Comparision of the efficacy of photodynamic therapy and imiquimod cream in patients with actinic keratosis: a systematic review and meta-analysis

Actinic keratosis is a common precancerous epidermal skin lesion characterized by rough, scaly patches on sun-exposed areas due to chronic UV exposure, and it carries a risk of progressing to squamous cell carcinoma. Both photodynamic therapy and imiquimod cream have been proven to be effective therapeutic option for actinic keratosis. However, there is no comprehensive systematic review that compare the efficacy of the two treatments. We conducted a comprehensive search of literature to evaluate the efficacy of photodynamic therapy and imiquimod cream in treating actinic keratosis. Meta-analysis was performed using Review Manager 5.4 software. After the screening of 1144 studies and 11 reports, six randomized controlled trials with two evaluation indicators were included. Our meta-analysis indicated that photodynamic therapy, particularly 5-aminolevulinic acid photodynamic therapy, produced superior results than imiquimod cream when analysing the lesion clearance rate, and imiquimod treatment is more likely to cause adverse reactions such as ulceration/crusting compared to photodynamic therapy.