remarkable. Only group III showed a significant reduction in solar elastosis (p = 0.034) and increased collagen type I (p = 0.028) after treatment.
CONCLUSIONS: DL-PDT-associated with physical methods had better clinical and histologic results. AK-clearance were significantly higher after 1 and 3 months with pretreatment-CO2 laser. Photorejuvenation were more evident with pretreatment-CO2 laser and microdermabrasion. Pretreatment-CO2 laser showed a significant reduction in solar elastosis and increase of collagen type 1. These results pointed to the pretreatment with laser as a potentially better option for skin field cancerization of the face.