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Kim H, Ryu C, Lee M, Lee KR, Kim J. A Phase I, Open-Label, Sequential, Single-Dose Clinical Trial to Evaluate the Pharmacokinetic, Pharmacodynamic, and Safety of IVL3001, a Finasteride-Based Novel Long-Acting Injection for Androgenetic Alopecia. Adv Ther 2024; 41:2936-2952. [PMID: 38833144 DOI: 10.1007/s12325-024-02890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Hair loss is driven by multiple factors, including genetics. Androgenetic alopecia (AGA) is a condition in which treatments necessitate prolonged compliance with prescribed medications. We have developed IVL3001, a long-acting injectable (LAI) formulation of finasteride encapsulated within poly lactic-co-glycolic acid microspheres, to enhance the efficacy of the finasteride and to achieve consistent positive outcomes in adults. An open-label, sequential, single-dose phase I clinical trial was designed to evaluate the safety, pharmacokinetic (PK), and pharmacodynamic (PD) of IVL3001. METHODS A total of 40 non-smoking, healthy adult males were divided into three cohorts where the IVL3001 group received a single subcutaneous injection of 12-36 mg IVL3001 and 1 mg finasteride (Propecia®) once daily for 28 days. The plasma concentrations of finasteride, dihydrotestosterone (DHT), and testosterone were measured using liquid chromatography-tandem mass spectrometry. The tolerability of the injections was assessed, and compartment models were developed to predict the effective dose and assess PK/PD profiles. RESULTS IVL3001 and finasteride 1 mg tablets were well tolerated. IVL3001 showed consistent plasma concentrations without bursts or fluctuations. Consistent with its mechanism of action, IVL3001 reduced DHT levels. Simulation data showed that the administration of 12-36 mg of IVL3001 every 4 weeks achieved plasma concentrations similar to finasteride, with comparable DHT reduction. CONCLUSION The present study represents the first clinical trial to evaluate the safety, pharmacokinetic (PK), pharmacodynamic (PD), and tolerability of finasteride long-acting injectables (LAI) in adults. The rapid onset of action sustained effective drug concentration and the prolonged half-life of IVL3001 suggest that it offers multiple benefits over conventional oral formulations in terms of therapeutic response and compliance. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04945226.
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Affiliation(s)
- Heesun Kim
- Inventage Lab, 9F Uspace2B, 670, Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13494, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06355, Republic of Korea
| | - Choongho Ryu
- Inventage Lab, 9F Uspace2B, 670, Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13494, Republic of Korea
| | - Mase Lee
- Inventage Lab, 9F Uspace2B, 670, Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13494, Republic of Korea
| | - Kyeong-Ryoon Lee
- Laboratory Animal Resource Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju, 28116, Republic of Korea
| | - Juhee Kim
- Inventage Lab, 9F Uspace2B, 670, Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13494, Republic of Korea.
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Chadha M, Walsh S, du Vivier A. A large case series on the use of diphencyprone immunotherapy in the clearance of palmoplantar warts. Clin Exp Dermatol 2023; 48:96-99. [PMID: 36730505 DOI: 10.1093/ced/llac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Palmoplantar viral warts are common, often affecting the quality of life of patients and present a major therapeutic challenge. Immunotherapy using diphencyprone (DCP) can be beneficial especially if first-line treatments fail. AIM To determine the effectiveness of DCP in clearing viral warts, and to provide detail on the number of treatments required and any adverse effects (AEs). METHODS This was a retrospective case series of 124 patients who had received DCP treatment in a UK private practice setting from 1991 to 2008, carried out by a dermatologist experienced in the procedure. All patients had been referred by other clinicians after failure of standard treatments. The study data were extracted from clinical records, with follow-up until wart clearance or treatment discontinuation. RESULTS There was an equal distribution in sexes (63 females, 61 males), with 37% of patients having warts present for greater than 5 years. The majority (93%) of patients had already tried cryotherapy, which was unsuccessful in clearing warts completely in all cases. Following DCP treatment, 77% of patients achieved full eradication of their warts, including three patients who were immunosuppressed. The mean number of DCP treatments required to achieve full clearance was 4·7, and the mean concentration of DCP required was 4%. Only 12% of patients experienced AEs, which were mild, and included urticaria and blistering. CONCLUSION We suggest that DCP immunotherapy is a safe and effective treatment for eradicating viral warts, especially in recalcitrant cases.
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Affiliation(s)
- Mehak Chadha
- Department of Dermatology, King's College Hospital, London, UK
| | - Sarah Walsh
- Department of Dermatology, King's College Hospital, London, UK
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Use of Contact Immunotherapy in the Treatment of Skin Diseases Other than Alopecia Areata. Dermatol Ther (Heidelb) 2022; 12:2415-2452. [PMID: 36136235 DOI: 10.1007/s13555-022-00818-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022] Open
Abstract
For decades, contact immunotherapy with dinitrochlorobenzene, diphencyprone, and squaric acid dibutylester has played an important role in both clinical practice and scientific research. It is listed as the first-line treatment for extensive alopecia areata and was more recently approved for melanoma treatment as an orphan drug in the USA. Moreover, owing to the relative low cost and safety, topical immunotherapy has also been used in many infectious, neoplastic, and inflammatory dermatological diseases. It is especially valuable in vulnerable groups, for cosmetic/pain sensitive areas, or for multiple lesions. In this review, we summarize the current evidence supporting the use of contact immunotherapy for treatment of skin diseases, from articles collected from PubMed database. Owing to space limitation and already numerous studies focusing on alopecia areata, we include only skin diseases other than alopecia areata. In addition to diseases that have been reported to be treated by contact immunotherapy, the hypothesized mechanism, prognosis prediction, efficacy, and safety of these topical agents are discussed.
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Lintzeri DA, Constantinou A, Hillmann K, Ghoreschi K, Vogt A, Blume-Peytavi U. Alopecia areata – Aktuelles Verständnis und Management. J Dtsch Dermatol Ges 2022; 20:59-93. [PMID: 35040563 DOI: 10.1111/ddg.14689_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Dimitra Aikaterini Lintzeri
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Andria Constantinou
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Kathrin Hillmann
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Annika Vogt
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
| | - Ulrike Blume-Peytavi
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin
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Lintzeri DA, Constantinou A, Hillmann K, Ghoreschi K, Vogt A, Blume-Peytavi U. Alopecia areata - Current understanding and management. J Dtsch Dermatol Ges 2022; 20:59-90. [PMID: 35040577 DOI: 10.1111/ddg.14689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023]
Abstract
Alopecia areata (AA) is a chronic, immune-mediated disease characterized by acute or chronic non-scarring hair loss, with a heterogeneity in clinical manifestations ranging from patchy hair loss to complete scalp and body hair loss. An overview of the up-to-date pathophysiology and the underlying signaling pathways involved in AA together with diagnostic and therapeutic recommendations will be provided. Current treatments, including topical, systemic and injectable interventions show varying response and frequent relapses reflecting the unmet clinical need. Thus, the new emerging concepts and therapeutic approaches, including Janus kinase inhibitors are eagerly awaited. Traditional and emerging therapies of AA will be discussed, in order to provide physicians with guidance for AA management. Since the latter is so challenging and often tends to take a chronic course, it can have an enormous psychosocial burden on patients, compromising their quality of life and often causing depression and anxiety. Therefore, the psychosocial aspects of the disease need to be evaluated and addressed, in order to implement appropriate psychological support when needed.
