Meta-Analysis: Similar AK Clearance With PDT and Cryotherapy

Key Takeaways

• Photodynamic therapy (PDT) and cryotherapy demonstrated comparable overall lesion clearance for actinic keratosis (AK).
• PDT was associated with significantly superior cosmetic outcomes but higher rates of pain and burning.
• Cryotherapy showed a higher incidence of vesicles/blisters and may be more effective for extremity lesions based on limited data.

A recent systematic review and meta-analysis suggested comparable efficacy and safety of photodynamic therapy (PDT) and cryotherapy for lesion clearence in actinic keratosis (AK).

The analysis, published in the Journal of Cosmetic Dermatology, included 7 RCTs and included 1,233 primarily older male patients (mean age range, 64 to 74.8 years). Pooled results from five of the analyzed studies showed no difference in complete lesion clearance between PDT and cryotherapy (risk ratio [RR], 1.02; 95% CI, 0.92 tyo 1.13; P = 0.74). Mean clearance rates were 79.17% for PDT and 72.47% for cryotherapy. Heterogeneity was high (I² = 92%). For head and face lesions, outcomes were comparable (RR, 1.10; P = 0.24). A single study suggested improved efficacy of cryotherapy for extremity lesions (RR, 0.88; P < 0.05). Cosmetic outcomes favored PDT, which showed higher rates of postive cosmetic results vs cryotherapy (74.62% vs 49.11%; RR, 1.52; 95% CI, 1.40 to 1.65; P < 0.00001). Patient satisfaction was higher with PDT but did not reach statistical significance (RR, 1.43; P = 0.12).

PDT was associated with a higher risk of pain and burning sensations (RR, 1.95; 95% CI, 1.27 to 3.02; P = 0.002), while cryotherapy more frequently resulted in vesicles and blistering.

“Our meta-analysis indicates that the efficacy of photodynamic therapy (PDT) versus cryotherapy in achieving complete lesion clearance is comparable and potentially dependent on anatomical location,” the authors wrote. “While both treatments are comparable for head and face lesions, cryotherapy showed better results for extremity lesions in one trial, requiring further research to explore this finding.”

Source: Aldraibi S. et al. Journal of Cosmetic Dermatology. 2026. Doi:10.1111/jocd.70749