Evaluation of 30% Urea Pretreatment in Enhancing the Efficacy of Photodynamic Therapy for Actinic Keratoses of the Scalp

Mariachiara Arisi; Matteo Crivellari; Benedetta Galli; Laura Grigolato; Francesca Di Lauro; Cesare Tomasi; Cesare Ariasi; Simone Soglia; Grazia Linda Artelli; Piergiacomo Calzavara Pinton; Gaetano Licata

doi:10.5826/dpc.1602a6578

Evaluation of 30% Urea Pretreatment in Enhancing the Efficacy of Photodynamic Therapy for Actinic Keratoses of the Scalp

Authors

Mariachiara Arisi Department of Dermatology, University of Brescia, Brescia, Italy
Matteo Crivellari Department of Dermatology, University of Brescia, Brescia, Italy
Benedetta Galli Department of Dermatology, University of Brescia, Brescia, Italy
Laura Grigolato Department of Dermatology, University of Brescia, Brescia, Italy
Francesca Di Lauro Department of Dermatology, University of Brescia, Brescia, Italy
Cesare Tomasi Department of Dermatology, University of Brescia, Brescia, Italy
Cesare Ariasi Department of Dermatology, University of Brescia, Brescia, Italy
Simone Soglia Department of Dermatology, University of Brescia, Brescia, Italy
Grazia Linda Artelli Department of Dermatology, University of Brescia, Brescia, Italy
Piergiacomo Calzavara Pinton Department of Dermatology, University of Brescia, Brescia, Italy
Gaetano Licata Department of Dermatology, Sant’Antonio Abate Hospital, Trapani, Italy

Keywords:

Actinic Keratosis, Photodynamic therapy (PDT), urea cream

Abstract

Introduction: The use of curettage to reduce the hyperkeratotic component of actinic keratoses is a recommended step prior to photodynamic therapy (PDT); however, the procedure may not be well tolerated by the patient. Due to these drawbacks, alternative approaches aimed at reducing lesion hyperkeratosis and optimizing PDT effectiveness have been studied.

Objective: The aim of the present study was to assess whether a 14-day pretreatment with 30% urea cream enhanced the penetration of methyl aminolevulinate (MAL) and improved clinical outcomes of photodynamic therapy (PDT) in the treatment of scalp actinic keratoses (AKs).

Methods: A split-scalp design was used on adult patients with multiple AKs. One half received 30% urea emollient cream for 14 days before conventional MAL-PDT. Outcomes included PpIX fluorescence, AK reduction, pain scores, local skin reaction (LSR), cosmetic results, and patient satisfaction.

Results: PpIX fluorescence was significantly higher in the urea-treated area (P=0.0128), indicating enhanced MAL penetration. Urea pretreatment yielded significant reductions in AKs, particularly for OLSEN II grade lesions (P<0.0001). Pain scores were slightly higher in the urea group (P=0.029), while overall LSR, cosmetic outcomes, and patient satisfaction were comparable between the two sides.

Conclusion: Pretreatment with 30% urea cream significantly improves MAL uptake and clinical response in PDT for scalp AKs without compromising tolerability or patient satisfaction.

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