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Affiliation(s)
- Dimitra Aikaterini Lintzeri
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Andria Constantinou
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
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Knackstedt R, Smile T, Yu J, Gastman BR. Non-Operative Options for Loco-regional Melanoma. Clin Plast Surg 2021; 48:631-642. [PMID: 34503723 DOI: 10.1016/j.cps.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant melanoma is the 5th most common cancer and stage IV melanoma accounts for approximately 4% of new melanoma diagnoses in the United States. The prognosis for regionally advanced disease is poor, but there have been numerous recent advances in the medical management of melanoma in-transit metastases. The goal of this paper is to review currently accepted treatment options for in-transit metastases and introduce emerging therapies. Therapies to be discussed include limb perfusion and infusion, immunotherapy, checkpoint inhibitors, and radiation therapy.
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Affiliation(s)
- Rebecca Knackstedt
- Department of Plastic Surgery, Cleveland Clinic, 2049 East 100th Street, Desk A60, Cleveland, OH 44195, USA
| | - Timothy Smile
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Avenue, Cleveland, OH 44195, USA
| | - Jennifer Yu
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Center, 10201 Carnegie Avenue, Cleveland, OH 44195, USA
| | - Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, 2049 East 100th Street, Desk A60, Cleveland, OH 44195, USA.
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Mahasaksiri T, Kositkuljorn C, Anuntrangsee T, Suchonwanit P. Application of Topical Immunotherapy in the Treatment of Alopecia Areata: A Review and Update. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:1285-1298. [PMID: 33790540 PMCID: PMC8001176 DOI: 10.2147/dddt.s297858] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/09/2021] [Indexed: 12/13/2022]
Abstract
Treatment of extensive or recalcitrant alopecia areata (AA) is a major clinical challenge. Even after thorough investigation of several medications, its treatment outcomes have remained unsatisfactory. While there is no US Food and Drug Administration-approved medication for AA yet, topical immunotherapy has been a well-documented treatment option. Dinitrochlorobenzene, squaric acid dibutylester, and diphenylcyclopropenone are three substances that have demonstrated efficacy in the treatment of extensive or recalcitrant AA. Despite being commonly used, the mechanism underlying topical immunotherapy is not well-elucidated and a wide range of clinical efficacies have been reported in the literature. The aim of this review was to summarize and update the pharmacology, mechanism of action, therapeutic efficacy, and tolerability of topical immunotherapy in the treatment of AA.
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Affiliation(s)
- Thipprapai Mahasaksiri
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanaporn Anuntrangsee
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Sterkens A, Lambert J, Bervoets A. Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options. Clin Exp Med 2021; 21:215-230. [PMID: 33386567 DOI: 10.1007/s10238-020-00673-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.
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Affiliation(s)
- A Sterkens
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - A Bervoets
- Department of Dermatology, University Hospital of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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Asadi LK, Goldberg LH, Jih MH. A case report of alopecia totalis associated with permanent hair dye use. JAAD Case Rep 2020; 6:801-803. [PMID: 32875023 PMCID: PMC7452178 DOI: 10.1016/j.jdcr.2020.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Leonard H. Goldberg
- DermSurgery Associates, Houston, Texas
- Department of Dermatology, Houston Methodist Hospital, Houston, Texas
- Weill Cornell Medical College, New York, New York
| | - Ming H. Jih
- DermSurgery Associates, Houston, Texas
- Department of Dermatology, Houston Methodist Hospital, Houston, Texas
- Weill Cornell Medical College, New York, New York
- Correspondence to: Ming H. Jih, MD, PhD, DermSurgery Associates, 7515 Main, Ste 240, Houston, TX 77030.
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Nasimi M, Ghandi N, Abedini R, Mirshamsi A, Shakoei S, Seirafi H. Efficacy and safety of anthralin in combination with diphenylcyclopropenone in the treatment of alopecia areata: a retrospective case series. Arch Dermatol Res 2019; 311:607-613. [DOI: 10.1007/s00403-019-01940-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 01/01/2023]
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Responses to Topical Diphenylcyclopropenone as an Adjunct Treatment for In-Transit Melanoma: A Tertiary Referral Center Experience. Dermatol Surg 2018; 44:1501-1508. [DOI: 10.1097/dss.0000000000001603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yang MY, Son JH, Kim GW, Kim HS, Ko HC, Kim MB, Lim KM, Kim BS. Quadrivalent human papilloma virus vaccine for the treatment of multiple warts: a retrospective analysis of 30 patients. J DERMATOL TREAT 2018; 30:405-409. [PMID: 30232912 DOI: 10.1080/09546634.2018.1527006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Various therapeutic modalities have been implemented for wart treatment, with limited efficacy. Recently, resistant warts treated using quadrivalent human papilloma virus (HPV) vaccine have been reported, although original articles on the efficacy of quadrivalent HPV vaccine on warts are rare. Objective: We performed the present study to evaluate the efficacy of quadrivalent HPV vaccine in the treatment of multiple warts. Methods: We retrospectively reviewed 30 patients from our centers. Patient demographics, clinical features such as duration of disease, number and location of lesions, therapeutic response, and adverse reactions were assessed. Results: Regarding therapeutic response, 14 patients (46.67%) showed "Complete response", 5 (16.67%) showed "Partial response", and 11 (36.67%) showed "No response". There were no statistically significant differences in sex, age, disease duration, and lesion number and location between the three groups divided by treatment response. No severe adverse events after quadrivalent HPV vaccination were noted. Conclusion: The advantage of quadrivalent HPV vaccine in the treatment of warts is that it is more convenient and less painful. HPV vaccine might be a good alternative to conventional destructive methods for incompetent cases such as those including multiple warts, dangerous lesion locations, and uncooperative patients.
