Sandpaper curettage: A simple method to improve PDT outcomes for actinic keratosis

Lauren E Heusinkveld, Taylor A Bullock, Jeffrey Negrey, Christine B Warren, Edward V Maytin, Lauren E Heusinkveld, Taylor A Bullock, Jeffrey Negrey, Christine B Warren, Edward V Maytin

Abstract

Introduction: Photodynamic therapy (PDT) is a non-scarring, repeatable, and safe treatment for actinic keratosis (AK), but improvements in efficacy are still needed.

Background: Devices such as steel blades, needle rollers, and lasers are currently used to remove hypertrophic stratum corneum on AKs to improve PDT outcomes. However, curettage with fine sandpaper could be a gentler, effective alternative.

Methods: A retrospective study was designed to compare PDT with or without sandpaper curettage. Patients were selected from a database registry of patients with face and scalp AKs (ClinicalTrials.gov NCT03319251). Patients in Group 1 underwent PDT alone (20% ALA, 15 min; blue light 417 nm, 30 min). Patients in Group 2 were pretreated with gentle sandpaper curettage prior to ALA and illumination. The two groups were compared using multivariate matching, normalizing for age, sex, initial AK counts, and time to follow-up.

Results: Sixty-six patients were selected for matching analysis (n=38, PDT only; n=28, PDT+curettage). Demographics between the groups were similar (mean ± SD), including age (71.0 ± 8.3 vs. 71.0 ± 8.0 years), baseline AK count (53 ± 39 vs. 44± 32), and time to post-PDT follow-up (111 ± 28 vs. 113 ± 32 days). At follow-up, patients who received curettage showed an overall 55% improvement in scalp AK clearance compared to patients who did not receive curettage, adjusting for sex, age, time to follow-up, and baseline AK count (p = 0.0322, multivariable linear regression).

Discussion: Sandpaper curettage before PDT treatment is an easy and inexpensive method to significantly improve AK clearance rates.

Keywords: Actinic keratosis; Curettage; Photodynamic therapy; Sandpaper curettage.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2022. Published by Elsevier B.V.

Figures

Fig. 1.. Patient enrollment.
Fig. 1.. Patient enrollment.
Patients were selected from a longitudinal, IRB-approved database registry of patients with at least 10 nonhyperkeratotic AKs (Olsen grade I or II) on the face and/or scalp at a single academic center (Clinicaltrials.gov NCT03319251). Patients were enrolled from October 2017 to October 2021. Group 1 comprised patients who underwent PDT alone. For patients in Group 2, all AK lesions were pretreated with sandpaper curettage prior to PDT.
Fig. 2.. Side effects after PDT with…
Fig. 2.. Side effects after PDT with or without sandpaper curettage.
Each bar represents the mean percentage of patients who experienced a given side effect during the 6 days following PDT (self-reported from a questionnaire). (*), Pain refers to irritation and burning during the week after PDT, not to pain experienced during PDT illumination. A side effects score (SES) was calculated for each patient, defined as the number of side effects experienced out of a total of 13 possible; the SES (mean ± SD) for PDT alone was 3.9 ± 1.9 and for PDT + curettage was 3.6 ± 1.9.

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