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Polypodium leucotomos supplementation in the treatment of scalp actinic keratosis: could it improve the efficacy of photodynamic therapy?

  • 2015-08
  • Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 41(8)
    • Matteo Auriemma
    • Marta Di Nicola
    • Salvador Gonzalez
    • Stefano Piaserico
    • Alessandra Capo
    • Paolo Amerio

Study Design

Type
Randomized Controlled Trial (RCT)
Population
34 bald patients with actinic keratoses on the scalp
Methods
Alternative assignment, two PDT sessions one week apart, PLE supplementation started one week after last PDT in one group
Blinding
Open-label
Duration
6 months
Funding
Unclear

Background

Actinic keratoses (AKs) are a common premalignant skin condition. Many treatments are available for AKs. Photodynamic therapy (PDT) is one of the most effective treatments. However, major concerns exist on the possibility of PDT-induced DNA-mutagenesis/immunosuppression, leading to AKs recurrence/treatment failure. An extract (PLE) from the fern polypodium leucotomos reduces UV-induced immunosuppression and mutagenesis.

Objective

To assess the ability of PLE to enhance the efficacy of PDT treatment, reducing AKs recurrence on the scalp.

Materials and methods

Thirty-four bald patients presenting at least two AKs on the scalp were alternatively assigned to two groups. Both groups underwent two PDT-sessions one-week apart. The first group began oral PLE supplementation one week after the last PDT session. Evaluation of the effect of PLE supplementation was performed by direct inspection of the bald areas, lesions count, and photodynamic diagnosis assessment at 2 and 6 months.

Results

Both groups were homogeneous in terms of skin phototype and previous UV exposure. Mean age was 75.7 ± 7.8 years and 76.5 ± 5.5 years, respectively. Both treatment modalities were successful in reducing AKs number (p < .001). However, PLE supplementation increased clearance rate compared with PDT alone (p = .040).

Conclusion

Polypodium leucotomos improves PDT clearance and decreases AK recurrence rate at 6 months, suggesting its use as a complementary agent in the treatment of field cancerization.

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