{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:01:50Z","timestamp":1787029310310,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Several solutions are now proposed to provide indoor illumination with so-called artificial white light or simulated daylight (SDL-PDT), resulting in an effective treatment for actinic keratosis (AK). However, the optimal PpIX-weighted light dose is still debated. Integrating the effective irradiance over the irradiation time yields the effective light dose, which is also known as the protoporphyrin IX-weighted light dose and is a key parameter for the efficacy of the treatment. Objectives: The paper aims to report the clinical outcomes of SDL-PDT when using the PpIX-weighted light dose of 4 J\/cm2, in patients treated for AK lesions of the scalp or the face at our medical dermatology center (ClinicalTrials.gov NCT052036). Methods: A total of 30 patients (16 males, 14 females), with a mean age of 71.0 \u00b1 10.2, with phototype 1 (16 patients) and phototype 2 (14 patients) with grade I\u2013II AK were treated with a drug light interval (DLI) of 10 min and a light exposure of 35 min (Dermaris, Surgiris, Croix, France), corresponding to a PpIX-weighted light dose of 4 J\/cm2. The primary endpoint was the cure rate of patients at six months post-treatment. Secondary endpoints included scores of pain, erythema, crusts, and discomfort during or\/and post the treatment. Results: In total, 762 AK were treated. Six months following treatment, the cure rate of the patients was 77%. The median pain score was less than 1 out of 10 for most of the patients. Erythema was observed in all patients and lasted 3 days (\u00b11.5 day). Crusts were seen in 28 patients. Discomfort was reported as mild or less in more than 97% of patients. Conclusions: The shortening of the PpIX-weighted light dose to 4 J\/cm2, corresponding to an illumination duration of 35 min with the Dermaris, does not modify the efficacy of the SDL-PDT. This observation is in agreement with recent published data demonstrating that the light dose can be reduced. Furthermore, this clinical study confirmed that SDL-PDT is an effective and nearly painless treatment with minimal side effects for patients with AK lesions of the scalp.<\/jats:p>","DOI":"10.3390\/ph16101454","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T06:07:26Z","timestamp":1697177246000},"page":"1454","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Is a 4 J\/cm2 PpIX-Weighted Simulated Daylight (SDL-PDT) Dose Still Efficient for Photodynamic Therapy of Actinic Keratosis?"],"prefix":"10.3390","volume":"16","author":[{"given":"Mathilde","family":"Fronville","sequence":"first","affiliation":[{"name":"Centre Dermatologique du Roy, Plancenoit, 1380 Lasne, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Creusot","sequence":"additional","affiliation":[{"name":"Centre Dermatologique du Roy, Plancenoit, 1380 Lasne, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1208-7153","authenticated-orcid":false,"given":"Serge R.","family":"Mordon","sequence":"additional","affiliation":[{"name":"Hemerion Therapeutics, 59650 Villeneuve d\u2019Ascq, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1038\/jid.2013.134","article-title":"Prevalence of actinic keratosis and its risk factors in the general population: The Rotterdam Study","volume":"133","author":"Flohil","year":"2013","journal-title":"J. Investig. Dermatol."},{"key":"ref_2","first-page":"1099","article-title":"Treatment of actinic keratosis: A systematic review","volume":"315","author":"Worley","year":"2023","journal-title":"Arch. Dermatol. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/jdv.15949","article-title":"The actinic dysplasia syndrome\u2014Diagnostic approaches defining a new concept in field carcinogenesis with multiple cSCC","volume":"33","author":"Dejonckheere","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/TCRM.S1769","article-title":"Review of photodynamic therapy in actinic keratosis and basal cell carcinoma","volume":"4","author":"Ericson","year":"2008","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bartosinska, J., Szczepanik-Kulak, P., Raczkiewicz, D., Niewiedziol, M., Gerkowicz, A., Kowalczuk, D., Kwasny, M., and Krasowska, D. (2022). Topical Photodynamic Therapy with Different Forms of 5-Aminolevulinic Acid in the Treatment of Actinic Keratosis. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14020346"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1111\/bjd.13138","article-title":"Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: A randomized controlled trial","volume":"171","author":"Rubel","year":"2014","journal-title":"Br. J. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1111\/j.1468-3083.2011.04386.x","article-title":"Daylight photodynamic therapy for actinic keratosis: An international consensus: International Society for Photodynamic Therapy in Dermatology","volume":"26","author":"Wiegell","year":"2012","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"545","DOI":"10.2340\/00015555-1101","article-title":"Predictors of pain associated with photodynamic therapy: A retrospective study of 658 treatments","volume":"91","author":"Halldin","year":"2011","journal-title":"Acta Derm. Venereol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/j.1365-2133.2012.11200.x","article-title":"Weather conditions and daylight-mediated photodynamic therapy: Protoporphyrin IX-weighted daylight doses measured in six geographical locations","volume":"168","author":"Wiegell","year":"2013","journal-title":"Br. J. