Background 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) is a reliable treatment for actinic keratosis (AK), though the concentration of 20 % is applied in most ALA-PDT for the treatment of AK, it was found that 10 % ALA could achieve similar outcome during clinical practice. However, there are limited number of reports comparing the efficacy and the safety of ALA-PDT with different ALA doses when treating AK. Objectives This study was designed to compare the efficacy, the adverse effects and the costs of 10 % and 20 % ALA-PDT for AK treatment. Methods We reviewed the records of patients who had received ALA-PDT in our department between January 1, 2012, and April 30, 2017, the efficacy, the adverse effects were recorded, and the costs were analyzed. Follow-up data were collected until April 30, 2018. Results A total of 59 AK patients’ records were analyzed for the efficacy, the adverse events, the recurrence and the costs. All the AK lesions were tapped with plum-blossom needle as a pre-treatment before receiving ALA-PDT. There was no statistical difference between 10 % ALA-PDT and 20 % ALA-PDT in terms of efficacy and adverse events. In the 10 % ALA group, there was one recurrence out of 34 patients and in the 20 % group there were none. The average treatment cost of each lesion was significantly lower in 10 % ALA group than in 20 % ALA group. Conclusions 10 % ALA-PDT has similar efficacy and adverse effects as 20 % ALA-PDT with lower costs. Taken together, this supports the use of 10 % ALA-PDT in clinical practice.
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