Photodynamic Therapy Combined with Curettage for Actinic Keratosis on the Face and Scalp: An Efficient Management for Field Cancerization.

Abstract

Background: Actinic keratosis (AK) frequently manifests as multiple regional lesions on the exposed areas of the face and scalp. The simultaneous treatment of extensive lesions with varying degrees poses a significant challenge.

Objective: This study evaluated the efficacy and patient satisfaction of 5-aminolevulinic acid (5-ALA) photodynamic therapy (PDT) combined with curettage in managing extensive AK on the face and scalp.

Methods: A retrospective analysis was conducted on patients with AK on the face and scalp treated at the dermatology department of a large hospital in a central Chinese city from 2020 to 2024. Each patient was histopathologically confirmed, exhibited a large lesion area exceeding 10 cm², and demonstrated evident field cancerization. All patients underwent curettage followed by 5-ALA PDT. During a 6-month follow-up, patient self-assessment and physician evaluations were conducted to systematically assess the treatment's efficacy, satisfaction, and adverse reactions.

Results: Fifty-six patients (38 females, 18 males) with a mean age of 76.26±9.16 years were included. Significant improvement in skin was observed, with the lesion count decreasing from 12.33±9.09 pretreatment to 1.98±1.50 post-treatment. Pain scores (VAS) decreased from 2.89±2.20 to 0.75±1.03, pruritus scores (NAS) from 2.46±0.95 to 0.51±0.73, and dermatology life quality index (DLQI) scores from 9.12±4.46 to 2.59±2.17. The primary adverse effect was pain during PDT.

Conclusion: Curettage combined with 5-ALA PDT is an efficacious, safe, and efficient treatment for field cancerization of extensive AK on the face and scalp, warranting its promotion in clinical practice.