Morton

Title: Methyl aminolevulinate: actinic keratoses and Bowen’s disease

Author: Colin A. Morton

Journal Reference: Dermatol Clin 2006;142:729-35 (by clicking on this link you will be leaving this site - Galderma is not responsible for the content)

Objective: Review of the use of methyl aminolevulinate (MAL; Metvix®) PDT in actinic keratoses (AK) and Bowen’s disease

Key statements

Actinic keratoses

  • Across five large randomised studies of patients with actinic keratoses, MAL-PDT achieved clearance rates of 69–92%. In a smaller study, MAL-PDT cleared AK in 13 of 17 patients, and produced a partial clearance in 3 more.
  • In three of the six studies that compared MAL-PDT with cryotherapy, MAL-PDT was found to have better cosmetic outcome.
  • MAL-PDT shows high efficacy for thin- to moderate-thickness AK, with good cosmesis, and has potential in immunosuppressed patients.

Bowen’s disease

  • In a recent study of MAL-PDT vs cryotherapy or 5-fluorouracil (n=225), MAL-PDT was associated with three-month clearance rates of 93%, compared with 86% for cryotherapy and 83% for 5-fluorouracil.

Conclusions

  • MAL-PDT is efficacious in the treatment of non-hyperkeratotic AK and Bowen’s disease, with good cosmesis.
  • MAL-PDT should now be considered as a first-line treatment in actinic keratoses and Bowen’s disease, ‘especially if multiple, large, or in cosmetically sensitive sites’.