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Garcia-Mouronte E, Pérez-González LA, Naharro-Rodriguez J, Fernández Guarino M. Understanding Active Photoprotection: DNA-Repair Enzymes and Antioxidants. Life (Basel) 2024; 14:822. [PMID: 39063576 PMCID: PMC11277730 DOI: 10.3390/life14070822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
The detrimental effects of ultraviolet radiation (UVR) on human skin are well-documented, encompassing DNA damage, oxidative stress, and an increased risk of carcinogenesis. Conventional photoprotective measures predominantly rely on filters, which scatter or absorb UV radiation, yet fail to address the cellular damage incurred post-exposure. To fill this gap, antioxidant molecules and DNA-repair enzymes have been extensively researched, offering a paradigm shift towards active photoprotection capable of both preventing and reversing UV-induced damage. In the current review, we focused on "active photoprotection", assessing the state-of-the-art, latest advancements and scientific data from clinical trials and in vivo models concerning the use of DNA-repair enzymes and naturally occurring antioxidant molecules.
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Affiliation(s)
- Emilio Garcia-Mouronte
- Dermatology Department, Hospital Universitario Ramon y Cajal, Carretera M-607 km 9.1, 28034 Madrid, Spain; (L.A.P.-G.); (M.F.G.)
| | | | - Jorge Naharro-Rodriguez
- Dermatology Department, Hospital Universitario Ramon y Cajal, Carretera M-607 km 9.1, 28034 Madrid, Spain; (L.A.P.-G.); (M.F.G.)
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Wang Z, Wang X, Shi Y, Wu S, Ding Y, Yao G, Chen J. Advancements in elucidating the pathogenesis of actinic keratosis: present state and future prospects. Front Med (Lausanne) 2024; 11:1330491. [PMID: 38566927 PMCID: PMC10985158 DOI: 10.3389/fmed.2024.1330491] [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: 10/30/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Solar keratosis, also known as actinic keratosis (AK), is becoming increasingly prevalent. It is a benign tumor that develops in the epidermis. Individuals with AK typically exhibit irregular, red, scaly bumps or patches as a result of prolonged exposure to UV rays. These growths primarily appear on sun-exposed areas of the skin such as the face, scalp, and hands. Presently, dermatologists are actively studying AK due to its rising incidence rate in the United States. However, the underlying causes of AK remain poorly understood. Previous research has indicated that the onset of AK involves various mechanisms including UV ray-induced inflammation, oxidative stress, complex mutagenesis, resulting immunosuppression, inhibited apoptosis, dysregulated cell cycle, altered cell proliferation, tissue remodeling, and human papillomavirus (HPV) infection. AK can develop in three ways: spontaneous regression, persistence, or progression into invasive cutaneous squamous cell carcinoma (cSCC). Multiple risk factors and diverse signaling pathways collectively contribute to its complex pathogenesis. To mitigate the risk of cancerous changes associated with long-term UV radiation exposure, prompt identification, management, and prevention of AK are crucial. The objective of this review is to elucidate the primary mechanisms underlying AK malignancy and identify potential treatment targets for dermatologists in clinical settings.
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Affiliation(s)
- Zhongzhi Wang
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Xiaolie Wang
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yuanyang Shi
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Siyu Wu
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Yu Ding
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Guotai Yao
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianghan Chen
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai, China
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Garcia-Mouronte E, Berna-Rico E, de Nicolas-Ruanes B, Azcarraga-Llobet C, Alonso-Martinez de Salinas L, Bea-Ardebol S. Imiquimod as Local Immunotherapy in the Management of Premalignant Cutaneous Conditions and Skin Cancer. Int J Mol Sci 2023; 24:10835. [PMID: 37446011 DOI: 10.3390/ijms241310835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Cutaneous cancers are, by far, the most common malignant neoplasms of the human being. Due to the great array of clinical conditions, their worldwide increasing incidence and the steady ageing of the population, non-invasive treatments modalities that show a good clinical response, a proper benefit-risk ratio and cosmetic results are becoming increasingly important in the clinical setting. Imiquimod is a topically applied immunomodulator which is often used in the management of several premalignant and malignant cutaneous disorders. This article is a review of the current literature on its mechanism of action, pharmacokinetics, and therapeutical effects.