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Affiliation(s)
- Min-Young Yang
- a Department of Dermatology, College of Medicine , Pusan National University , Busan , Korea.,b Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Jin-Hwa Son
- a Department of Dermatology, College of Medicine , Pusan National University , Busan , Korea.,b Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Gun-Wook Kim
- a Department of Dermatology, College of Medicine , Pusan National University , Busan , Korea.,b Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Hoon-Soo Kim
- a Department of Dermatology, College of Medicine , Pusan National University , Busan , Korea.,b Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Hyun-Chang Ko
- a Department of Dermatology, College of Medicine , Pusan National University , Busan , Korea
| | - Moon-Bum Kim
- a Department of Dermatology, College of Medicine , Pusan National University , Busan , Korea.,b Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Kyung-Min Lim
- c Department of Nursing Science , Dongju College , Busan , Korea
| | - Byung-Soo Kim
- a Department of Dermatology, College of Medicine , Pusan National University , Busan , Korea.,b Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
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Choe SJ, Lee S, Pi LQ, Keum DI, Lee CH, Kim BJ, Lee WS. Subclinical sensitization with diphenylcyclopropenone is sufficient for the treatment of alopecia areata: Retrospective analysis of 159 cases. J Am Acad Dermatol 2018; 78:515-521.e4. [PMID: 29108907 DOI: 10.1016/j.jaad.2017.10.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Contact immunotherapy with diphenylcyclopropenone (DPCP) is presently considered the treatment of choice for extensive alopecia areata. However, a major concern with contact immunotherapy is that it causes various adverse effects (AEs) that contribute to discontinuation of treatment. OBJECTIVE We investigated whether a modified DPCP treatment protocol can promote hair regrowth with fewer AEs. METHODS All patients were sensitized with 0.1% DPCP and began treatment with 0.01% DPCP. Thereafter, the DPCP concentration was slowly increased according to the treatment response and AEs. This was a retrospective review of DPCP treatment with modified protocols in 159 patients with alopecia areata. RESULTS Of the 159 patients, 46 (28.9%) showed a complete response and 59 (37.1%) showed a partial response. No patients had AEs after sensitization. During the treatment, only 3 patients (1.9%) showed severe AEs, and 55 showed moderate AEs; however, all were well controlled with antihistamines alone or antihistamines and medium-potency topical steroids. There was no association between treatment response and AEs. LIMITATIONS Sample size, subject composition, and the retrospective study design represent potential limitations. CONCLUSION A modified DPCP treatment protocol with subclinical sensitization could induce a favorable therapeutic response and result in fewer AEs.
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Affiliation(s)
- Sung Jay Choe
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Solam Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Long Quan Pi
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dong In Keum
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chung Hyeok Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Beom Jun Kim
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Soo Lee
- Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Uzuncakmak TK, Koska MC, Karadağ AS, Akdeniz N. A Case Report of Verruca Vulgaris on basis of Alopecia Areata Successfully Treated with Diphenylcyclopropenone. Int J Trichology 2017; 9:35-37. [PMID: 28761264 PMCID: PMC5514795 DOI: 10.4103/ijt.ijt_86_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Alopecia areata is an autoimmune skin disease which is usually characterized by patchy hair loss in effected regions. Diagnosis usually based on clinical findings and main treatment options include topical, intralesional, systemic corticosteroids, and topical immunotherapy. Verruca vulgaris is an infectious disease caused by human papillomavirus which is usually characterized by well-marginated hyperkeratotic papules or plaques. There are several treatment modalities such as physical and chemical destruction and topical immunotherapy. A 23-year-old male patient presented to our outpatient clinic with multifocal noncicatrial alopecic plaques on scalp and multiple periungual verrucous papules on bilateral hands. High potent corticosteroid cream and minoxidil lotion 5% were offered for his scalp lesions, and topical 5-fluorouracil lotion was initiated for his verrucous lesions. In the 1st month visit, we detected contamination of viral warts on alopecic plaques of his scalp and all the previous therapeutics were stopped. We initiated topical diphenylcyclopropenone (DPCP) sensitization weekly. After the fourth application of DPCP, we observed that all of hyperkeratotic papules disappeared. Diphencyprone treatment was continued, and with further applications, hair growth as vellus type was observed. DPCP is relatively beneficial treatment option for both diseases although it is not a first-line therapy most times. There are case reports and series about this treatment for both of these diseases. We want to present this case to by regard of the unusual presentation and efficacy of DPCP in both indications.
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Affiliation(s)
- Tugba Kevser Uzuncakmak
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Can Koska
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayşe Serap Karadağ
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Read T, Webber S, Tan J, Wagels M, Schaider H, Soyer HP, Smithers BM. Diphenylcyclopropenone for the treatment of cutaneous in-transit melanoma metastases - results of a prospective, non-randomized, single-centre study. J Eur Acad Dermatol Venereol 2017. [PMID: 28626861 DOI: 10.1111/jdv.14422] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current treatments for in-transit melanoma (ITM) metastases are frequently invasive and do not improve overall survival. Recently, there has been increasing investigation into the use of topical agents. Diphenylcyclopropenone or diphencyprone (DPCP) is a novel, topical therapy that has been reported to have immune-sensitizing properties useful in the treatment of ITM. OBJECTIVE To assess the clinical outcomes of patients treated within a prospective, non-randomized, non-comparative study using DPCP for cutaneous ITM metastases. METHODS A review was conducted assessing the outcomes of 58 patients prospectively treated using DPCP. Patients had satellite or in-transit disease (stage IIIB+), with all lesion morphology types included. The patients were treated through a single, specialized clinic with regular outpatient follow-up. DPCP was topically applied as an aqueous cream in 0.005-1% concentrations once to twice per week for up to 24-48 h of duration. To assess variables associated with response, a per-protocol statistical analysis was performed. RESULTS Fifty-four patients were treated who satisfied eligibility criteria for analysis. The overall response rates were as follows: complete response 22%, partial response 39%, stable disease 24% and progressive disease 15%. The mean time to complete response was 10.5 months, mean duration (disease-free interval) 12.3 months and recurrence rate in complete responders 41%. Lesion morphology was predictive of clinical benefit with a higher response in epidermotropic disease (P < 0.05). CONCLUSIONS DPCP provided a well-tolerated, convenient and efficacious treatment for cutaneous ITM metastases. Identifying patterns of response may assist treatment selection and improve patient-rated outcomes.
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Affiliation(s)
- T Read
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia.,School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | - S Webber
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia
| | - J Tan
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia
| | - M Wagels
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - H Schaider
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Dermatology Research Centre, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - H P Soyer
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Dermatology Research Centre, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - B M Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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16
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Friedmann PS, Haddadeen C, Lai C, Healy E. In vitro human T cell responses to diphencyprone. Contact Dermatitis 2017; 76:251-253. [PMID: 28317194 DOI: 10.1111/cod.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Peter S Friedmann
- Faculty of Medicine, Dermatopharmacology Unit, Sir Henry Wellcome Laboratories, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Ciara Haddadeen
- Faculty of Medicine, Dermatopharmacology Unit, Sir Henry Wellcome Laboratories, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.,Dermatology Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Chester Lai
- Faculty of Medicine, Dermatopharmacology Unit, Sir Henry Wellcome Laboratories, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.,Dermatology Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Eugene Healy
- Faculty of Medicine, Dermatopharmacology Unit, Sir Henry Wellcome Laboratories, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.,Dermatology Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
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17
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Weide B, Neri D, Elia G. Intralesional treatment of metastatic melanoma: a review of therapeutic options. Cancer Immunol Immunother 2017; 66:647-656. [PMID: 28078357 DOI: 10.1007/s00262-016-1952-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/22/2016] [Indexed: 02/07/2023]
Abstract
Intralesional therapy of melanoma patients with locally advanced metastatic disease is attracting increasing interest, not least due to its ability to lead to both direct tumor cell killing and the stimulation of both a local and a systemic immune response. An obvious pre-requisite for this type of approach is the presence of accessible metastases that are amenable to direct injection with the therapeutic agent of interest. Patients who present with these characteristics belong to stages IIIB/C or IV of the disease. Surgical resection with intention to cure is the standard of care for patients with limited tumor burden and confined spread of disease (resectable patients). However, this category of patients is at a high risk of further recurrences until the disease becomes inoperable (unresectable) or progresses to a more advanced stage with visceral organ involvement, after which the prognosis is particularly grim. Most of the intralesional treatments tested so far, including the recently approved oncolytic virus talimogene laherparepvec, target the subpopulation of patients with unresectable disease, but the possibility to use the intralesional treatment in a neoadjuvant setting for fully resectable patients is attracting considerable interest. The present article reviews approved products and advanced stage pharmaceutical agents in development for the intralesional treatment of melanoma patients.
