The Recurrence and Cosmetic Results After Topical Photodynamic Therapy

Background and Design: Photodynamic therapy (FDT) is a photochemotherapy modality which is used frequently and effectively in the treatment of actinic keratosis, Bowen disease and basal cell carcinomas. This study was performed to determine cure rates, cosmetic outcome and recurrence rates after aminolevulinic acid (ALA)-based photodynamic therapy for skin lesions showing complete response to treatment procedure. Material and Method: Sixty-eight patients (27 females and 41 males) with 78 lesions were included in the study. Among them, 25 were actinic keratosis (AK), 8 were actinic cheilitis (AC), 30 were basal cell carcinomas (BCC), 3 were Bowen disease, 10 were intraepidermal epithelioma (IEE), one lesion was parapsoriasis and one lesion was verruca plantaris. Six to 8 hours after topical administration of ALA (20%), the lesions were exposed to light from a broad-band light source. Skin biopsy specimens were obtained from 74 lesions for histopathological control. Results: At the end of the second month of treatment, fifty-six (72%) of seventy-eight lesions showed complete clinical response, whereas fourty-seven of 74 lesions (63.5%) exhibited complete histopathological clearance. A total of 9 recurrences (16%) was observed during a median follow-up of 36 months. Recurrence rates were 3 (14%) in AK, 1 (17%) in AC, 1 (8%) in superficial BCC, 3 (75%) nodular BCC and 1 (12.5%) in IEE. Cosmetic outcome was excellent and good in 42 lesions (89%), fair in 3 lesions (6%) and poor in 2 lesions (5%). Conclusion: Topical photodynamic therapy is a noninvasive, effective and cosmetic modality of treatment in the selected skin lesions, as an alternative to the conventional procedures.

Keywords: Photodynamic therapy, aminolaevulinic acid, recurrence, cosmetic result

Topikal Fotodinamik Tedavi Sonras? Rekürrens ve Kozmetik ?yile?me Sonuçlar?

Amaç: Fotodinamik terapi (FDT), aktinik keratoz, Bowen hastal??? ve yüzeyel bazal hücreli karsinom gibi lezyonlarda yayg?n ve etkin olarak kullan?lan bir fotokemoterapi yöntemidir. Bu çal??ma, topikal aminolevülinik asit (ALA) ve geni? bant ???k kayna?? ile ???nlama sonras? tedaviye tam yan?t veren deri lezyonlar?nda elde edilen kür oranlar?, rekürrens ve kozmetik iyile?me sonuçlar?n? de?erlendirmek için yap?lm??t?r. Gereç ve Yöntem: Alm?? sekiz hastadaki (27 kad?n, 41 erkek) 78 lezyon çal??ma kapsam?na al?nd?. Lezyonlardan 25’i aktinik keratoz, 8’i aktinik keilit, 30’u bazal hücreli karsinom, 3’ü Bowen hastal???, 10’u intraepidermal epitelyoma ve birer tanesi de parapsoriazis ve plantar verrükadan olu?maktayd?. Lezyonlar, topikal %20 ALA uygulamas? sonras? 6-8 saat süreyle inkübasyona b?rak?ld?ktan sonra geni? bant ???k kayna?? ile ???nland?. Histopatolojik kontrol için 74 lezyondan deri biyopsisi al?nd?. Bulgular: Tedaviden iki ay sonra yap?lan de?erlendirmede 78 lezyonun 56’s?nda (%72) tam yan?t elde edilirken, histopatolojik olarak 74 lezyonun 47’sinde (%63,5) tam düzelme sa?land??? görüldü. Ortalama 36 ayl?k takip sonunda ise toplam 9 (%16) rekürrens saptand?. Rekürrens oranlar? aktinik keratozda 3 (%14), aktinik keilitte 1(%17), yüzeyel bazal hücreli karsinomda 1 (%8), nodüler bazal hücreli karsinomda 3 (%75) ve intraepidermal epitelyomada 1 (%12,5) oldu. K?rk yedi lezyonun 42’si (%89) mükemmel ve iyi, 3’ü (%6) orta, 2’si (%5) kötü kozmetik sonuç ile iyile?me gösterdi. Sonuç: Topikal fotodinamik terapi, seçilmi? deri lezyonlar?nda standart tedavi yöntemlerine iyi bir alternatif olu?turan noninvaziv, etkin ve kozmetik bir tedavi yöntemidir.

Anahtar Kelimeler: Fotodinamik tedavi, aminolevülinik asit, rekürrens, kozmetik sonuç