The Comparison Between Conventional Photodynamic Therapy and "Painless"TM Photodynamic Therapy in the Treatment of Actinic Keratosis: A Mini Review.

Actinic keratosis is a prevalent skin condition associated with prolonged exposure to ultraviolet radiation and serves as a precursor to squamous cell carcinoma. This condition arises from DNA mutations and abnormal cell growth triggered by ultraviolet rays. While uncertainties persist regarding the progression rate of actinic keratosis (AK) to squamous cell carcinoma, the significance of nonmelanoma skin cancers underscores the need for safe, efficient, cost-effective, and accessible treatment options. Factors such as number of lesions, skin type, and sun exposure increase the risk of progression into squamous cell carcinoma. Available therapeutics include cryosurgery, topical medications, laser ablation, field ablative treatments, and photodynamic therapy (PDT). PDT has emerged as a frontline choice for addressing widespread damage, demonstrating its effectiveness in impeding the carcinogenic progression of actinic keratosis. PDT utilizes topical photosensitizers such as 5-aminolevulinic acid or methyl aminolevulinate, followed by an incubation period and subsequent exposure to either red or blue light. Both light sources exhibit similar efficacy in treating actinic keratosis and are likely to possess distinct advantages and disadvantages. Conventional PDT presents the challenge of causing significant pain and inflammation. In contrast, 'painless' PDT minimizes incubation time and extends light exposure, showing similar efficacy and improved patient comfort. Insights into pain management during photodynamic therapy reveal a correlation to protoporphyrin IX tissue accumulation. Limiting the incubation time has demonstrated a decrease in protoporphyrin IX accumulation, thus reducing pain. Further research through larger trials is imperative to establish standardized protocols and validate the potential of 'painless' PDT in reducing patient discomfort during AK treatment while preserving effectiveness.Citation: Yousefian F, Ismaili A, Sachdeva S, et al. The comparison between conventional photodynamic therapy and ‘painless’ photodynamic therapy in the treatment of actinic keratosis: a mini review. J Drugs Dermatol. 2025;24(5):502-506. doi:10.36849/JDD.8638.