Related Experiment Video
Updated: Sep 2, 2025
An In Vitro Approach to Photodynamic Therapy
Published on: August 17, 2018
Sandpaper curettage: A simple method to improve PDT outcomes for actinic keratosis
Lauren E Heusinkveld1, Taylor A Bullock2, Jeffrey Negrey3
1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, United States.
Introduction:
Photodynamic therapy (PDT) is a non-scarring, repeatable, and safe treatment for actinic keratosis (AK), but improvements in efficacy are still needed.
Background:
Devices such as steel blades, needle rollers, and lasers are currently used to remove hypertrophic stratum corneum on AKs to improve PDT outcomes. However, curettage with fine sandpaper could be a gentler, effective alternative.
Methods:
A retrospective study was designed to compare PDT with or without sandpaper curettage. Patients were selected from a database registry of patients with face and scalp AKs (ClinicalTrials.gov NCT03319251). Patients in Group 1 underwent PDT alone (20% ALA, 15 min; blue light 417 nm, 30 min). Patients in Group 2 were pretreated with gentle sandpaper curettage prior to ALA and illumination. The two groups were compared using multivariate matching, normalizing for age, sex, initial AK counts, and time to follow-up.
Results:
Sixty-six patients were selected for matching analysis (n=38, PDT only; n=28, PDT+curettage). Demographics between the groups were similar (mean ± SD), including age (71.0 ± 8.3 vs. 71.0 ± 8.0 years), baseline AK count (53 ± 39 vs. 44± 32), and time to post-PDT follow-up (111 ± 28 vs. 113 ± 32 days). At follow-up, patients who received curettage showed an overall 55% improvement in scalp AK clearance compared to patients who did not receive curettage, adjusting for sex, age, time to follow-up, and baseline AK count (p = 0.0322, multivariable linear regression).
Discussion:
Sandpaper curettage before PDT treatment is an easy and inexpensive method to significantly improve AK clearance rates.
