Dermatologic Uses of Interferons

Pegylated Interferon Alpha 2a for the Treatment of Ocular Surface Squamous Neoplasia

PURPOSE

The purpose of this study was to introduce the initial experience in the use of topical pegylated interferon alpha 2a (PegIFN-α-2a) for ocular surface squamous neoplasia (OSSN).

METHODS

A retrospective medical record review of 8 eyes of 8 patients diagnosed with OSSN and treated with PegIFN-α-2a was performed. All cases were diagnosed of noninvasive OSSN both clinically and histologically. The pegIFN-α-2a was prescribed at a concentration of 20 μg/mL and applied 4 times a day for at least 3 months.

RESULTS

In all 8 cases, topical PegIFN-α-2a was well-tolerated and did not lead to discomfort or any adverse side effects. It resulted in reduction in lesion size and extent in all cases and complete resolution of the lesions.

CONCLUSIONS

Topical PegIFN-α-2a might be an effective and safe treatment option for noninvasive OSSN.

Long-term follow-up of conjunctival and corneal intraepithelial neoplasia treated with topical interferon alfa-2b

OBJECTIVE

To evaluate the long-term recurrence rate (>1 year) of conjunctival and corneal intraepithelial neoplasia (CIN) treated with topical interferon alfa-2b.

DESIGN

Retrospective, noncomparative, interventional case series.

PARTICIPANTS

Twenty-eight eyes of 26 patients from 2 institutions, treated between April 1997 and June 2005, with CIN lesions utilized topical interferon alfa-2b drops 4 times daily until clinical resolution was achieved.

METHODS

Patients' charts and clinical photographs were reviewed, and data were analyzed.

MAIN OUTCOME MEASURES

All eyes were monitored for the possibility of recurrence with a minimum of 1-year follow-up from the time of documented clinical resolution.

RESULTS

Complete clinical resolution of the CIN lesions was achieved in 27 of the 28 eyes treated (96.4%). One of the 28 eyes treated (3.6%) had only a partial response to treatment. For the 27 eyes with complete response, resolution occurred after a median of 2.0 months (range, 10 days-15 months). Eyes were treated for a median of 3.2 months (range, 1-15). Median follow-up after clinical resolution (tumor-free period) was 42.4 months (range, 14-89). One eye of the 27 analyzed (3.7%) experienced a recurrence. Side effects of treatment were limited to mild conjunctival hyperemia and follicular conjunctivitis in 3 patients (12%). In all cases, there was total resolution of the side effects within 1 month after cessation of the medication.

CONCLUSIONS

In this group of patients with CIN lesions observed for >1 year, topical interferon alfa-2b was effective in treating lesions with minimal self-limited side effects.

Gene expression patterns in isolated keloid fibroblasts

Keloid scars after skin trauma are a significant clinical problem, especially in black populations, in which the incidence of keloids has been estimated at 4-16%. Keloids are abnormal dermal proliferative scars secondary to dysregulated wound healing. Despite several biochemical studies on the role of extracellular matrix proteins and growth factors during keloid formation, we still do not know what molecules and signals induce this change. Fibroblasts are thought to be the major inductive cell for keloid scar formation. The aim of this study was to identify gene expression patterns that characterize keloid fibroblasts; identifying such genetic disequilibrium may shed light on the molecular signaling events responsible for keloid formation. In this study, we performed gene expression analysis of fibroblasts isolated from keloid lesions from three individuals in comparison with the fibroblasts isolated from normal skin using the Affymetrix U133a chip (22,284 genes and expression sequence tags). We found through J5 test score expression analysis that among 22,284 genes, there were 43 genes that were overexpressed and five genes were underexpressed in keloid fibroblasts when compared with dermal fibroblasts from persons without keloids. The overexpression of three genes not previously reported as being up-regulated in keloids (annexin A2, Transgelin, and RPS18) was confirmed by real-time polymerase chain reaction. Certain overexpressed genes were similar to previous biochemical observations on the protein levels of these overexpressed genes during keloid formation. We also report for the first time that a few tumor-related genes are overexpressed in keloid fibroblasts.

