New aspects in photodynamic therapy of actinic keratoses

Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) or its methyl ester (MAL) is a very effective method to treat actinic keratosis (AK). New developments will contribute to optimization of this treatment modality. This will partly be based on a better understanding of the nature of AKs. Since pain during treatment is a frequent side effect of PDT, new methods of alleviating pain are of high interest, especially when large areas are treated. A better understanding of the underlying mechanism of specific protoporphyrin IX (PPIX) accumulation can lead to further increase the response rates. New formulations might contribute to a wider acceptance of the treatment, for example a self-adhesive patch containing 5-ALA, promises easy handling, while maintaining high efficacy. New concepts in illumination, such as ambulatory PDT or daylight illumination might contribute to the further acceptance of this method. (C) 2009 Elsevier B.V. All rights reserved.