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Affiliation(s)
- Benjamin Weide
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Dario Neri
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Giuliano Elia
- Philochem AG, Libernstrasse 3, 8112, Otelfingen, Switzerland.
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DallʼOglio F, Luca M, Barresi S, Micali G. Treatment of Multiple-Resistant and/or Recurrent Cutaneous Warts With Squaric Acid Dibutylester: A Randomized, Double-blind, Vehicle-controlled Clinical Trial. Dermatitis 2017; 28:308-312. [PMID: 28885314 DOI: 10.1097/der.0000000000000317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contact immunotherapy with squaric acid dibutylester (SADBE) for cutaneous warts has been reported to be effective, although no controlled studies are available so far. OBJECTIVE The aim of this study was to evaluate the efficacy of SADBE on cutaneous warts by a randomized, double-blind, vehicle-controlled, clinical trial. METHODS Thirty-six patients were randomly assigned to SADBE (18 cases) or vehicle (18 cases) group. At 8 weeks, subjects were clinically evaluated for number/size reduction rate and for Investigator Global Assessment. Those who showed improvement extended therapy up to 40 weeks, whereas those who showed unresponsiveness were either switched to SADBE application for up to 48 weeks (if in the vehicle group) or withdrawn from the study (if under SADBE). RESULTS At 8 weeks, a significant reduction in wart number (P = 0.020) and size (P = 0.010) in the SADBE group, with clearing rates of 41.2% versus 12.5% in the SADBE and vehicle groups, respectively, was observed. Nine remaining SADBE responders who underwent treatment extension up to 40 weeks achieved clearing versus 2 patients of the vehicle group who remained unresponsive. Clearing was obtained in 81.8% of patients who underwent previous ineffective vehicle treatment and had been switched to SADBE. CONCLUSIONS Squaric acid dibutylester is an effective therapeutic option and is significantly more effective than vehicle.
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19
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Paranjpe A, Bordador LCF, Wang MY, Hume WR, Jewett A. Resin Monomer 2-Hydroxyethyl Methacrylate (HEMA) is a Potent Inducer of Apoptotic Cell Death in Human and Mouse Cells. J Dent Res 2016; 84:172-7. [PMID: 15668336 DOI: 10.1177/154405910508400212] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mechanisms by which the resin monomer 2-hydroxyethyl methacrylate (HEMA) induces hypersensitivity reactions in humans are not well-established, nor have the direct effects of HEMA on cell death been fully characterized. The objective of this study was to establish whether HEMA is capable of inducing apoptotic cell death, and whether differences exist in the levels of apoptotic death induced by HEMA in cells obtained from healthy individuals and from patients with established HEMA hypersensitivity. HEMA induced apoptotic death in Peripheral Blood Mononuclear Cells (PBMCs) obtained from both healthy and HEMA-sensitized patients and in the murine RAW cells in a dose-dependent manner. However, induction of cell death by HEMA was lower in PBMCs obtained from patients in comparison with healthy individuals. Studies reported in this paper demonstrate that HEMA induces apoptotic death, and that decreased susceptibility of lymphocytes to HEMA-mediated death might be an important mechanism for the generation and persistence of hypersensitivity reactions in patients.
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Affiliation(s)
- A Paranjpe
- Division of Oral Biology and Oral Medicine, UCLA School of Dentistry, The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, Los Angeles, CA 90095, USA
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Sloot S, Rashid OM, Sarnaik AA, Zager JS. Developments in Intralesional Therapy for Metastatic Melanoma. Cancer Control 2016; 23:12-20. [PMID: 27009452 DOI: 10.1177/107327481602300104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Locoregional advanced melanoma poses a complex clinical challenge that requires a multidisciplinary, patient-centered approach. Numerous agents have been studied for their suitability as intralesional therapy in the past decades, but few have successfully completed phase 3 clinical trial testing. METHODS The relevant medical literature was searched for articles regarding use of intralesional therapies in metastatic melanoma. Therapies with data from phase 2 or higher studies were selected for review. This review also summarizes the mechanisms of action, adverse-event profiles, and clinical data for these agents. RESULTS Intralesional therapies demonstrate promising effects in select patients with advanced melanoma. The optimal approach should be individually tailored and consist of a combination of intralesional therapies, regional perfusions, systemic immunotherapies, targeted therapies, and surgery, if necessary. CONCLUSIONS Due to its relatively good local response rates and tolerable adverse-event profile, intralesional therapy may be a treatment option for select patients with unresectable, locally advanced or metastatic melanoma.
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Affiliation(s)
| | | | | | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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21
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Yoshimasu T, Furukawa F. Modified immunotherapy for alopecia areata. Autoimmun Rev 2016; 15:664-7. [DOI: 10.1016/j.autrev.2016.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
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22
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Park HK, Kim JS. Factors contributing to the treatment duration of diphenylcyclopropenone immunotherapy for periungual warts. Dermatol Ther 2015; 29:114-9. [DOI: 10.1111/dth.12312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hyung Kwon Park
- Department of Dermatology; Hanyang University Guri Hospital; Guri, Korea
| | - Joung Soo Kim
- Department of Dermatology; Hanyang University Guri Hospital; Guri, Korea
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23
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Kuin R, Spuls P, Limpens J, van Zuuren EJ. Diphenylcyclopropenone in patients with alopecia areata. A critically appraised topic. Br J Dermatol 2015; 173:896-909. [DOI: 10.1111/bjd.14040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- R.A. Kuin
- Dutch Association for Dermatology and Venereology (NVDV); Utrecht the Netherlands
| | - P.I. Spuls
- Dermatology Department; Academic Medical Center; Amsterdam the Netherlands
| | - J. Limpens
- Academic Medical Center; Amsterdam the Netherlands
| | - E. J. van Zuuren
- Dermatology Department; Leiden University Medical Center; Leiden the Netherlands
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24
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Vedak P, Kroshinsky D. Squaric acid sensitization is not required for response in the treatment of alopecia areata. J Am Acad Dermatol 2015; 73:471-6. [DOI: 10.1016/j.jaad.2015.04.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 12/01/2022]
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Abstract
INTRODUCTION Hair loss or alopecia affects the majority of the population at some time in their life, and increasingly, sufferers are demanding treatment. Three main types of alopecia (androgenic [AGA], areata [AA] and chemotherapy-induced [CIA]) are very different, and have their own laboratory models and separate drug-discovery efforts. AREAS COVERED In this article, the authors review the biology of hair, hair follicle (HF) cycling, stem cells and signaling pathways. AGA, due to dihydrotesterone, is treated by 5-α reductase inhibitors, androgen receptor blockers and ATP-sensitive potassium channel-openers. AA, which involves attack by CD8(+)NK group 2D-positive (NKG2D(+)) T cells, is treated with immunosuppressives, biologics and JAK inhibitors. Meanwhile, CIA is treated by apoptosis inhibitors, cytokines and topical immunotherapy. EXPERT OPINION The desire to treat alopecia with an easy topical preparation is expected to grow with time, particularly with an increasing aging population. The discovery of epidermal stem cells in the HF has given new life to the search for a cure for baldness. Drug discovery efforts are being increasingly centered on these stem cells, boosting the hair cycle and reversing miniaturization of HF. Better understanding of the molecular mechanisms underlying the immune attack in AA will yield new drugs. New discoveries in HF neogenesis and low-level light therapy will undoubtedly have a role to play.
