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Expert opinions at the 11th Annual Meeting
of the “European Society for Photodynamic Therapy”
Paris, May 2011
Actinic keratosis in view of immune modulation
“Consistent light protection is the most effective prophylactic method”, emphas - Sequence therapy optimizes
ized Dirschka. This also applies for people sustained therapeutic success developing new lesions can be reduced.
Actinic keratosis has become endemic, with a constant upward trend.
New innovative prophylactic and therapeutic approaches are needed since the
transformation rates are constantly increasing with manifestations of squamous
cell carcinoma and pronounced recurrence rates. According to expert opinions
during the 11th Annual Meeting of the European Society for Photodynamic
Therapy, new pathophysiological findings as well as current clinical trial data
suggest the use of a sequential combination approach composed of photodynamic
therapy (PDT) followed by topical immune modulation.
The prevalence of actinic keratosis varies Australia, for example, has a prevalence of carcinomas depends on lesions. In patients year and 11–26% in northern countries.
with untreated single lesions, the 10-year risk is between 6 – 16%, and 10 – 20% Incidence of actinic ceratosis* in Germany developing actinic keratosis“, emphasized Fig. 1: Incidence of actinic keratosis increases steadily O N K O D E R M E . V . –
the incidence rate sky rockets in the over A N O U T S T A N D I N G
■■ Selective surface therapy
■■ Not simply a cosmetic
Generally, carcinoma in situ due to actinic baga telle but carcinoma
onkoderm e.V., established in 2009 Dermato-Oncologists. The goal is to curettage and lasers as well as cytotoxic Actinic keratosis is, by definition, a UV- establish and to strengthen derma - dependent, early, squamous cell carcinoma tology as an integral part of medicine lesions, but do not affect the underlying (in situ), limited to the epidermal layer. and to optimize the quality of patient care. The 20 onkoderm centres with high relapse rate following the application over 40 specialists cover an area with well over 6 million residents. subclinical lesions, which occur in close as well as UV-induced suppression of cell- effect. Further treatment is necessary if and the destruction of neoplastic cells via is a vital process within the carcinogenic *Expert opinions during the 11th Annual Conference of the “Euro - pean Society for Photodynamic Therapy” on 10 March 2011 in Paris.
they are clinically manifest. In general, this Diagram: Combination therapy PDT and imiquimod
leads to an unsatisfactory cosmetic result. Imiquimod
According to the Guideline for “Actinic Keratosis“, published by the DDG (AWMF, cycles. The cosmetic result is better than Sequence therapy followed by PDT and imiquimod: a reasonable pathophysiological approach ■■ Sequential therapy
for sustained therapeutic
This data is consistent with results from a sign that imiquimod is effective; a specific explanation prior to the start of treatment sensible therapeutic strategy. “Follow-up lesions. The sustained treatment effect of ■■ Immune modulator deprives
actinic keratosis of its base
■■ Prior use of PDT increases
treatment comfort
“Immune Response Modifiers” (IRM). The comparative clinical trial presented at the substance binds to the toll-like receptors 7 ably alleviated when PDT is given prior to Nagore, Valencia, Spain, suggest the same findings. The prospective, random clinical identified receptors (TLR 1–10), which can keratosis on facial areas or bald patches.
medical practice. For patients this implies which are expressed on antigen presenting treatment that is far more comfortable. In cells. Dendritic cells establish the link to best clinical and histological results were sequential method. In addition, imiquimod should become well established in medical the Spanish study, the optimal strategy for New 4-tiered light protection concept for individual sun protection
Safe in the sun
An individualized sun protection concept offers the safest protection against
sun damage and skin cancer. Such an innovative, standardized concept for sun
protection advice available at dermatology practices has recently been developed by
the sun protection group of experts within the national network of practicing
The practical aspects of sun protection are Central America is photo protective.
melanocytic skin cancer has doubled every ten years. In 2009, this alarming increase ● Rules of conduct
Textile sun protection: Tightly woven
Usage of sun protection cream and
sun protection factors: The UV protec -
■■ Education in the hand
of the dermatologists
increased risk profile, even with short UV ● Oral sun protection: Oral sun protec -
■■ Sun protection starts
crown of the head. Scientific examinations with behaviour
As a matter of principle, the 4-tiered UV sunny regions outdoor activities should be oncologists in private practice (onkoderm terms of geographic location is often not e.V.) has developed a 4-tiered UV protec - tion model, which will for the first time central, western and southern Europe high noon is noticeably after 12 o’clock. The Recommended Sun Protection
Skin type and intensity of UV exposure are classed into four different risk levels (from normal to highly elevated). The combina - tion thus provides levels of different sun Table 1: The importance, i.e. of your individual skin type, particular environment and codes of conduct, pivotal point for sun protection advice is where your employment is concerned, increases in line in an easy to understand patient brochure. dermatologist in terms of individual risk SPF = sun protection factor in sun creams PLE = Polypodium Leucotomos Extract as an example of additional oral sun protection UPF = Standardized UV protection factor for textiles Innovative treatment for actinic keratosis
Combination therapy combines
improved effectiveness and superior tolerability

The advantages of sequence combination therapy with photodynamic therapy (PDT) followed by imiquimod is explained
in the following interview with Prof. Dr. Thomas Dirschka, Düsseldorf, and Prof. Dr. Uwe Reinhold, Bonn.
Why is the combination of imiquimod
Which patients do you prefer to treat
and PDT recommended for the
with this method?
treatment of actinic keratosis?
Dirschka: Combination treatment is
Dirschka: The marked advantage of this
extensive surface cancerification, which I effects occur and that the side effects of Will this treatment be used
Prof. Dr. Thomas Dirschka, Düsseldorf (left) in the future?
target structures, i.e. the pathologically and Prof. Dr. Uwe Reinhold, Bonn (right). Reinhold: That would be preferable. In
How is the combination tolerated?
transformed tissue, which is subsequently Reinhold: Prior PDT treatment markedly
recurrence, and can reinforce the level of thus causing a decrease in the imiquimod- Which treatment schedule do you
patients, especially those with pronounced choose for this combination?
How can the increased effectiveness of
field cancerification, also experience pain these therapies be explained?
Dirschka: We start with two cycles of
Reinhold: The phototoxic reaction during
How should patients be informed?
Two weeks later we start with Aldara, e.g.
three applications per week, for a total apoptosis of tumour cells and activates a Dirschka: Pronounced actinic keratosis
cellular immune response. However, not all Why is PDT treatment administered
during surface cancerification. Sub sequent local therapy with imiquimod can activate additional effector T-cells, which kill the Reinhold: The number of cells damaged
by actinic keratosis is significantly initially What is the recurrence rate compared
What is the marked advantage of
to conventional treatment options?
using such a combination?
Reinhold: Due to the currently limited
Dirschka: The cumulative effect prolongs
clinical trial data this question cannot, as the so called time-to relapse. Furthermore, yet be accurately answered. Moreover, the term relapse is not clearly defined. Does when using this combination is excellent. this include a time period of three, six or Editor and Design: Scriptamed All Medical only with the permission of the publishers


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