{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T23:41:30Z","timestamp":1779234090054,"version":"3.51.4"},"reference-count":18,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2011,6,1]],"date-time":"2011-06-01T00:00:00Z","timestamp":1306886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Photomedicine and Laser Surgery"],"published-print":{"date-parts":[[2011,6]]},"abstract":"<jats:p>\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Background and objective:<\/jats:italic>\n                    <\/jats:bold>\n                    Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) and intense pulsed light (IPL) is a relatively new combination for the treatment of actinic keratosis (AK) and photodamage. The objective of this study was to determine the effect of increasing the fluence of IPL on the outcome of patients with these skin conditions.\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Methods:<\/jats:italic>\n                    <\/jats:bold>\n                    Patients (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    \u2009=\u200924) were randomly assigned to five treatment treatment groups: control (IPL alone) and ALA with 20, 25, 40, and 50\u2009J\/cm\n                    <jats:sup>2<\/jats:sup>\n                    fluence of IPL. Each patient received a single treatment. ALA was applied twice and allowed to incubate 2\u2009h before IPL irradiation. Results were evaluated 5\u20137 days and 8 weeks after treatment. Clearance of AK lesions was evaluated by counting lesions before and after treatment, and improvement in photodamage was assessed by comparing pre- and post-treatment photographs. Statistical evaluation was based at nonparametric tests with a cut-off level at\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.10 and a confidence interval at 95%.\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Results:<\/jats:italic>\n                    <\/jats:bold>\n                    Responses to treatment were greatest in patients who received ALA and IPL fluences of 40 and 50\u2009J\/cm\n                    <jats:sup>2<\/jats:sup>\n                    . Responses were \u201cmarked\u201d in 19% of the patients receiving 50\u2009J and \u201cmoderate\u201d in 19% of the patients receiving 40\u2009J. Compared to the mean pre-treatment AK grades, the mean post-treatment grades were 56% lower in the 50\u2009J treatment group, 32% lower in the 25\u2009J group, 50% lower in the 40\u2009J group, 20% lower in the 20\u2009J group, and 7% lower in the control group. Erythema, edema, crusts and erosion, and pain did not cause any patient to discontinue the study.\n                    <jats:bold>\n                      <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    <\/jats:bold>\n                    AK clearance, but not photorejuvenation, appears to improve with increasing fluence at the ALA PDT-IPL levels used in this study without serious adverse effects.\n                  <\/jats:p>","DOI":"10.1089\/pho.2009.2733","type":"journal-article","created":{"date-parts":[[2011,6,3]],"date-time":"2011-06-03T09:48:34Z","timestamp":1307094514000},"page":"427-432","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":38,"title":["The Effect of Increasing Fluence on the Treatment of Actinic Keratosis and Photodamage by Photodynamic Therapy with 5-Aminolevulinic Acid and Intense Pulsed Light"],"prefix":"10.1177","volume":"29","author":[{"given":"Alessandra","family":"Haddad","sequence":"first","affiliation":[{"name":"Federal University of S\u00e3o Paulo","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan Dunshee de Abranches Oliveira","family":"Santos","sequence":"additional","affiliation":[{"name":"Federal University of S\u00e3o Paulo","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfredo","family":"Gragnani","sequence":"additional","affiliation":[{"name":"Federal University of S\u00e3o Paulo","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lydia Masako","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Federal University of S\u00e3o Paulo","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2011,6]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.134.2.207"},{"key":"e_1_3_3_3_2","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1179\/joc.2001.13.5.494","article-title":"Topical 5-aminolevulinic acid and photodynamic therapy in dermatology: a minireview","volume":"13","author":"Capuggi P.","year":"2001","unstructured":"Capuggi P., , Campolini P., , Mavilio L., , Prignano F, , Rossi R. 2001. Topical 5-aminolevulinic acid and photodynamic therapy in dermatology: a minireview. J. Chemother., 13:494\u2013499.","journal-title":"J. Chemother."