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Affiliation(s)
- Zenildo Santos
- Massachusetts General Hospital, Wellman Center for Photomedicine , Boston, MA 02114 , USA +1 617 726 6182 ; +1 617 726 6643 ;
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26
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Na CH, Choi H, Song SH, Kim MS, Shin BS. Two-year experience of using the measles, mumps and rubella vaccine as intralesional immunotherapy for warts. Clin Exp Dermatol 2015; 39:583-9. [PMID: 24934912 DOI: 10.1111/ced.12369] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The currently available treatments for warts, including cryosurgery, laser surgery, electrosurgery, and topical keratolytic applications, are often very painful and can induce disfiguring scars. Recently, intralesional immunotherapy with skin test antigens and vaccines has been shown to be effective in the management of warts. AIMS To evaluate the efficacy of a new intralesional immunotherapy for warts, using the measles, mumps and rubella (MMR) vaccine. METHODS A retrospective study was performed, and we enrolled 136 patients with various types of warts into the study, which was for a duration of 2 years. Patients were treated for a total of six times at 2-week intervals. The treatment response was classified as one of three levels, based on reduction in the size and number of warts, and patients with complete response (CR) were checked for recurrence. Clinical evaluations were carried out using photographs and medical records. RESULTS Over half (51.5%) of patients experienced > 50% reduction in the size and number of warts, and 46.7% who had distant warts (in different locations) showed good response. Common warts showed significantly higher treatment response than other types of warts (P < 0.05). However, other clinical variables did not have any effect on efficacy. Almost all the patients reported mild pain during the injection, but other side effects were rarely observed. Only 5.6% of patients who experienced CR had recurrence of warts after 6 months. CONCLUSIONS We suggest that intralesional immunotherapy with MMR vaccine is a tolerable and effective method for patients who are sensitive to pain, concerned about side effects, or have common warts. Treatment response is improved by increasing the number of injections.
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Affiliation(s)
- C H Na
- Department of Dermatology, Chosun University Medical School, Gwangju, Korea
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27
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Pandey S, Wilmer EN, Morrell DS. Examining the efficacy and safety of squaric acid therapy for treatment of recalcitrant warts in children. Pediatr Dermatol 2015; 32:85-90. [PMID: 25040421 DOI: 10.1111/pde.12387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of the study was to determine the safety and efficacy of squaric acid dibutyl ester (SADBE) therapy on the treatment of recalcitrant warts in children. This retrospective chart review examined 72 patients treated using SADBE from July 2002 to December 2012. Patients were followed for 6 months to 11 years. Patients were treated at a pediatric dermatology outpatient clinic at the University of North Carolina at Chapel Hill. Seventy-two children with verrucae who failed initial treatment for warts were selected for the study. Full long-term follow-up was obtained in 48 patients. Four patients discontinued the use of SADBE because of adverse effects. The primary study outcome was efficacy of SADBE treatment. Adverse effects, dosages administered, type of wart, other cutaneous disease present, and level of immunosuppression were measured. Forty of 48 (83%) patients in whom treatment outcomes could be obtained reported complete resolution of their warts. Seventy percent of patients used a maximum concentration of 0.4% SADBE and 60% of patients reported no adverse effects. The majority of patients treated with SADBE reported complete resolution of warts. Most patients reported no adverse effects even while receiving doses as high as 2% daily. This study shows that SADBE is a safe and effective treatment for recalcitrant warts in children.
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Affiliation(s)
- Shaily Pandey
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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28
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Sutherland L, Laschinger M, Syed ZU, Gaspari A. Treatment of Alopecia Areata With Topical Sensitizers. Dermatitis 2015; 26:26-31. [DOI: 10.1097/der.0000000000000094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Suh DW, Lew BL, Sim WY. Investigations of the efficacy of diphenylcyclopropenone immunotherapy for the treatment of warts. Int J Dermatol 2014; 53:e567-71. [DOI: 10.1111/ijd.12688] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dong-Woo Suh
- Department of Dermatology; College of Medicine; Kyunghee University; Seoul Korea
| | - Bark-Lynn Lew
- Department of Dermatology; College of Medicine; Kyunghee University; Seoul Korea
| | - Woo-Young Sim
- Department of Dermatology; College of Medicine; Kyunghee University; Seoul Korea
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Abstract
INTRODUCTION Intralesional therapy for metastatic melanoma has some advantages over systemic therapy. Local drug administration allows for delivery of an increased concentration of the agent and reduced systemic exposure, thereby increasing local efficacy and limiting toxicity. Moreover, since in vivo tumor nodules contain the tumor antigens, this tumor tissue may serve as an autologous vaccine to induce systemic immunity. This so-called 'bystander effect', where uninjected distant lesions exhibit a response, has been reported in select intralesional therapy trials. AREAS COVERED This review will give an overview of the working mechanisms, clinical evidence and side effects for available intralesional and topical therapies and summarize the most recent developments in this field. EXPERT OPINION The ideal treatment approach for locoregionally advanced melanoma should be multidisciplinary and tailored to the patient, taking into consideration patient-related, tumor-related factors (such as location, tumor burden, mutation status) and previous treatments received. It will likely not be a single therapy, but rather a combination of injectable treatments, regional perfusions and systemic therapies.
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Affiliation(s)
- Sarah Sloot
- University Medical Center Groningen , Groningen , Netherlands
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Hapten-induced contact hypersensitivity, autoimmune reactions, and tumor regression: plausibility of mediating antitumor immunity. J Immunol Res 2014; 2014:175265. [PMID: 24949488 PMCID: PMC4052058 DOI: 10.1155/2014/175265] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/27/2014] [Indexed: 01/21/2023] Open
Abstract
Haptens are small molecule irritants that bind to proteins and elicit an immune response. Haptens have been commonly used to study allergic contact dermatitis (ACD) using animal contact hypersensitivity (CHS) models. However, extensive research into contact hypersensitivity has offered a confusing and intriguing mechanism of allergic reactions occurring in the skin. The abilities of haptens to induce such reactions have been frequently utilized to study the mechanisms of inflammatory bowel disease (IBD) to induce autoimmune-like responses such as autoimmune hemolytic anemia and to elicit viral wart and tumor regression. Hapten-induced tumor regression has been studied since the mid-1900s and relies on four major concepts: (1) ex vivo haptenation, (2) in situ haptenation, (3) epifocal hapten application, and (4) antigen-hapten conjugate injection. Each of these approaches elicits unique responses in mice and humans. The present review attempts to provide a critical appraisal of the hapten-mediated tumor treatments and offers insights for future development of the field.
