Treatment of Photodamaged Skin of the décolleté

NCT ID: NCT03573076

Last Updated: 2020-07-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-10

Study Completion Date

2018-12-18

Brief Summary

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This study investigates a non-ablative fractional thulium laser and a radio-frequency microneedling device as pre-treatment for combination photodynamic therapy in treatment of photoaged skin and actinic keratoses.

Detailed Description

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Photoaging of skin and actinic keratoses Photoaging of the skin is the result of UV radiation in chronic sun exposure and its deleterious effects. Photoaging includes fine and coarse wrinkles, roughness, laxity, mottled pigmentation, coarseness, sallowness, telangiectasia, solar lentigines and dysplastic actinic keratoses. The process can be of both cosmetic and medical importance. Actinic keratoses (AK) are common dysplastic pre-malignant lesions that may develop into a malign invasive squamous cell carcinomas (SCC). SCCs have metastatic potential at up to 3%. The risk of malign transformation from AK to SCC is highest in chronic sun-damaged skin with confluent field-cancerization from multiple AK. National guidelines recommend treatment of the entire field of sun damaged skin with photodynamic therapy and several topical drugs, e.g. imiquimod, diclofenac, ingenol mebutate, and 5-fluoruracil. Repeat treatments are usually necessary to achieve the desired results in patients with chronic sun damaged skin.

Photochemical treatment with photodynamic therapy

Photodynamic therapy (PDT) is a treatment that uses a photosensitizer drug activated in the skin by light in the visible spectrum. Methyl aminolevulinate (MAL) is a photosensitizing agent with great affinity for dysplastic cells, and transforms into the light-sensitive Protoporphyrin PpIX. When exposed to light, photoactivated PpIX catalyzes a reactive oxygen species reaction, which leads to irreversible cell apoptosis of the dysplastic or neoplastic tissue. PDT can be used as treatment of a wide range of photoaging skin defects including actinic keratoses, and is exceedingly well suited for treatment of larger skin areas. PDT produces cosmetically pleasing results in extension of the excellent AK clearance.

Physical intervention with fractional laser and light-based interventions

Fractional laser and light-based treatments with lasers and microneedles are approaches that can be applied very precisely, and can be used to rejuvenate photodamaged skin.

Laser-treatment for rejuvenation of skin can be achieved using a non-ablative 1927 nm fractionated thulium laser (NAFL), good results have been reported for many aspects of photoaging, and specifically for actinic keratoses with good results. The thulium laser works by creating vertical thermal laser-channels in the skin without the ablative effect to the epidermis. Laser-treatment with the thulium laser may be combined with other treatments like PDT to produce synergistic effects.

Microneedling (MN) is a treatment option in which the skin epidermis is penetrated by closely arranged multiple microneedles. This can induce collagen production and stimulate the release of growth factors, and collagen synthesis and remodeling, producing the effects of rejuvenation. Radio-frequency (RF) microneedling (MN), also known as RF-MN, adds RF making it possible for insulated needles to emit heat at the needle-heads when the epidermis is fully punctured, possibly enhancing the described effects even further. Good results have been reported using MN as skin rejuvenation, and can the treatment be used in conjunction with PDT.

The delicate skin of the décolleté is subject to a high amount of accumulated life-time sun exposure, and is thus highly susceptible to photoaging effects. A mild and effective treatment of photodamaged skin for this particular area is highly desirable, and may be achieved by developing new combination strategies, in which the thulium laser or a microneedling device can be used as effective pre-treatment for PDT. To our knowledge, no previous randomized study has compared the use of the non-ablative thulium laser or microneedling in combination with photodynamic treatment (PDT).

Conditions

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Photodamaged Skin

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Thulium laser + photodynamic therapy

Non-ablative Thulium laser (NAFL) + Photodynamic therapy combination treatment

Group Type EXPERIMENTAL

Photodynamic therapy

Intervention Type COMBINATION_PRODUCT

Photodynamic therapy with Methyl Aminolevulinate creme and red light.

Non-ablative Thulium laser (NAFL)

Intervention Type DEVICE

Non-ablative Thulium laser (NAFL).

RF microneedles + photodynamic therapy

Radio-frequency microneedles (RF-MN) + Photodynamic therapy combination treatment

Group Type EXPERIMENTAL

Photodynamic therapy

Intervention Type COMBINATION_PRODUCT

Photodynamic therapy with Methyl Aminolevulinate creme and red light.

Radio-frequency microneedles (RF-MN)

Intervention Type DEVICE

Radio-frequency microneedles (RF-MN).

Non-ablative Thulium laser

Non-ablative Thulium laser (NAFL) single treatment

Group Type ACTIVE_COMPARATOR

Non-ablative Thulium laser (NAFL)

Intervention Type DEVICE

Non-ablative Thulium laser (NAFL).

RF microneedles

Radio-frequency microneedles (RF-MN) single treatment

Group Type ACTIVE_COMPARATOR

Radio-frequency microneedles (RF-MN)

Intervention Type DEVICE

Radio-frequency microneedles (RF-MN).

Control

Control receiving no intervention

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Photodynamic therapy

Photodynamic therapy with Methyl Aminolevulinate creme and red light.

Intervention Type COMBINATION_PRODUCT

Non-ablative Thulium laser (NAFL)

Non-ablative Thulium laser (NAFL).

Intervention Type DEVICE

Radio-frequency microneedles (RF-MN)

Radio-frequency microneedles (RF-MN).

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Décolleté with chronic field-change photodamaged skin.
* Area with visually homogenous photodamage.
* Provide informed written consent.
* Fertile women must provide a negative U-hCG pregnancy test at the time of inclusion, and use safe anticontraceptive during the entire study period, e.g. oral hormonal contraceptives, intrauterine devices, subdermal implantation, or hormonal vaginal ring.

Exclusion Criteria

* Treatment of actinic keratoses in the décolleté area within the last 30 days.
* Porphyria.
* Pregnant or nursing women.
* Skin cancer (invasive, in situ), keratoacanthoma, or other infiltrating tumors in the study area.
* Known tendencies to produce hypertrophic scarring or keloids.
* Allergies against Metvix creme solution, peanuts, or soy.
* Considered unable to follow the study protocol, e.g. alcohol dependence syndrome.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Merete Haedersdal

OTHER

Sponsor Role lead

Responsible Party

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Merete Haedersdal

Professor, Physician Consultant

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Merete Haedersdal, MD

Role: PRINCIPAL_INVESTIGATOR

Bispebjerg Hospital

Locations

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Bispebjerg University Hospital

Copenhagen, Copenhagen NV, Denmark

Site Status

Countries

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Denmark

Other Identifiers

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2018-000189-12

Identifier Type: -

Identifier Source: org_study_id

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