Ocular Surface Squamous Neoplasia

Even though ocular surface squamous neoplasia (OSSN) has been recognized for well over a century, the past decade has witnessed advances that have helped rewrite many of the paradigms for the diagnosis and management of these lesions. OSSN occurs predominantly in the elderly for whom they are the third most common oculoorbital tumors after melanoma and lymphoma. In addition to advanced age and male sex, other major risk factors linked to its pathogenesis are ultraviolet light, cigarette smoking, and the human papilloma virus. Although the latter has been linked to OSSN for nearly 4 decades, its identification and role in the pathogenesis of these tumors has been elucidated recently and is addressed in detail in this review. Newer techniques of impression cytology represent a noninvasive and reliable method of diagnosing OSSN and monitoring treated cases. The efficacy of chemotherapeutic agents such as mitomycin C and 5-fluorouracil have been proven in the recent past, making them a clear alternative to the time-tested treatment of surgical excision and cryotherapy. Early reports on the efficacy of topical Iterferon alpha 2b indicate significant promise in providing another alternative for the treatment of some of these neoplasms. These advances thus represent a minimally invasive and highly successful approach to the diagnosis and treatment of OSSN.

Treatment of conjunctival and corneal intraepithelial neoplasia with topical interferon alpha-2b

OBJECTIVE

To evaluate the role of topical interferon alfa-2b (IFNalpha2b) in the treatment of conjunctival and corneal intraepithelial neoplasia (CIN).

DESIGN

Noncomparative case series.

PARTICIPANTS

Five patients with histologically proven CIN or recurrences of proven CIN were studied prospectively.

INTERVENTION

After histologic confirmation, patients were given topical recombinant IFNalpha2b (INTRON A, Schering Plough, Kenilworth, NJ) 1 million IU/ml four times a day. Patients were continued on interferon until complete resolution of the tumor had occurred.

MAIN OUTCOME MEASURES

Patients were followed clinically and photographically for evidence of tumor resolution.

RESULTS

All patients had complete resolution of the CIN lesion on IFNalpha2b. The mean time to clinical resolution was 11.6 weeks (range, 4-22 weeks). The mean follow-up was 17.6 months (range, 7-28 months). One patient had a clinical recurrence of his corneal CIN 1 year after tumor resolution. This patient was retreated, resulting in clinical resolution within 6 weeks, and has been tumor free for 8 months of follow-up.

Complete remission of hypereosinophilic syndrome after interferon-alpha therapy: report of a case and literature review

Hypereosinophilic syndrome (HES) is a multisystem disease with a significant mortality rate. It is characterized by peripheral blood eosinophilia and infiltration of eosinophils into many organs including skin. We describe a patient with cutaneous, pulmonary, and gastric symptoms of HES. He was first treated with systemic and topical corticosteroids, antihistamines, and photochemotherapy. Therapy was switched to interferon-alpha, because we had to consider side effects of corticosteroids and no significant improvement had been achieved. During the period of usage of interferon-alpha for 50 weeks, his symptoms of HES nearly cleared. There has been no recurrence in the eight months since the discontinuation of interferon-alpha therapy.

Scleromyxedema: treatment with interferon alfa

Scleromyxedema is a variant of papular mucinosis characterized by fibroblast proliferation and mucin deposition in the dermis. Historically, it has been very difficult to treat and can cause significant morbidity and mortality with systemic involvement. We describe a case of a woman with scleromyxedema and systemic manifestations treated with interferon alfa. Her skin responded very well to therapy within 3 months; however, her systemic manifestations showed little change. We conclude that interferon alfa may be a useful therapy for patients with scleromyxedema, particularly if the disease process is limited to the skin.

Perilesional and topical interferon alfa-2b for conjunctival and corneal neoplasia

OBJECTIVE

To evaluate the role of combined subconjunctival and topical interferon alfa-2b (IFN alpha 2b) in the treatment of conjunctival and corneal intraepithelial neoplasia (CIN).

DESIGN

Noncomparative case series.

PARTICIPANTS

Six patients with histologically proven CIN or recurrences of histologically proven CIN were studied prospectively.

INTERVENTION

Patients were given a single subconjunctival/perilesional injection of recombinant IFN alpha 2b (Schering Plough, Kenilworth, NJ) 3 million international units (IU) in 0.5 ml and then started receiving topical interferon drops (1 million U/ml) four times a day. Patients were followed weekly until complete resolution of the tumor. After 1 week, patients with minimal response while receiving topical therapy were retreated with perilesional injections three times a week until resolution. Patients received topical interferon drops for a month after clinical resolution of the lesion.

MAIN OUTCOME MEASURES

Patients were followed clinically and photographically for evidence of tumor resolution.

RESULTS

The authors present a series of six patients who were treated successfully with a combination of subconjunctival/perilesional and topical IFN alpha 2b. All six patients had complete clinical resolution of the CIN lesion within 6 weeks of initiation of treatment. In the time of follow-up (average, 7.2 months; range, 2-11 months), there have been no treatment failures or recurrences.

CONCLUSION

IFN alpha 2b may be a viable medical alternative to surgical excision for primary or recurrent CIN.