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Kang HS, Lee MW, Paek JO, Yu HJ, Kim JS. Comparison of cure rates and durations of treatment with diphenylcyclopropenone immunotherapy for warts in children/adolescents and adults. Int J Dermatol 2014; 53:1293-8. [DOI: 10.1111/ijd.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ho Song Kang
- Department of Dermatology; Hanyang University Guri Hospital; Guri Korea
| | - Min Won Lee
- Department of Dermatology; Hanyang University Guri Hospital; Guri Korea
| | - Jun Oh Paek
- Department of Dermatology; Hanyang University Guri Hospital; Guri Korea
| | - Hee Joon Yu
- Department of Dermatology; Hanyang University Guri Hospital; Guri Korea
| | - Joung Soo Kim
- Department of Dermatology; Hanyang University Guri Hospital; Guri Korea
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Damian DL, Saw RPM, Thompson JF. Topical immunotherapy with diphencyprone for in transit and cutaneously metastatic melanoma. J Surg Oncol 2013; 109:308-13. [PMID: 24522938 DOI: 10.1002/jso.23506] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 10/28/2013] [Indexed: 12/21/2022]
Abstract
Topical diphencyprone (DPCP) can be used to treat in transit and cutaneously metastastatic melanoma. To date, 50 patients have received DPCP therapy for at least 1 month at our institution, with complete clearance of cutaneous disease in 46% and partial response in a further 38% of patients. Topical immunotherapy with DPCP is inexpensive and well-tolerated and should be considered in patients with skin metastases unsuitable for or refractory to other forms of therapy.
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Affiliation(s)
- Diona L Damian
- Department of Dermatology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; The University of Sydney at Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Melanoma Institute Australia, North Sydney, New South Wales, Australia
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Park HJ, Choi YW, Kim SH, Shin MS, Lee SW, Oh MK, Choi HY. Change in cytokines in patients with warts after contact immunotherapy with squaric acid dibutylester. Clin Exp Dermatol 2013; 38:775-81. [PMID: 23611147 DOI: 10.1111/ced.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND A wart is a skin lesion caused by infection with human papillomavirus (HPV). Contact immunotherapy is one of the many therapeutic options that have been used to treat warts; however, the effectiveness of contact immunotherapy differs from patient to patient, and the cause of this variation in clinical response is unclear. AIM To assess cytokine changes in patients after contact immunotherapy with squaric acid dibutylester (SADBE). METHODS In total, 21 patients with warts and 9 healthy control subjects were enrolled in the study. The frequencies of CD3+ T cells expressing interleukin (IL)-4, IL-10, IL-12, tumour necrosis factor-α and interferon-γ were measured by flow cytometry analysis of peripheral blood at baseline in both patients and controls, and after SADBE treatment in patients. RESULTS Lower expression of IL-4 and higher expression of IL-12 in CD3+ T cells were found in patients compared with controls. The percentage of CD3+/IL-4+ T cells significantly increased after contact immunotherapy in all responders, but was significantly higher in those with an excellent response, who also had a significantly higher percentage of CD3+/IL-10+ T cells. The patients with an excellent response also had a significant decrease in the percentage of CD3+/IL-12+ T cells, and the percentage of CD3+/IL-4+ T cells normalized. CONCLUSIONS Response to contact immunotherapy can vary depending on the types of cytokine changes produced by treatment. An excessive shift to a Th2 pattern and increased IL-10 production after contact immunotherapy may hinder clearance of HPV.
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Affiliation(s)
- H J Park
- Department of Dermatology, Ilsanpaik Hospital, Inje University School of Medicine, Goyang, South Korea
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&NA;. Treat cutaneous warts on a case-by-case basis, taking into account patient factors and the available clinical evidence. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.2165/11608610-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Treat cutaneous warts on a case-by-case basis, taking into account patient factors and the available clinical evidence. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.1007/bf03262114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Moos S, Johansen P, Waeckerle-Men Y, Mohanan D, Senti G, Häffner A, Kündig TM. The contact sensitizer diphenylcyclopropenone has adjuvant properties in mice and potential application in epicutaneous immunotherapy. Allergy 2012; 67:638-46. [PMID: 22380933 DOI: 10.1111/j.1398-9995.2012.02802.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epicutaneous vaccination has gained increasing interest during the past decade as it offers a safe, needle-free, and patient-friendly alternative to invasive vaccine administrations. Recently, the safety and early efficacy of epicutaneous immunotherapy were also demonstrated in patients with hay fever, as an alternative to conventional subcutaneous allergen-specific immunotherapy (SCIT). One major challenge to epicutaneous vaccination is the barrier function of the stratum corneum, which must be overcome either by abrasive methods or by hydration. Such barrier function of the stratum corneum also hampers the use of common adjuvants used to enhance the efficacy of vaccination. METHODS In a mouse model of allergy, we tested the adjuvant potential of diphenylcyclopropenone (DCP), a strong contact sensitizer, which is currently used for the treatment of a T cell-mediated hair loss disease (alopezia areata). RESULTS Diphenylcyclopropenone enhanced antigen-specific IgG2a antibody responses as well as IL-10 cytokine production after epicutaneous immunization with ovalbumin (OVA). Epicutaneous allergen-specific immunotherapy (EPIT) with OVA and DCP also protected sensitized mice from anaphylaxis and asthma. The protective effect was more robust than that of conventional SCIT, which did not significantly alleviate the symptoms of allergy in the murine models of anaphylaxis and asthma. CONCLUSIONS This preclinical study confirmed previous clinical data that have demonstrated the potential of the skin as a target for allergen immunotherapy. The study also suggests that epicutaneous immunization or immunotherapy can be improved when an appropriate adjuvant such as DCP is used.
