PMC3591197_01
Clinical followup, Case 1. (a) Status before PDT; several hyperkeratotic lesions, hardly visible, and palpable (b) two weeks after PDT, before imiquimod; (c) two weeks after imiquimod; (d) four weeks after imiquimod, end of first course; (e) four weeks after imiquimod, end of second course; (f) seven months after the end of treatment: no visible or palpable AKs and less hyperpigmentation.
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fig1
He presented with numerous hyperkeratotic lesions on his scalp (Figure 1(a)). After a single session of PDT (Figure 1(b)), the patient treated the target lesions and each hyperkeratotic region with an application of imiquimod three times per week for one course in accordance with the treatment protocol. The follow-up control two weeks after the imiquimod treatment showed mild erythema, erosion, and some desquamation (Figure 1(c)). The patient felt moderately affected by the treatment (Figure 1(d)). The local side effects were intense and the patient was still moderately affected by the treatment (Figure 1(e)). JR still had no apparent actinic lesions on his scalp or forehead (Figure 1(f)).
PMC3591197_02
Clinical followup, Case 2. (a) Two weeks after PDT, before imiquimod; (b) two weeks after imiquimod; (c) end of first course; (d) two weeks after imiquimod, second course; (e) four weeks after imiquimod, end of second course; (f) eleven months after the end of treatment: even surface and no visible or palpable AKs.
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fig2
The reaction to the PDT-treatment was pronounced (Figure 2(a)). The patient reported mild erythema, erosion, and scaling during the follow-up control two weeks after the imiquimod treatment (Figure 2(b)). The patient felt moderately affected by the treatment (Figure 2(c)). After reevaluation, the second course of treatment was repeated and this resulted in milder LSE, and the patient was hardly affected by the treatment (Figures 2(d)-2(e)). HF still had no apparent actinic lesions on his scalp or forehead and he was highly satisfied with the clinical and cosmetic outcome (Figure 2(f)).
PMC3591197_03
Clinical followup, Case  3. (a) Before PDT; (b) two weeks after PDT; (c) two weeks after imiquimod; (d) four weeks after imiquimod, end of first course; (e) two weeks after imiquimod, second course; (f) four weeks after imiquimod, end of second session: less scaling of the skin, more homogenous surface, the skin texture appeared even better, and AKs still present.
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fig3
Numerous hyperkeratotic lesions were localized on her hands (Figure 3(a)). The patient reported some erythema, edema, and scaling directly after the PDT (Figure 3(b)). But there were no local side effects noted in the follow-up control two weeks after the imiquimod treatment (Figure 3(c)). After completing the first session four weeks later, there were still no local side effects observed (Figure 3(d)). No local side effects were noted (Figures 3(e)-3(f)). However, the actinic keratoses were still present (Figures 3(e)-3(f)).