Terapia fotodinâmica e imiquimode no tratamento de ceratoses actínicas múltiplas da face: um estudo comparativo e randomizado

Introduction: The importance of early diagnosis and treatment of actinic keratoses is well established. There are several effective therapeutic options for the treatment of this condition. Objectives: To compare the efficacy and patient preference between 5% imiquimod cream and photodynamic therapy in the treatment of actinic keratoses. Methods: Twelve patients with a total of 245 lesions were treated with MAL-PDT and 5% imiquimod cream. Randomization was performed in order to determine the hemiface (left or right) for each treatment. First, the patients underwent MAL-PDT.After one month, they started using imiquimod in the other hemiface twice a week for 16 weeks.After six months, the two treatments were analyzed for efficacy, tolerability, patient preference, and aesthetic results using the observations of a blinded investigator. Results: Both treatments showed good therapeutic responses, with 72% of lesions treated with MAL-PDT and 76% of lesions treated with imiquimod having complete improvement. The average size of residual lesions was similar in the two treatments. Ten patients (83%) preferred the treatment with photodynamic therapy (p = 0.03). Conclusions: Photodynamic therapy and imiquimod are effective in the treatment of actinic keratoses. The results of this study showed similar efficacy and good aesthetic results with the two treatments. Nevertheless, most patients preferred the photodynamic therapy. Introducao: A importância do diagnostico e tratamento precoces das ceratoses actinicas (CA) esta bem estabelecida. Existem varias opcoes terapeuticas eficazes no tratamento das CA. Objetivos: Comparar a eficacia e preferencia do paciente entre imiquimode creme 5% e terapia fotodinâmica para o tratamento de CA. Metodos: 12 pacientes com total de 245 lesoes foram tratados com MAL-PDT e imiquimode creme 5%. Foi realizada randomizacao para determinar a hemiface (direita ou esquerda) para cada tratamento. Inicialmente os pacientes foram submetidos a MAL-PDT. Apos um mes, iniciaram o uso de imiquimode no outro lado da face, duas vezes por semana durante 16 semanas. Apos seis meses, os dois tratamentos foram analisados por um investigador cego quanto a eficacia, tolerabilidade, preferencia do paciente e resultado estetico. Resultados: Ambos os tratamentos apresentaram boa resposta terapeutica: 72% das lesoes tratadas com MAL-PDT e 76% das tratadas com imiquimode tiveram melhora completa. O tamanho medio das lesoes residuais foi similar com os dois tratamentos. 10 pacientes (83%) preferiram o tratamento com PDT (p: 0,03). Conclusoes: PDT e imiquimode sao eficazes no tratamento das CA. Os resultados deste estudo mostraram eficacia similar e bons resultados esteticos com os dois tratamentos. Entretanto, a maioria dos pacientes preferiu a PDT.