Methyl Aminolevulinate

INTRODUCTION

Indications

Thin and moderately thick nonhyperkeratotic, nonpigmented actinic keratoses of the face/scalp in immunocompetent patients (with débridement and specific wavelength red light therapy).

Action

Converted to photoactive porphyrins which when exposed to specific wavelength red light result in a photodynamic cytotoxic reaction. Therapeutic Effects: Resolution of precancerous lesions.

Adverse Reactions/Side Effects

Derm: burning, contact sensitization, erythema, irritation, itching, pain in area of application, edema at site.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess the area being treated to help document whether drug therapy is successful in resolving skin lesions.

• Watch for any new or increased reactions at the site of application, including irritation, burning, itching, and swelling. Report severe or prolonged skin reactions to the physician.

Patient/Client-Related Instruction

• Make sure patient understands how this drug works; that is, red light exposure activates the cytotoxic effects and decreases cell growth in precancerous skin lesions.

• Instruct patient to prevent new lesions by limiting sun exposure, using sunscreens, and wearing protective clothing.

Pharmacokinetics

Absorption: Unknown.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Cutaneous photosensitivity or allergy to porphyrins, peanuts or almonds; Lactation/Pedi: Lactation or children.

Use Cautiously in: Bleeding disorders; OB: Use only if clearly needed.

Interactions

Drug-Drug: Concurrent use with other photosensitizing agents may result in an exaggerated reaction.

Route/Dosage

Topical (Adults): Following local débridement, apply a 1-mm layer of cream to lesion and surrounding 5 mm of skin (not to exceed 1 g/treatment), cover with occlusive, nonabsorbent dressing for 3 hr. Dressing is then removed, excess cream rinsed off, and skin exposed to red light treatment. Treatment is repeated 7 days later.

Availability

16.8% Cream: 2-g tubes.