Objectives: Actinic keratoses (AKs) are one of the most common reasons for consultation in the elderly population. This study aimed to assess the efficacy of 5-ALA PDT in AK treatment using high-frequency ultrasonography (HFUS) to evaluate skin layer changes during therapy. Methods: In our study, we included 44 AK patients aged 53 to 89 years. All patients had lesions clinically evaluated with the Olsen and AKASI scale. HFUS imaging was performed on seemingly healthy skin and lesions before and at 4, 8, and 12 weeks of therapy. Ultrasound markers such as skin thickness, echogenicity, and pixel intensity were measured. 5-ALA was applied under occlusion for 3 h. After removing the occlusive dressing, 5-ALA was removed with a saline solution and a directed therapy with a BF-200 lamp. Full follow-ups of 56 markers of suitable quality were selected. Results: The thickness of SLEB significantly decreased in the following weeks compared to the pre-therapy results, reaching its lowest values after 12 weeks. The average pixel intensity significantly increased in each skin layer after therapy (p < 0.01). For SLEB, there were statistically significant differences in LEP, MEP and contrast. The AKASI score before and after treatment was determined for the 39 patients who underwent follow-up at week 12. The median AKASI score was 3.2 (1.2–8.6) before treatment and 0.6 (0–2.8) after. Conclusions: According to the literature data, this is the first study describing the ALA-PDT treatment efficacy in different AK severities evaluated in HFUS. HFUS provides a valuable non-invasive tool for monitoring the efficacy of PDT in AK treatment, showing significant improvements in skin texture and structure.
目的：光化性角化病（AK）是老年人群就诊最常见的原因之一。本研究旨在通过高频超声（HFUS）评估治疗过程中皮肤层的变化，以评估5-氨基酮戊酸光动力疗法（5-ALA PDT）治疗AK的疗效。方法：本研究纳入44例年龄在53至89岁之间的AK患者。所有患者的皮损均采用Olsen分级和AKASI评分进行临床评估。在治疗前及治疗第4、8、12周，分别对看似健康的皮肤和皮损部位进行HFUS成像。测量皮肤厚度、回声强度和像素强度等超声标志物。将5-ALA封包敷用3小时，移除封包敷料后，用生理盐水清除5-ALA，并使用BF-200灯进行定向照射治疗。最终筛选出56个质量合格的标志物进行完整随访分析。结果：与治疗前相比，亚表皮低回声带（SLEB）的厚度在后续数周内显著下降，并在第12周达到最低值。治疗后各皮肤层的平均像素强度均显著增加（p < 0.01）。对于SLEB，其低回声区、中回声区及对比度均存在统计学显著差异。对第12周完成随访的39例患者进行AKASI评分比较，治疗前中位AKASI评分为3.2（范围1.2–8.6），治疗后降至0.6（范围0–2.8）。结论：据文献资料显示，这是首项采用HFUS评估ALA-PDT对不同严重程度AK疗效的研究。HFUS为监测PDT治疗AK的疗效提供了有价值的无创工具，结果显示皮肤质地和结构均有显著改善。
肿瘤(癌症)患者之家