Spanish-Portuguese Consensus Statement on the Use of Daylight Photodynamic Therapy With Methyl Aminolevulinate in the Treatment of Actinic Keratosis

Abstract

IntroductionDaylight photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in mild and moderate actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol. ObjectiveWe describe a protocol for the treatment of grade I and II actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries. MethodsTwelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol. ResultsAccording to the recommendations adopted, patients with multiple mild and moderate lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours. ConclusionThis consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight PDT with MAL in Spain and Portugal with minimal adverse effects.