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Journal of the American Academy of Dermatology
Volume 66, n° 4
pages e131-e137 (avril 2012)
Doi : 10.1016/j.jaad.2011.11.933
accepted : 3 November 2011
JAAD Online

A randomized pilot comparative study of topical methyl aminolevulinate photodynamic therapy versus imiquimod 5% versus sequential application of both therapies in immunocompetent patients with actinic keratosis: Clinical and histologic outcomes

Carlos Serra-Guillén, MD a, , Eduardo Nagore, MD a, Luis Hueso, MD a, Victor Traves, MD b, Francesc Messeguer, MD a, Onofre Sanmartín, MD a, Beatriz Llombart, MD a, Celia Requena, MD a, Rafael Botella-Estrada, MD a, Carlos Guillén, MD a
a Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain 
b Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain 

Reprint requests: Carlos Serra-Guillén, MD, Instituto Valenciano de Oncología, Calle Beltrán Báguena, 8, 46009 Valencia, Spain.

Photodynamic therapy (PDT) and imiquimod are the treatments of choice for actinic keratosis (AK). As they have different mechanisms of action, it seems reasonable to assume that applying both treatments sequentially would be efficacious.


We sought to determine which of these therapeutic modalities provides a better clinical and histologic response in patients with AK and whether sequential use of both was more efficacious than each separately.


Patients were randomly assigned to one treatment group: group 1, PDT only; group 2, imiquimod only; or group 3, sequential use of PDT and imiquimod. The primary outcome measure was complete clinical response. Partial clinical response was defined as a reduction of more than 75% in the initial number of lesions. A complete clinicopathologic response was defined as lack of evidence of AK in the biopsy specimen.


In all, 105 patients completed the study (group 1, 40 patients; group 2, 33 patients; group 3, 32 patients). Sequential application of PDT and imiquimod was more efficacious in all the outcome measures. More patients were satisfied with PDT than with the other two modalities (P  = .003). No significant differences were observed among the 3 modalities and tolerance to treatment.


Only one cycle of imiquimod was administered. The follow-up period was brief.


Sequential application of PDT and imiquimod provides a significantly better clinical and histologic response in the treatment of AK than PDT or imiquimod monotherapy. It also produces less intense local reactions and better tolerance and satisfaction than imiquimod monotherapy.

The full text of this article is available in PDF format.

Key words : actinic keratosis, clinical response, comparative study, histologic response, imiquimod, photodynamic therapy, satisfaction, sequential, tolerant

 Funding sources: None.
 Conflicts of interest: None declared.

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