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Affiliation(s)
| | - P. Johansen
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - Y. Waeckerle-Men
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - D. Mohanan
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - G. Senti
- Clinical Trials Center; University of Zurich; Zurich; Switzerland
| | - A. Häffner
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - T. M. Kündig
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
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Dall'oglio F, D'Amico V, Nasca MR, Micali G. Treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol 2012; 13:73-96. [PMID: 22292461 DOI: 10.2165/11594610-000000000-00000] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cutaneous warts are common skin lesions caused by human papillomavirus infection. Treatment is aimed at relieving the patient's physical and psychological discomfort and at preventing the spread of infection by autoinoculation. Among the available medical and destructive therapeutic options for cutaneous warts, none is uniformly effective or virucidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, so that the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. The aim of this article is to describe the outcome of current therapies for each clinical wart type according to evidence-based medicine studies published in the literature. For each clinical form, the existing treatments are classified as first-, second-, and third-line therapy. First-line therapy includes medical treatments (salicylic acid, silver nitrate, glutaraldehyde) that are useful to treat a single wart or a few and/or small common warts of short duration (less than 1 year). If these treatments have failed or are contraindicated, cryotherapy may be considered as second-line therapy. For recurrent or difficult-to-treat lesions, third-line therapy includes a variety of alternative therapeutic options (topical, intralesional, systemic, and physical destruction) that are generally off-label (not US FDA approved), and whose use is limited by drawbacks or adverse effects. From pooled evidence-based medicine data, it is possible to conclude that significantly higher remission rates may be expected only with cryotherapy and salicylic acid used in combination.
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Belij S, Popov A, Zolotarevski L, Mirkov I, Djokic J, Kataranovski D, Kataranovski M. Systemic immunomodulatory effects of topical dinitrochlorobenzene (DNCB) in rats. Activity of peripheral blood polymorphonuclear cells. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2012; 33:168-180. [PMID: 22222559 DOI: 10.1016/j.etap.2011.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/07/2011] [Accepted: 11/23/2011] [Indexed: 05/31/2023]
Abstract
Topical application of dinitrochlorobenzene (DNCB) is employed in the immunotherapy of skin diseases. Activation of T-cell mediated immune responses (Th1/type1) is the supposed mechanism of the clinical effect of DNCB, but there are no data concerning innate/inflammatory mechanisms. In this study, the effect of repeated topical DNCB application on peripheral blood polymorphonuclear (PMN) leukocytes has been examined in two rat strains which differ in the propensity to mount Th1/type1 or Th2/type2 responses. The dynamics of changes in PMN numbers and effector activities (respiratory burst, nitric oxide production and myeloperoxidase content), as well as in adhesion and TNF-α production following the rat skin sensitization with low (0.4%) and high (4%) DNCB doses were measured. Both priming and activation of PMNs were observed following skin sensitization with DNCB, with dose-dependent as well as time-dependent differences in some PMN activities. Obtained data might be relevant for understanding the immune mechanisms of topical DNCB therapy.
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Affiliation(s)
- Sandra Belij
- Department of Ecology, Institute for Biological Research Sinisa Stankovic, University of Belgrade, Bulevar despota Stefana 142, 11000 Belgrade, Serbia
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Harper Smith AD, Coakley SL, Ward MD, Macfarlane AW, Friedmann PS, Walsh NP. Exercise-induced stress inhibits both the induction and elicitation phases of in vivo T-cell-mediated immune responses in humans. Brain Behav Immun 2011; 25:1136-42. [PMID: 21362469 DOI: 10.1016/j.bbi.2011.02.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 11/19/2022] Open
Abstract
Little is known about the influence of exercise on induction and elicitation phases of in vivo immunity in humans. We used experimental contact-hypersensitivity, a clinically relevant in vivo measure of T cell-mediated immunity, to investigate the effects of exercise on induction and elicitation phases of immune responses to a novel antigen. The effects of 2 h-moderate-intensity-exercise upon the induction (Study One) and elicitation of in vivo immune memory (Study Two) to diphenylcyclopropenone (DPCP) were examined. Study One: matched, healthy males were randomly-assigned to exercise (N=16) or control (N=16) and received a primary DPCP exposure (sensitization), 20 min after either 2 h running at 60% V O(2peak) (EX) or 2 h seated rest (CON). Four weeks later, participants received a low, dose-series DPCP challenge (elicitation) on their upper inner arm, which was read at 24 and 48 h as clinical score, oedema (skinfold thickness) and redness (erythema). Study Two: pilot; 13 healthy males were sensitized to DPCP. Elicitation challenges were repeated every 4 weeks until responses reached a reproducible plateau. Then, N=9 from the pilot study completed both EX and CON trials in a randomized order. Elicitation challenges were applied and evaluated as in Study One. Results demonstrate that exercise-induced stress significantly impairs both the induction (oedema -53% at 48 h; P<0.001) and elicitation (oedema -19% at 48 h; P<0.05) phases of the in vivo T-cell-mediated immune response. These findings demonstrate that prolonged moderate-intensity exercise impairs the induction and elicitation phases of in vivo T-cell-mediated immunity. Moreover, the induction component of new immune responses appears more sensitive to systemic-stress-induced modulation than the elicitation component.
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Affiliation(s)
- Adam D Harper Smith
- College of Health and Behavioural Sciences, Bangor University, Bangor LL57 2PZ, UK
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Abstract
Alopecia Areata (AA) is a common non-scarring alopecia directed against the anagenic hair follicle. Various treatment modalities have been used for the treatment of severe AA. Topical immunotherapy is the best documented treatment so far for severe and refractory AA. Dinitrochlorobenzene (DNCB), squaric acid dibutylester (SADBE), and diphencyprone (DPCP) are the contact allergens used for this purpose. DNCB has been found to be mutagenic by the Ames test and is largely replaced by DPCP and SADBE. DPCP and SADBE are both known to be non-mutagenic compounds and have comparable efficacy results and relapse rates. SADBE requires special solvents and additives to maintain its potency and is more expensive than the rest. DPCP has a response rate varying from 60% in severe Alopecia Areata to 17% in patients with alopecia totalis or universalis, and shows about 88 to 100% high response rate in patients with patchy Alopecia Areata.
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Affiliation(s)
- Gurcharan Singh
- Department of Dermatology and STD, Sri Devaraj Urs Medical College, Tamaka, Kolar - 563 101, India
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Chularojanamontri L, Tuchinda P, Kulthanan K, Manuskiatti W. Generalized molluscum contagiosum in an HIV patient treated with diphencyprone. J Dermatol Case Rep 2010; 4:60-2. [PMID: 21886754 DOI: 10.3315/jdcr.2010.1059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 12/05/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Diphencyprone is a universal contact immunotherapy. The mechanism of action is based on an induction of the delayed-type hypersensitivity. Diphencyprone has been used in various forms for treatments of recalcitrant and facial warts, and alopecia areata. However, this treatment modality has not been generally used in immunocompromised patients. MAIN OBSERVATION The present report demonstrated the efficacy of diphencyprone immunotherapy on the treatment of generalized molluscum contagiosum in a human immunodeficiency virus (HIV)-infected patient. Minimal and transient side effects including pruritus, postinflammatory hyperpigmentation and irritation were noted. CONCLUSION Diphencyprone contact immunotherapy appears to be a possible alternative treatment of widespread molluscum contagiosum in immunocompromised patients.
