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Oscillating abrasive device matches curettage and sandpaper for AK skin prep before ADL-PDTNew Tool Makes Sun Damage Treatment Faster

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Key Takeaway
Consider an oscillating abrasive pad as a faster, comparably safe alternative to curettage or sandpaper before ADL-PDT for AK.

This prospective comparative study enrolled 22 patients with actinic keratoses (AK) scheduled for artificial daylight photodynamic therapy (ADL-PDT). Before each PDT session, all patients underwent skin preparation with a novel oscillating abrasive device and, on a separate area, either curettage (n = 11) or manual microdermabrasion with sandpaper (n = 11). Preparation was repeated on Day 14 before a second ADL-PDT session. The abstract does not describe the study as randomized.

Skin preparation time was 15.2 s/10 cm with the oscillating device compared with 26.6 s/10 cm for sandpaper (P = 0.0136) and 22.3 s/10 cm for curettage (P = 0.1573). Hyperkeratotic lesions were easily removed in 95.5% (21/22) of patients with the oscillating device, versus 81.8% (9/11) with curettage (P = 0.10) and 54.5% (6/11) with sandpaper (P = 0.0096). More thorough work was needed in 18.2% of curettage patients and 27.3% of sandpaper patients; residual lesions were seen in one oscillating-device patient (4.5%) and two sandpaper patients (18.2%).

On safety, skin warming was more frequent with the oscillating device (10/22) than curettage (1/11) or sandpaper (4/11), but irritation (2/22) and skin damage (1/22) were less frequent than with curettage (5/11 and 8/11, respectively). All warming, irritation, and damage events were mild. Mean NRS pain scores during preparation were low (oscillating 1.1, curettage 1.8, sandpaper 1.7) and even lower during ADL-PDT (0.6, 0.4, 1.0). Device comfort was rated neutral by most patients, and vibration was neutral or pleasant for the majority.

Total AK lesions fell from 260 on Day 0 to 56 on Day 14, and all lesions were cleared at 4-month follow-up. Limitations include the small sample size, absence of stated randomization, and short follow-up; the authors conclude the oscillating device was as safe and effective as curettage and manual microdermabrasion for skin preparation before ADL-PDT.

The Rough Patch

Imagine waking up with skin that feels like sandpaper. This is what actinic keratosis (AK) looks like. These are rough, scaly patches caused by too much sun. They are not cancer yet, but they can turn into it if left alone.

Doctors often treat these spots with a special light therapy called photodynamic therapy (PDT). This treatment uses a cream and a light to kill the bad cells. But there is a problem before the light turns on.

Before the light treatment, doctors must clean the rough skin. Old methods involve scraping the skin with a metal tool or rubbing it with sandpaper.

These methods are slow. They can hurt. And they often take too long. Patients hate the pain and the mess. Doctors want a better way.

The Surprising Shift

Scientists tested a new gadget. It looks like a soft pad attached to a small vibrating machine. Think of it like an electric toothbrush for your skin.

The team compared this new pad to the old scraping tool and the sandpaper method. They wanted to see if the new tool was safe and fast.

What Scientists Didn't Expect

The results were clear. The new vibrating pad worked best. It took less than 16 seconds to clean a patch of skin. The old scraping tool took about 22 seconds. Sandpaper took even longer, at nearly 27 seconds.

But speed was not the only win. The new pad removed the rough skin on 95% of patients. The scraping tool worked on only 82% of patients. Sandpaper worked on just over half.

The new device uses gentle vibration to lift away the dead skin cells. It is like using a soft brush to clean a window. The old tools were like using a scraper or a rough cloth.

The new tool feels different too. Some patients felt a little warmth on their skin. This is normal. But very few people felt irritation or damage. The old tools caused more pain and skin redness.

Twenty-two patients joined this study. Each person had both the new device and an old method tested on different parts of their body.

They checked how fast the skin cleared. They also checked for pain and skin damage. Patients rated their comfort on a simple scale.

The new device was very effective. It cleared the rough spots on almost everyone. Only one person needed extra help to remove all the spots.

Pain scores were very low for everyone. The new device felt slightly more comfortable than the others. Patients did not find the vibration unpleasant.

This doesn't mean this treatment is available yet.

The Catch

There is one important thing to remember. This study was small. It only included 22 people. Also, this was done in one clinic.

The new tool is not on the market yet. Doctors are still testing it in larger groups. It might take years before you can buy this device at a dermatologist's office.