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1177\/0036933017695156","article-title":"Daylight photodynamic therapy in Scotland","volume":"62","author":"Cordey","year":"2017","journal-title":"Scott. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1562\/0031-8655(2002)076<0452:TEOAOP>2.0.CO;2","article-title":"Temperature effect on accumulation of protoporphyrin IX after topical application of 5-aminolevulinic acid and its methylester and hexylester derivatives in normal mouse skin","volume":"76","author":"Juzeniene","year":"2002","journal-title":"Photochem. Photobiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.pdpdt.2014.05.004","article-title":"A commentary on the role of skin temperature on the effectiveness of ALA-PDT in Dermatology","volume":"11","author":"Mordon","year":"2014","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_13","first-page":"811","article-title":"Can daylight-PDT be performed indoor?","volume":"153","author":"Mordon","year":"2018","journal-title":"G. Ital. Di Dermatol. E Venereol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e165","DOI":"10.1111\/jdv.16112","article-title":"Artificial white light photodynamic therapy for actinic keratosis: A study of 38 patients in private office practice","volume":"34","author":"Maire","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102618","DOI":"10.1016\/j.pdpdt.2021.102618","article-title":"Clinical evaluation of a short illumination duration (1 hour) when performing photodynamic therapy of actinic keratosis using the Dermaris light source","volume":"36","author":"Creusot","year":"2021","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1080\/09546634.2021.1944594","article-title":"A randomized split-face clinical trial of conventional vs indoor-daylight photodynamic therapy for the treatment of multiple actinic keratosis of the face and scalp and photoaging","volume":"33","author":"Arisi","year":"2022","journal-title":"J. Dermatol. Treat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1111\/j.1365-2133.2009.09119.x","article-title":"Photodynamic therapy of actinic keratoses with 8% and 16% methyl aminolaevulinate and home-based daylight exposure: A double-blinded randomized clinical trial","volume":"160","author":"Wiegell","year":"2009","journal-title":"Br. J. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wulf, H.C., Heerfordt, I.M., and Philipsen, P.A. (2021). How Much Protoporphyrin IX Must Be Activated to Obtain Full Efficacy of Methyl Aminolevulinate Photodynamic Therapy? Implication for Treatment Modifications. Pharmaceuticals, 14.","DOI":"10.3390\/ph14040333"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1111\/jdv.15744","article-title":"Daylight photodynamic therapy of actinic keratosis without curettage is as effective as with curettage: A randomized clinical trial","volume":"33","author":"Heerfordt","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"617","DOI":"10.2340\/00015555-2612","article-title":"Pretreatment with 5-Fluorouracil Cream Enhances the Efficacy of Daylight-mediated Photodynamic Therapy for Actinic Keratosis","volume":"97","author":"Nissen","year":"2017","journal-title":"Acta Derm. Venereol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1111\/bjd.14465","article-title":"Pulse photodynamic therapy reduces inflammation without compromising efficacy in the treatment of multiple mild actinic keratoses of the face and scalp: A randomized clinical trial","volume":"174","author":"Wiegell","year":"2016","journal-title":"Br. J. Dermatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1111\/phpp.12671","article-title":"Comparative study of imiquimod 3.75% vs. photodynamic therapy for actinic keratosis of the scalp","volume":"37","author":"Cortelazzi","year":"2021","journal-title":"Photodermatol. Photoimmunol. Photomed."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s00403-019-02028-2","article-title":"Combined daylight and conventional photodynamic therapy with 5-aminolaevulinic acid nanoemulsion (BF-200 ALA) for actinic keratosis of the face and scalp: A new and efficient approach","volume":"312","author":"Velez","year":"2020","journal-title":"Arch. Dermatol. Res."},{"key":"ref_24","first-page":"92","article-title":"Evaluation of Ingenol mebutate efficacy for the treatment of actinic keratosis with Antera 3D camera","volume":"19","author":"Cantisani","year":"2015","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1111\/j.1365-2133.2012.10833.x","article-title":"Daylight-mediated photodynamic therapy of moderate to thick actinic keratoses of the face and scalp: A randomized multicentre study","volume":"166","author":"Wiegell","year":"2012","journal-title":"Br. J. Dermatol."