Topical Photodynamic Therapy with Different Forms of 5-Aminolevulinic Acid in the Treatment of Actinic Keratosis

Joanna Bartosińska; Paulina Szczepanik-Kułak; Dorota Raczkiewicz; Marta Niewiedzioł; Agnieszka Gerkowicz; Dorota Kowalczuk; Mirosław Kwaśny; Dorota Krasowska

doi:10.3390/pharmaceutics14020346

Topical Photodynamic Therapy with Different Forms of 5-Aminolevulinic Acid in the Treatment of Actinic Keratosis

Pharmaceutics. 2022 Feb 1;14(2):346. doi: 10.3390/pharmaceutics14020346.

Authors

Joanna Bartosińska¹, Paulina Szczepanik-Kułak², Dorota Raczkiewicz³, Marta Niewiedzioł², Agnieszka Gerkowicz², Dorota Kowalczuk⁴, Mirosław Kwaśny⁵, Dorota Krasowska²

Affiliations

¹ Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, Chodźki 1 St., 20-093 Lublin, Poland.
² Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Staszica 11 St., 20-081 Lublin, Poland.
³ Department of Medical Statistics, School of Public Health, Center of Postgraduate Medical Education, Kleczewska 61/63 St., 01-826 Warsaw, Poland.
⁴ Department of Medicinal Chemistry, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 4 St. 20-090 Lublin, Poland.
⁵ Institute of Optoelectronics, The Military University of Technology, Kaliskiego 2 St., 01-476 Warsaw, Poland.

Abstract

Photodynamic therapy (PDT) is safe and effective in the treatment of patients with actinic keratosis (AK). The aim of the study was to assess the efficacy, tolerability and cosmetic outcome of topical PDT in the treatment of AKs with three forms of photosensitizers: 5-Aminolevulinic acid hydrochloride (ALA-HCl), 5-Aminolevulinate methyl ester hydrochloride (MAL-HCl) and 5-Aminolevulinate phosphate (ALA-P). The formulations were applied onto selected scalp/face areas. Fluorescence was assessed with a FotoFinder Dermoscope 800 attachment. Skin areas were irradiated with Red Beam Pro+, Model APRO (MedLight GmbH, Herford, Germany). Applied treatments were assessed during the PDT as well as 7 days and 12 weeks after its completion. Ninety-four percent of patients rated obtained cosmetic effect excellent. The efficacy of applied PSs did not differ significantly. However, pain intensity during the PDT procedure was significantly lower in the area treated with ALA-P (5.8 on average) in comparison to the areas treated with ALA-HCl or MAL-HCl (7.0 on average on 0-10 scale). Obtained results show that ALA-P may undergo more selective accumulation than ALA-HCl and MAL-HCl. Our promising results suggest that PDT with the use of ALA-P in AK treatment may be an advantageous alternative to the already used ALA-HCl and MAL-HCl.

Keywords: 5-aminolevulinic acid; actinic keratosis; photodynamic therapy; photosensitizer.