Evaluation of 30% Urea Pretreatment in Enhancing the Efficacy of Photodynamic Therapy for Actinic Keratoses of the Scalp

Introduction: The use of curettage to reduce the hyperkeratotic component of actinic keratoses is a recommended step prior to photodynamic therapy (PDT); however, the procedure may not be well tolerated by the patient. Due to these drawbacks, alternative approaches aimed at reducing lesion hyperkeratosis and optimizing PDT effectiveness have been studied. Objective: The aim of the present study was to assess whether a 14-day pretreatment with 30% urea cream enhanced the penetration of methyl aminolevulinate (MAL) and improved clinical outcomes of photodynamic therapy (PDT) in the treatment of scalp actinic keratoses (AKs). Methods: A split-scalp design was used on adult patients with multiple AKs. One half received 30% urea emollient cream for 14 days before conventional MAL-PDT. Outcomes included PpIX fluorescence, AK reduction, pain scores, local skin reaction (LSR), cosmetic results, and patient satisfaction. Results: PpIX fluorescence was significantly higher in the urea-treated area (P=0.0128), indicating enhanced MAL penetration. Urea pretreatment yielded significant reductions in AKs, particularly for OLSEN II grade lesions (P<0.0001). Pain scores were slightly higher in the urea group (P=0.029), while overall LSR, cosmetic outcomes, and patient satisfaction were comparable between the two sides. Conclusion: Pretreatment with 30% urea cream significantly improves MAL uptake and clinical response in PDT for scalp AKs without compromising tolerability or patient satisfaction.