Pre-treatment with topical 5-fluorouracil increases the efficacy of daylight photodynamic therapy for actinic keratoses - A randomized controlled trial

BACKGROUND: Daylight photodynamic therapy (dPDT) and topical 5-fluorouracil (5-FU) are each effective treatments for thin grade I actinic keratosis (AKs), but less so for thicker grade II-III AKs. Prolonged topical treatment regimens can be associated with severe skin reactions and low compliance. This study compares the efficacy of sequential 4 % 5-FU and dPDT with dPDT monotherapy for multiple actinic keratoses.METHODS: Sixty patients with a total of 1547 AKs (grade I: 1278; grade II: 246; grade III: 23) were treated in two symmetrical areas (mean size 75 cm2) of the face or scalp, which were randomized to (i) 4% 5-FU creme twice daily for 7 days before a single dPDT procedure and (ii) dPDT monotherapy. Daylight exposure was either outdoor or indoor daylight.RESULTS: Twelve weeks after treatment 87 % of all AKs cleared after 5-FU+dPDT compared to 74 % after dPDT alone (p&lt;0.0001). For grade II AKs, the lesion response rate increased from 55 % with dPDT monotherapy to 79 % after 5-FU+dPDT (p&lt;0.0056). Moderate/severe erythema was seen in 88 % 5-FU+dPDT areas compared to 41 % of dPDT areas two days after dPDT. Twelve weeks after treatment 75 % of the patients were very satisfied with both treatments.CONCLUSIONS: Sequential 5-FU and dPDT was more effective than dPDT monotherapy in the treatment of AKs, especially for grade II AKs. Local skin reactions were more pronounced after combination treatment, but no patients discontinued the treatment. The combination of 5-FU and dPDT is an effective treatment of large treatment areas with high compliance and satisfaction.</p

Mycobacterium marinum infection cured by photodynamic therapy

Mycobacterium marinum is the cause of swimming-pool granuloma, which most commonly occurs in patients exposed to fish or fish tanks. Mycobacterium marinum contains porphyrins (coproporphyrin III),1 which are activated by appropriate wavelengths of light leading to the development of various cytotoxic compounds that damage essential cellular components. We report a case of M marinum infection treated with blue light, red light, and photodynamic therapy (PDT). Report of a Case A 59-year-old woman was referred to our department with a 1.5-year history of erythematous granuloma on the dorsal surface of her left fifth finger after a burn (Figure 1A). The patient regularly had contact with fish tanks