This study focus on the efficacity of tumescent anesthesia in pain management during a photodynamic therapy on the vertex for treatment of actinic keratosis. To do this we carried out a prospective, randomized, controlled, open-ended study. Our aim is to show a 40% reduction in pain during photodynamic therapy session compared to a conventionally used analgesic method (paracetamol + cold water)

Inclusion Criteria:

• Patients over the age of 18
• Diagnosis of clinical or histological actintic keratoses validated by a dermatologist
• More than 4 vertex actinic keratoses lesions that can be treated with a dynamic phototherapy session
• Free subject, without guardianship or curatorship or subordination
• Person affiliated or beneficiary of a social security plan
• Informed and signed consent by the patient after clear and fair information about the study

Exclusion Criteria:

• Known lidocaine hydrochlostate hypersensitivity, local amide-binding anesthetics or one of the excipients
• Hypersensitivity to paracetamol or one of the excipients
• Weight < 50 kg
• Patients with an elongated TQ interval at the ECG (>450 ms in men and >470 ms in women)
• Patients with recurrent porphyria
• Severe hepato-cellular insufficient patients
• Patients who have received treatment for actinic keratoses in the last three months (cryotherapy, 5-fluorouracil, imiquinod, daylight-PTD)
• Patients who have already participated in this study
• People who do not have a social security plan or do not benefit from it through a third party.
• Persons with enhanced protection, namely minors, persons deprived of their liberty by judicial or administrative decision, persons staying in a health or social institution, adults under legal protection and finally the sick in an emergency situation.
• Pregnant or lactating women, women of childbearing age who do not have effective contraception (hormonal/mechanical: per bone, injectable, transcutaneous, implantable, intrauterine device, or surgical: tubal ligation, hysterectomy, total oophorectomy).
• Concurrent participation in another clinical research study.