SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 127 

RISING DERM STARS® 
 

 
Photodynamic therapy with δ-aminolevulinic acid and blue light for the 
treatment of actinic cheilitis  
 
Dagrosa AT, MD1, Paul J, Chen Y, Gangar P, Ressler D, Chapman MS  
1Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH 

 
 
Background/Objectives: Actinic cheilitis is 
a common precancerous malformation of the 
lower lip caused by ultraviolet radiation. 
Photodynamic therapy (PDT) is a potential 
treatment option for actinic cheilitis. However, 
controlled clinical trials assessing the efficacy 
of PDT for actinic cheilitis are lacking. PDT is 
based on the combined use of 
photosensitizers and photoradiation. 
Topically applied δ-aminolevulinic acid (ALA) 
is theorized to be taken up by premalignant 
cells. Upon irradiation with a light source, 
photoactivated porphyrins produce singlet 
oxygen and other potent oxidizers, resulting 
in cell death.1,2 We hypothesized that the use 
of PDT with blue light and topical ALA 
treatment is a safe and effective treatment for 
actinic cheilitis. 
 
Methods: We conducted a single center, 
investigator-initiated, nonrandomized, open-
label, proof of concept study of topical ALA 
and PDT with blue light for the treatment of 
actinic cheilitis. We enrolled 24 subjects with 
a diagnosis of actinic cheilitis; 20 of these 
subjects met inclusion and exclusion criteria 
for participation in the study. One subject 
withdrew from the study prior to treatment. 
The study consisted of a screening visit, one 
to three scheduled treatments with ALA 
followed by PDT, and two follow-up visits. 
The primary outcome was assessed by the 
investigator at each visit as clinical 

improvement of actinic cheilitis from baseline. 
Improvement was estimated as no (0%), mild 
(25%), moderate (50%), marked (75%), or 
excellent improvement (100%). Post-
treatment assessments based upon visual 
observation of swelling, 
vesiculation/pustulation, erosion/ulceration, 
erythema, flaking/scaling, and crusting were 
also completed. Subjects completed the 
Dermatological Life Quality Index (DLQI) 
questionnaire and a subject global 
assessment of improvement at each visit. 
Pain was also assessed at each treatment 
visit. 
 
Results: Of the 19 subjects that completed 
the study, 84.2% achieved clinical 
improvement of 75% or better based on 
investigator assessment (primary outcome). 
Five subjects (26.3%) achieved 100% 
improvement by the end of the study. Based 
on the subjects’ assessment of improvement, 
68.4% achieved improvement of 75% or 
better by the end of the study. Treatments 
were well tolerated with minimal discomfort. 
Many subjects had transient adverse effects 
of treatment including swelling, erythema, 
and flaking/scaling; few subjects had more 
serious adverse effects such as 
vesiculation/pustulation or crusting. No 
subjects experienced erosion/ulceration. 
 



SKIN 
 

March 2019     Volume 3  Issue 2 
 

Copyright 2018 The National Society for Cutaneous Medicine 128 

Conclusion: Overall our study supports the 
use of topical ALA and PDT as a therapeutic 
option for the treatment of actinic cheilitis. 
 

References: 
1. Choudhary S, Nouri K, Elsaie ML. 

Photodynamic therapy in dermatology: 
a review. Lasers Med Sci. 
2009;24(6):971-980.  

2. 2. Akimoto M, Maeda K, Omi T, 
Nishimura T, Miyakawa M. 
Photodynamic Therapy in the 
Dermatological Field and Enhanced 
Cutaneous Absorption of 
Photosensitizer. Progress in 
Electromagnetics Research 
Symposium, Cambridge, MA. Sess 2A7. 
2010:314.