Photodynamic daylight therapy

Method used for the photodynamic treatment of actinic keratoses by means of daylight applications. Methyl-5-amino-4-oxopentanoate is used as a photodynamically effective externum, which is also used when artificial light sources are used.

Actinic keratoses I and II, face and capillitium, since 2020 also for mild to moderate actinic keratoses in the area of the trunk, neck or extremities with Ameluz®.

Practical procedure for the daylight therapeutic Luxerm®.

First, a photoprotective preparation (SPF 50+ - ® is recommended) is applied to the lesion to be treated and its surroundings. This should be left on for at least 15 minutes. The lesional skin is then prepared for treatment with an abrasive pad. The topical is then applied thinly to the diseased area with a wooden spatula. The therapeutic agent must not come into contact with the eyes! Afterwards the hands are to be cleaned with water and a washing lotion.

After 30 minutes at the latest the patient goes outdoors where he stays for 2 hours. A light intensity of at least 2300 lux is required. It is not necessary to stay in the blazing sun. Shade (tree or sunshade possible, not between high-rise buildings) is sufficient. The treatment also works on cloudy days, not in rain.

After the 2 hours stay outdoors, the active substance cream is carefully washed off. The patient should not expose the affected skin areas to sunlight for the following 48 hours, textile light protection or stay indoors. After this time, the photoactive effect of the drug has worn off.

During exposure, sunburn-like pain sensations may occur.

Alternatively: (with similar good or even better results) an artificial light source e.g. in the quality of a surgical light can be used (O'Gorman 2016), resp. MultiLite®: daylight PDT- lamp can be used. Here, the irradiation is carried out after 1 hour of exposure time of the sensitizer and lasts a little more than 30 minutes. A sunscreen is not required in advance for the daylight lamp, as no UV rays are emitted.

After the treatment, the lesional skin is red and sensitive to touch. The redness usually lasts for 1 week. Rarely, a stronger inflammatory reaction with swelling may occur, which should then be treated with a wound healing ointment.

After about 2 weeks, the top layer of skin will flake off.

After another 2 weeks, a further treatment with the same procedure may be necessary, this will be decided on the occasion of the follow-up control.

1. Calzavara-Pinton P et al(2016) Bucher's indirect comparison of daylight photodynamic therapy with methyl aminolevulinate cream versus diclofenac plus hyaluronic acid gel for the treatment of multiple actinic keratosis. Eur J Dermatol 26:487-492.
2. Fargnoli MC et al (2016) Long-term efficacy and safety of daylight photodynamic therapy with methyl aminolevulinate for actinic keratosis of the face and scalp. Eur J Dermatol PubMed PMID: 27748261.
3. Grinblat B et al(2016) Feasibility of daylight-mediated photodynamic'therapy for actinic keratosis throughout the year in Central and South America: a meteorological study. Int J Dermatol 55:e488-493.
4. Ibbotson S et al.(2016) A consensus on the use of daylight-mediated photodynamic'therapy in the UK. J Dermatolog Treat. 2016 Oct 27:1-8 PubMed PMID: 27788605.
5. O'Gorman SM et al (2016) Artificial White Light vs Daylight Photodynamic Therapy for Actinic Keratoses: A
   Randomized Clinical Trial. JAMA Dermatol 152:638-44.
6. Moggio E et al.(2016) A randomized split-face clinical trial analyzing daylight photodynamic therapy with methyl aminolaevulinate vs ingenol mebutate gel for the treatment of multiple actinic keratoses of the face and the scalp. Photodiagnosis Photodyn Ther 16:161-165.