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INUI S, NAKAJIMA T, TODA N, ITAMI S. Pigmented contact dermatitis due to therapeutic sensitizer as complication of contact immunotherapy in alopecia areata. J Dermatol 2010; 37:888-93. [DOI: 10.1111/j.1346-8138.2010.00903.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Damian DL, Shannon KF, Saw RP, Thompson JF. Topical diphencyprone immunotherapy for cutaneous metastatic melanoma. Australas J Dermatol 2009; 50:266-71. [DOI: 10.1111/j.1440-0960.2009.00556.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dall'oglio F, Nasca MR, Musumeci ML, La Torre G, Ricciardi G, Potenza C, Micali G. Topical immunomodulator therapy with squaric acid dibutylester (SADBE) is effective treatment for severe alopecia areata (AA): Results of an open‐label, paired‐comparison, clinical trial. J DERMATOL TREAT 2009; 16:10-4. [PMID: 15897160 DOI: 10.1080/09546630410023601] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED Severe alopecia areata (AA) may have a chronic relapsing course and is often resistant to current treatments. OBJECTIVES The aim of our study was to evaluate whether topical immunotherapy with squaric acid dibutylester (SADBE) is able to improve the course of severe AA and to reduce the severity of relapses. METHODS Fifty-four patients affected by severe AA treated with SADBE who were followed for a period of at least 2 years were selected as the study group. Data collected were compared with those of a matched control group of 54 patients who did not receive any treatment. Student's t-test, analysis of variance (ANOVA) and Pearson's chi-squared test were utilized for data analysis. RESULTS At the end of therapy, in comparison with the control group, the treatment group showed a statistically significant (p < 0.001) improvement. At follow-up, there was no significant change in relapse rate (treated 44% vs control 52%). However, relapses in the treated group were significantly less severe compared with the control group (p < 0.001). CONCLUSIONS Our data suggest that topical SADBE represents a valid therapeutic option in severe AA, and may prove to be disease modifying.
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Affiliation(s)
- F Dall'oglio
- Dermatology Clinic, University of Catania, Catania, Italy
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He XJ, Chu YQ, Jiang GY, Dai ZY. A potential carrier for targeted therapy of DNFB hapten-induced immune. Shijie Huaren Xiaohua Zazhi 2009; 17:1350-1354. [DOI: 10.11569/wcjd.v17.i13.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the influence of dinitroflourobenzene (DNFB) on the antibody titer of hepatitis B immunoglobulin (HBIG).
METHODS: Three different doses (2, 4, 8 mg) of DNFB were mixed with phosphate buffer solution (PBS) of HBIG respectively, 13 mg in a volume of 500 µL PBS, while same solutions of HBIG were used as controls. The 2, 4 mg tubes and the control tubes were not precipitated except for the 8 mg tube with 10 000 r/min configuration. The 3 transparent tubes were desalted with column of Sephadex G-25 Superfine HiTrap respectively. All of the eluents of the 3 tubes were half-diluted consecutively with phosphate buffer saline (PBS) respectively to change totally into 36 samples of 2 mg group, 4 mg group and control group, with 12 in each group. The above samples were all tested for the antibody titer of HBIG using ELISA. The 2 mg tube, 4 mg tube and the control tube were all precipitated in solution of saturated (NH4)2SO4. Compared with standard curves of both quantity of DNFB and gauges of A340 in supernants made of same controlled tubes, the remaining DNFB in supernants in different tubes were all obtained respectively.
RESULTS: Except for the 8 mg group, there were no difference in the 3 groups in terms of the absorbance values (A450-A630) of HBIG in same dilution grade of any group with two-way anova (analysis of variance)(P > 0.05). However there was great difference between different dilution grades in any group with two-way anova (P < 0.01). The 6.5 mg of HBIG in the 2 mg tube and 4 mg tube were respectively combined with 0.67 mg and 0.86 mg of DNFB, meaning that each molecule of HBIG with 88.72 and 103.48 molecules of DNFB, namely 6.12% and 7.86% in residual amino acid of each molecule of HBIG combined with DNFB.
CONCLUSION: The immune globulin (antibody) might be used as a carrier for DNFB target therapy.
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Papadavid E, Stratigos AJ, Falagas ME. Imiquimod: an immune response modifier in the treatment of precancerous skin lesions and skin cancer. Expert Opin Pharmacother 2007; 8:1743-55. [PMID: 17685890 DOI: 10.1517/14656566.8.11.1743] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Actinic keratosis (AK) and basal cell carcinoma (BCC) are precancerous and cancerous skin lesions that should be treated especially when multiple or in cosmetically important areas. Apart from 5% 5-fluorouracil topical cream, which some feel is the gold standard topical treatment for AK, several invasive treatment modalities are available for AK and superficial BCC, such as cryotherapy, electrodessication, carbon dioxide laser and surgery causing patients discomfort and pain, pigmentary changes or necessitate multiple office visits. Additionally, there are precancerous lesions that necessitate non-invasive treatment with good esthetic results or skin cancer refractory to invasive techniques. Imiquimod is an immune response modifier approved by the FDA for the treatment of AK and superficial BCC lesions and its use is gradually expanded to various off-label precancerous and cancerous skin lesions.
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Affiliation(s)
- Evangelia Papadavid
- 2nd Department of Dermatology, ATTIKON University General Hospital, University of Athens Medical School, Athens, Greece
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Abstract
O objetivo deste artigo é discutir alguns fatos dos imunomoduladores modernos que podem ser úteis para o dermatologista clínico. Outro objetivo importante é o de dissipar mitos que possam ter impacto negativo no uso dessas drogas pelo clínico. O foco inicial está em imunomoduladores estimuladores que podem conduzir à acentuação da resposta normal das células imunocompetentes. Para tanto, diversos aspectos associados à regulação do sistema imune e às vias regulatórias das células do sistema imune são mencionados. Discutem-se a regulação aberrante e seu impacto no sistema imune e examina-se a classe de drogas imunossupressoras que têm sua função bem estabelecida. Diversas drogas não foram mencionadas. A razão para isso é o foco do artigo que pretende cobrir os fatos bem estabelecidos ou os mitos que as novas evidências científicas modificaram. Com esse padrão em mente, é provável que exista uma quantidade considerável de similaridade nos conceitos, uma vez que descrevem drogas imunomoduladoras. Nesse contexto, a intenção de fornecer novas perspectivas de como o sistema imune pode ser modulado por essas drogas supera esse problema.
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Damian DL, Thompson JF. Treatment of extensive cutaneous metastatic melanoma with topical diphencyprone. J Am Acad Dermatol 2007; 56:869-71. [PMID: 17276544 DOI: 10.1016/j.jaad.2006.12.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 12/14/2006] [Accepted: 12/24/2006] [Indexed: 11/19/2022]
Abstract
Diphencyprone is a potent contact sensitizer sometimes used to treat alopecia areata and cutaneous warts. A patient with previous primary nodular melanoma on the scalp developed extensive, confluent cutaneous metastases near the primary site, unsuitable for treatment with surgery or radiotherapy. Topical treatment with diphencyprone as a single agent resulted in regression of all lesions, and the patient remains well 18 months later. Topical immunotherapy with diphencyprone was an inexpensive and well-tolerated treatment for extensive cutaneous melanoma metastases in our patient unsuitable for other therapies.
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Affiliation(s)
- Diona L Damian
- Department of Dermatology, University of Sydney at Royal Prince Alfred Hospital, Australia.
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