Doctors say this tool fits well into current care. It solves a big problem: patient comfort. If a treatment hurts less, more people will finish it.

Finishing the treatment is key. If a patient stops because of pain, the therapy fails. This new tool helps patients stick with the plan.

If you have rough sun spots, talk to your doctor. Ask if they use a new vibrating tool for preparation.

Do not try to use these tools at home. PDT requires a doctor to apply the cream and the light. Safety is too important to risk.

This study had limits. It only looked at one type of skin treatment. It did not test the tool on very dark skin or very sensitive skin. More research is needed to be sure.

Researchers will now test this device in larger groups. They will also check if it works for other skin conditions.

If the results hold up, this tool could become standard care soon. It would make visits to the doctor faster and less painful. Until then, stick with the treatments your doctor recommends.

Study Details

Study typeRct
Sample sizen = 22
EvidenceLevel 2
Follow-up4.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Photodynamic therapy (PDT) is recommended as a first-line treatment for multiple actinic keratoses (AK) and field cancerized skin. When using PDT, skin preparation is recommended before application of photosensitizer cream to enhance absorption. Different physical methods exist to remove crusts and scales from the AK lesions. However, currently widely used methods can be time-consuming, unpleasant to the patient, or require expensive equipment. OBJECTIVES: To investigate the performance, safety, and comfort of a novel skin preparation device consisting of a soft biocompatible abrasive pad attached to an oscillating device, compared to widely used methods such as curettage and manual microdermabrasion. METHODS: Before artificial daylight PDT (ADL-PDT) all patients (n = 22) underwent skin preparation with the oscillating abrasive device and either curettage (n = 11) or manual microdermabrasion with sandpaper (n = 11). Removal of hyperkeratotic skin and operation times were evaluated. Safety was defined through skin warming (SW), skin irritation (SI), and skin damage (SD). Device comfort was monitored by user and patient questionnaires. Skin preparation was repeated if needed on Day 14 before second ADL-PDT session. Patients determined pain using numerical rate scale (NRS) during skin preparation and ADL-PDT. AK clearance was measured with number and Olsen grade of AKs assessed on Day 0, Day 14, and at 4 months. RESULTS: Primary outcomes: Skin preparation times of AK lesions using the oscillating abrasive device was 15.2 s/10 cm compared to manual sandpaper 26.6 s/10 cm (P = 0.0136) and curettage 22.3 s/10 cm (P = 0.1573). Hyperkeratotic lesions were easily removed with oscillating device for 95.5% (n = 21/22) of the patients. Corresponding values for curettage were 81.8% (n = 9/11, P = 0.10) and for sandpaper 54.5% (n = 6/11, P = 0.0096). More thorough work was required to remove hyperkeratotic lesions for 18.2% of patients (n = 2/11) in the curettage group and for 27.3% of patients (n = 3/11) in the sandpaper group. Some lesions remained on the skin area prepared with the oscillating device in one patient (4.5%, n = 1/22) and in two patients with sandpaper (18.2% n = 2/11). SECONDARY OUTCOMES: Skin warming was reported more often with oscillating device (SW: n = 10/22), but caused less irritation (SI: n = 2/22) and skin damage (SD: n = 1/22), compared to curettage (SW: n = 1/11, SI: n = 5/11, SD: n = 8/11) and manual sandpaper (SW: n = 4/11, SI: n = 2/11, SD: n = 2/11). All reported cases of SW, SI and SD were mild. Device comfort was in general assessed by patients as neutral: oscillating device (n = 17/22), curettage (n = 8/11) and sandpaper (n = 9/11). Vibration of the oscillating device was assessed as neutral by many patients (n = 16), pleasant by four patients (n = 4) and unpleasant by two patients (n = 2). None of the patients found the vibration very unpleasant. The mean pain scores (NRS) were low during skin preparation (oscillating device 1.1, curettage 1.8, sandpaper 1.7) and even lower during ADL-PDT (oscillating device 0.6, curettage 0.4, sandpaper 1.0). Total number of AK lesions were 260 on Day 0, with a reduction to 56 AK lesions on Day 14 (Olsen grade 1: n = 46/108, Olsen grade 2: n = 10/116, Olsen grade 3: n = 0/35). All lesions were cleared at 4-month follow-up. CONCLUSIONS: The novel oscillating abrasive skin preparation device was as safe and as effective as curettage and manual microdermabrasion in preparation of AKs before ADL-PDT.
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