Randomized, Controlled Trial of Fractional Carbon Dioxide Laser Resurfacing Followed by Ultrashort Incubation Aminolevulinic Acid Blue Light Photodynamic Therapy for Actinic Keratosis

BACKGROUND Aminolevulinic acid (ALA) photodynamic therapy (PDT) is an established treatment option for actinic keratosis (AK), and recently fractional carbon dioxide (CO2) laser was shown to improve outcomes; but studies of short incubation photosensitizer are lacking. OBJECTIVE Assess the efficacy of short incubation ALA followed by blue light PDT with and without previous fractional CO2 treatment for the treatment of AK. METHODS Randomized, paired split-design, controlled trial of fractional CO2 followed by ultrashort 15-minute versus 30-minute incubation ALA and blue light PDT for the treatment of AK on the face. RESULTS The complete clearance rates (CRs) at 8 weeks after ALA PDT with and without FxCO(2) at 30- and 15-minute ALA incubation times were 89.78% (+FxCO(2)) versus 71.20% CR (-FxCO(2)) at 309, and 86.38% (+FxCO(2)) versus 69.23% (-FxCO(2)) at 159 ALA incubation. All lesion improvements were statistically significant. CONCLUSION This randomized, comparative paired group controlled clinical study demonstrates that ultrashort 15- and 30-minute incubation ALA PDTs are of limited efficacy for the treatment of AK. Pretreatment with fractional ablative resurfacing yields statistically significant greater AK clearance with ALA-PDT at ultrashort ALA incubations followed by blue light.