Daylight methyl‐aminolevulinate photodynamic therapy versus ingenol mebutate for the treatment of actinic keratoses: an intraindividual comparative analysis

Daylight‐photodynamic therapy (D‐PDT) and ingenol mebutate (IM) are novel therapies directed to actinic keratoses (AK). The purpose of our study was to compare effectiveness, tolerability, cosmetic outcome and patient preference of D‐PDT versus IM in the treatment of grade I and II AK. Twenty‐seven patients with AK on the face or scalp were enrolled. Each patient received, in a 25 cm² target area, D‐PDT on right side and IM on left side. Overall 323 AK were treated. Both target areas achieved complete response in 40.47% of the cases and average AK clearance rate was similar for D‐PDT and IM (p=0.74). In D‐PDT areas mean grade II AK clearance rate was lower compared with that of grade I AK (p=0.015). In IM areas grade I and II AK average clearance rates were similar (p=0.28). At week 1 and month 1, mean local skin responses (LSR) score were higher in areas treated with IM. IM areas showed more severe pain and cosmetic sequelae. D‐PDT had similar effectiveness to IM, even if IM demonstrated higher grade II AK clearance rate. Tolerability profile was superior for D‐PDT in terms of LSR and pain. D‐PDT was more cosmetically acceptable. Patients preferred D‐PDT to IM in most cases.