},{"key":"e_1_3_3_4_2","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1001\/archderm.1991.01680060103013","article-title":"Malignant potential of actinic keratoses and the controversy over treatment. A patient-oriented perspective","volume":"127","author":"Dodson J.M.","year":"1991","unstructured":"Dodson J.M., , DeSpain J., , Hewett J.E., , Clark D.P. 1991. Malignant potential of actinic keratoses and the controversy over treatment. A patient-oriented perspective. Arch. Dermatol., 127:1029\u20131031.","journal-title":"Arch. Dermatol."},{"issue":"5","key":"e_1_3_3_5_2","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1067\/mjd.2000.108373","article-title":"Actinic keratosis is squamous cell carcinoma","volume":"43","author":"Lober B.A.","year":"2000","unstructured":"Lober B.A., , Lober C.W., , Accola J. 2000. Actinic keratosis is squamous cell carcinoma. J. Am. Acad. Dermatol., 43,5 Pt 1:881\u2013882.","journal-title":"J. Am. Acad. Dermatol."},{"key":"e_1_3_3_6_2","first-page":"7","article-title":"Histopathology of incipient intraepidermal squamous cell carcinoma","volume":"42","author":"Cockrell C. J.","year":"2000","unstructured":"Cockrell C. J. 2000. Histopathology of incipient intraepidermal squamous cell carcinoma. J. Am. Acad. Dermatol., 42:7.","journal-title":"J. Am. Acad. Dermatol."},{"key":"e_1_3_3_7_2","first-page":"742","article-title":"Photodynamic Photorejuvenation","volume":"28","author":"Ruiz-Rodriguez R.","year":"2002","unstructured":"Ruiz-Rodriguez R., , Sans-Sanchez T., , C\u00f3rdoba S. 2002. Photodynamic Photorejuvenation. Dermatol. Surg., 28:742\u2013744.","journal-title":"Dermatol. Surg."},{"key":"e_1_3_3_8_2","first-page":"629","article-title":"Short incubation PDT versus 5-FU in treating actinic keratoses","volume":"2","author":"Smith S.","year":"2003","unstructured":"Smith S., , Piacquadio D., , Morhenn V., , Atkin D., , Fitzpatrick R. 2003. Short incubation PDT versus 5-FU in treating actinic keratoses. J. Drugs. Dermatol., 2:629\u2013635.","journal-title":"J. Drugs. Dermatol."},{"key":"e_1_3_3_9_2","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1002\/lsm.1029","article-title":"Intense pulsed light and Nd:YAG laser non-ablative treatment of facial rhytids","volume":"28","author":"Goldberg D.J.","year":"2003","unstructured":"Goldberg D.J., , Samady J.A. 2003. Intense pulsed light and Nd:YAG laser non-ablative treatment of facial rhytids. Lasers Surg. Med., l28:141\u2013144.","journal-title":"Lasers Surg. 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Real-life practice study of the clinical outcome and cost-effectiveness of photodynamic therapy using methyl aminolevulinate (MAL-PDT) in the management of actinic keratosis and basal cell carcinoma. Eur. J. Dermatol., 18:539\u2013546.","journal-title":"Eur. J. Dermatol."},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1992.01680130061006"},{"key":"e_1_3_3_13_2","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.det.2006.09.010","article-title":"Aminolevulinic acid-photodynamic therapy for Photorejuvenation","volume":"25","author":"Nootheti P.K.","year":"2007","unstructured":"Nootheti P.K., , Goldman M.P. 2007. Aminolevulinic acid-photodynamic therapy for Photorejuvenation. Dermatol. Clin., 25:35\u201345.","journal-title":"Dermatol. 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Dermatol."},{"key":"e_1_3_3_16_2","first-page":"795","article-title":"Split-face comparison of photodynamic therapy with 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone for photodamage","volume":"32","author":"Gold M.H.","year":"2006","unstructured":"Gold M.H., , Bradshaw V.L., , Boring M.M., , Bridges T.M., , Biron J.A. 2006. Split-face comparison of photodynamic therapy with 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone for photodamage. Dermatol. Surg., 32:795\u2013801.","journal-title":"Dermatol. Surg."},{"key":"e_1_3_3_17_2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/j.1365-2133.2007.07959.x","article-title":"Variable pulsed light is less painful than light-emitting diodes for topical photodynamic therapy of actinic keratosis: a prospective randomized controlled trial","volume":"157","author":"Babilas P.","year":"2007","unstructured":"Babilas P., , Knobler R., , Hummel S. et al. 2007. Variable pulsed light is less painful than light-emitting diodes for topical photodynamic therapy of actinic keratosis: a prospective randomized controlled trial. Br. J. Dermatol., 157:111\u2013117.","journal-title":"Br. J. Dermatol."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","unstructured":"Downs A.M.R. Bower C.B. Oliver D.A. Stone C.A. 2009. Methyl aminolaevulinate\u2013photodynamic therapy for actinic keratoses squamous cell carcinoma in situ and superficial basal cell carcinoma employing a square wave intense pulsed light device for photoactivation. Br. J. 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