Photodiagnosis and photodynamic therapy · 2026
Advances in enhancing photodynamic therapy for actinic keratoses and field-damage with laser pretreatments: A scoping review.
СтатьяScoping ReviewНазвание и аннотация: Перевод в очереди
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Boostani Mehdi, Giordano Cerrene N, Kuraitis Drew, Brady Kimberly L, Bax Michael J, Kiss Norbert, Zeitouni Nathalie C, Paragh Gyorgy
Аннотация
BACKGROUND: Actinic keratoses (AKs) arise in chronically ultraviolet-damaged skin and may progress to cutaneous squamous cell carcinoma. Photodynamic therapy (PDT) is an established field-directed treatment, but efficacy may be limited by lesion thickness, hyperkeratosis, inadequate photosensitizer penetration, acral location, and immunosuppression. Laser pretreatment may enhance PDT by disrupting the epidermal barrier and improving photosensitizer delivery.
OBJECTIVE: To identify and summarize the clinical evidence on laser pretreatment before PDT for AKs and field cancerization, and compare outcomes with non-laser-pretreated PDT.
METHODS: A scoping review was conducted according to PRISMA-ScR guidance. Embase, Scopus, and PubMed were searched on May 6, 2026, for English-language human studies evaluating laser pretreatment before PDT for AKs or field cancerization. Data were extracted on study design, population, laser device, PDT protocol, outcomes, and adverse events. Methodological quality was assessed using the Mixed Methods Appraisal Tool.
RESULTS: 14 studies were included. Seven used carbon dioxide (CO2) ablative fractional laser pretreatment, six used erbium:yttrium-aluminum-garnet (Er:YAG) ablative fractional laser pretreatment, and one used fractional 1927-nm thulium laser pretreatment. Eleven studies directly compared laser-pretreated PDT with non-laser PDT, and three provided supportive evidence without a non-laser PDT comparator. Overall, laser pretreatment improved AK clearance, early lesion reduction, or sustained clearance. Laser pretreatment also reduced recurrence in several trials and maintained higher lesion-specific clearance. Benefits were most evident for thicker lesions and treatment-resistant fields. Adverse events were usually local and transient.
CONCLUSION: Laser pretreatment, particularly with ablative fractional Er:YAG or CO2 lasers, can improve outcomes for AKs and field cancerization.
OBJECTIVE: To identify and summarize the clinical evidence on laser pretreatment before PDT for AKs and field cancerization, and compare outcomes with non-laser-pretreated PDT.
METHODS: A scoping review was conducted according to PRISMA-ScR guidance. Embase, Scopus, and PubMed were searched on May 6, 2026, for English-language human studies evaluating laser pretreatment before PDT for AKs or field cancerization. Data were extracted on study design, population, laser device, PDT protocol, outcomes, and adverse events. Methodological quality was assessed using the Mixed Methods Appraisal Tool.
RESULTS: 14 studies were included. Seven used carbon dioxide (CO2) ablative fractional laser pretreatment, six used erbium:yttrium-aluminum-garnet (Er:YAG) ablative fractional laser pretreatment, and one used fractional 1927-nm thulium laser pretreatment. Eleven studies directly compared laser-pretreated PDT with non-laser PDT, and three provided supportive evidence without a non-laser PDT comparator. Overall, laser pretreatment improved AK clearance, early lesion reduction, or sustained clearance. Laser pretreatment also reduced recurrence in several trials and maintained higher lesion-specific clearance. Benefits were most evident for thicker lesions and treatment-resistant fields. Adverse events were usually local and transient.
CONCLUSION: Laser pretreatment, particularly with ablative fractional Er:YAG or CO2 lasers, can improve outcomes for AKs and field cancerization.