},{"key":"ref_26","unstructured":"Schmitz, L., and Stockfleth, E. (2019, January 8\u20139). First clinical experiences on MAL-PDT with an artificial white light irradiation device (Dermaris\u00ae) in patients with multiple AK of the face and scalp: A split face study. Proceedings of the 18 Annual Congress of the European Society for Photodynamic Therapy in Dermatology (Euro-PDT 2019), Brussels, Belgium."},{"key":"ref_27","unstructured":"Maire, C., and Mordon, S. (2019, January 8\u20139). Simulated daylight (SDL-PDT) treatment of AK with a new LED white light device: Clinical results in a prospective observational pilot series of 30 patients. Proceedings of the 18 Annual Congress of the European Society for Photodynamic Therapy in Dermatology (Euro-PDT 2019), Brussels, Belgium."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/ajd.12354","article-title":"Consensus recommendations on the use of daylight photodynamic therapy with methyl aminolevulinate cream for actinic keratoses in Australia","volume":"57","author":"See","year":"2016","journal-title":"Australas. J. Dermatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103260","DOI":"10.1016\/j.pdpdt.2022.103260","article-title":"Effective fluence and dose at skin depth of daylight and lamp sources for PpIX-based photodynamic therapy","volume":"41","author":"Ruiz","year":"2023","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e13423","DOI":"10.1111\/dth.13423","article-title":"Painless and efficient ALA-PDT and MAL-PDT of actinic keratosis can be achieved by drastically reducing the drug-light interval","volume":"33","author":"Mordon","year":"2020","journal-title":"Dermatol. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1111\/j.1365-2133.2008.08450.x","article-title":"Continuous activation of PpIX by daylight is as effective as and less painful than conventional photodynamic therapy for actinic keratoses; a randomized, controlled, single-blinded study","volume":"158","author":"Wiegell","year":"2008","journal-title":"Br. J. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1111\/j.1365-2133.2004.05652.x","article-title":"A randomized, double-blind, placebo-controlled study of the efficacy of tetracaine gel (Ametop) for pain relief during topical photodynamic therapy","volume":"150","author":"Holmes","year":"2004","journal-title":"Br. J. Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/j.1365-2133.2005.06991.x","article-title":"Randomized, double-blind, placebo-controlled prospective study of the efficacy of topical anaesthesia with a eutetic mixture of lignocaine 2.5% and prilocaine 2.5% for topical 5-aminolaevulinic acid-photodynamic therapy for extensive scalp actinic keratoses","volume":"154","author":"Langan","year":"2006","journal-title":"Br. J. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1001\/archderm.140.1.33","article-title":"A trial of short incubation, broad-area photodynamic therapy for facial actinic keratoses and diffuse photodamage","volume":"140","author":"Touma","year":"2004","journal-title":"Arch. Dermatol."},{"key":"ref_35","first-page":"63","article-title":"Cold air analgesia in photodynamic therapy of basal cell carcinomas and Bowen\u2019s disease: An effective addition to treatment: A pilot study","volume":"30","author":"Pagliaro","year":"2004","journal-title":"Dermatol. Surg."},{"key":"ref_36","first-page":"275","article-title":"Photodynamic Therapy Effectively Treats Actinic Keratoses Without Pre-Illumination Incubation Time","volume":"16","author":"Gandy","year":"2017","journal-title":"J. Drugs Dermatol."},{"key":"ref_37","first-page":"76","article-title":"The conventional protocol vs. a protocol including illumination with a fabric-based biophotonic device (the Phosistos protocol) in photodynamic therapy for actinic keratosis: A randomized, controlled, noninferiority clinical study","volume":"182","author":"Mordon","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Lee, C.N., Hsu, R., Chen, H., and Wong, T.W. (2020). Daylight Photodynamic Therapy: An Update. Molecules, 25.","DOI":"10.3390\/molecules25215195"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1684\/ejd.2015.2570","article-title":"European Dermatology Forum Guidelines on topical photodynamic therapy","volume":"25","author":"Morton","year":"2015","journal-title":"Eur. J. Dermatol."},{"key":"ref_40","unstructured":"(2023, October 10). Clinical Evaluation of a Short Illumination Duration (35 Minutes) When Performing PDT of AK Using the Dermaris \u00ae (Dermaris-35), Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05522036."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/0190-9622(91)70113-G","article-title":"A double-blind, vehicle-controlled study evaluating masoprocol cream in the treatment of actinic keratoses on the head and neck","volume":"24","author":"Olsen","year":"1991","journal-title":"J. Am. Acad. Dermatol."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/16\/10\/1454\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:06:14Z","timestamp":1760130374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/16\/10\/1454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,13]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["ph16101454"],"URL":"https:\/\/doi.org\/10.3390\/ph16101454","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,13]]}}}