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Affiliation(s)
| | - Emilio Berna-Rico
- Dermatology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | | | | | | | - Sonia Bea-Ardebol
- Dermatology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
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Jedlowski PM. Ingenol Mebutate Is Associated With Increased Reporting Odds for Squamous Cell Carcinoma in Actinic Keratosis Patients, a Pharmacovigilance Study of the FDA Adverse Event Reporting System (FAERS). J Cutan Med Surg 2023; 27:39-43. [PMID: 36495205 DOI: 10.1177/12034754221143091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recently the production and marketing of ingenol mebutate in the European Union (EU) and Canada was halted due to a possible increased risk of squamous cell carcinoma (SCC) in patients with actinic keratosis (AK). OBJECTIVE To investigate the relationship between SCC and topical AK medications including ingenol mebutate in the FDA Adverse Event Reporting System (FAERS). METHODS Case/non-case analyses were performed in FAERS using data from 2012 to 2020 to examine the reporting odds ratio (ROR) signal for SCC for ingenol mebutate and all classes of topical AK medications under multiple conditions: i. comparison to all other drugs in FAERs, ii. comparison to other topical AK medications, iii. comparison to all other topical AK medications where only a single agent was implicated, iv. comparison of ingenol mebutate vs. imiquimod. RESULTS A statistically significant ROR for SCC was found for ingenol mebutate under all conditions (i. 31.57 (25.45, 39.16), ii. 50.35 (32.21, 78.82), iii 61.09 (35.36, 105.56), iv. 2.53 (1.27, 5.05). A significant but substantially smaller signal was observed for imiquimod (i. 12.38 (6.42, 32.84), ii. 5.18 (2.61, 10.26), iii 5.42 (2.49, 11.78), but not for fluorouracil or diclofenac. When compared to imiquimod directly, ingenol mebutate had a statistically significant ROR for SCC (2.53 (1.27, 5.05). CONCLUSION Our findings support an association between SCC and ingenol mebutate. This association is maintained under controls to limit bias and falsely elevated signal including controlling for disease state and cases with multiple drug exposures and when compared to imiquimod as in Phase IV studies of ingenol mebutate.
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Baker C, James A, Supranowicz M, Spelman L, Shumack S, Cole J, Weightman W, Sinclair R, Foley P. Method of Assessing Skin Cancerization and Keratoses TM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization. Clin Exp Dermatol 2022; 47:1144-1153. [PMID: 35150158 PMCID: PMC9313559 DOI: 10.1111/ced.15136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A range of 'field-directed' treatments is available for the management of extensive skin field cancerization (ESFC), but to date, the only validated objective quantitative tools are limited to assessment of actinic keratoses (AKs) affecting the head. AIMS To develop a versatile quantitative instrument for objective clinical assessment of ESFC and perform initial internal validation across multiple anatomical zones. METHODS The study comprised instrument development, pilot testing and instrument refinement and two rounds of reliability and inter-rater validation testing. The study was noninterventional and used a convenience sample of de-identified patient photographs selected based on preset criteria. An expert panel developed the instrument and scoring system via a modified Delphi voting process. A sample of 16 healthcare professionals from multiple specialties undertook the pilot testing, and a panel of seven dermatologists were involved in validation testing. Validation was determined by assessment of overall inter-rater agreement using Gwet chance-corrected agreement coefficients (ACs). RESULTS The instrument produced, called the Method for Assessing Skin Cancer and Keratoses™ (MASCK™), comprises the Skin Field Cancerization Index (SFCIndex), derived from area of skin involvement and AKs (number and thickness), a global assessment score and a cancer-in-zone score, and uses Likert scales for quantitative scoring. The SFCIndex is a composite score comprising the number and thickness of AKs multiplied by area of skin involvement. ACs for the SFCIndex components, the overall SFCIndex score and the global assessment score were > 0.80 (rated 'almost perfect') while the AC for the cancer-in-zone metric was lower (0.33, rated 'fair'). Internal consistency was demonstrated via positive correlation between the overall SFCIndex score and the global assessment score. CONCLUSIONS Our study found near-perfect agreement in inter-rater reliability when using MASCK to assess the severity of ESFC in multiple anatomical sites. Further validation of this novel instrument is planned to specifically assess its reliability, utility and feasibility in clinical practice.
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Affiliation(s)
- Christopher Baker
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia
| | - Amelia James
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia
| | | | | | - Stephen Shumack
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia,Department of DermatologyRoyal North Shore HospitalSydneyNSWAustralia
| | - Judith Cole
- Department of DermatologySt John of God HospitalSubiacoWAAustralia
| | - Warren Weightman
- Department of Dermatology Queen Elizabeth HospitalWoodvilleSAAustralia
| | | | - Peter Foley
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia,Probity Medical ResearchSkin Health InstituteMelbourneVic.Australia
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Potter AE, Baker C, Shumack S, Sinclair R, Curran WJ, Christie D, Wong B, Foley P, O’Brien P, Spelman L. Preliminary efficacy and safety analysis: 12-month results in 83 patients using a novel approach of widefield radiation therapy for extensive skin field cancerization with or without keratinocyte cancers. J DERMATOL TREAT 2022; 33:2634-2642. [DOI: 10.1080/09546634.2022.2067814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Christopher Baker
- Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, The University Melbourne, Melbourne, Australia
| | - Stephen Shumack
- Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia
| | - Robert Sinclair
- Queensland Institute of Dermatology, Brisbane, Australia
- Specialist Connect Services, Brisbane, Australia
| | - Walter J. Curran
- Oncology, GenesisCare, Fort Myers, FL, USA
- Emory University, Atlanta, GA, USA
| | - David Christie
- GenesisCare, Gold Coast, QLD, Australia
- School of Medicine, Bond University, Gold Coast, QLD, Australia
| | - Bradley Wong
- GenesisCare Radiation Oncology, Buderim, QLD, Australia
| | - Peter Foley
- Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, The University Melbourne, Melbourne, Australia
- Probity Medical Research, Skin Health Institute, Melbourne, Australia
| | - Peter O’Brien
- GenesisCare Radiation Oncology, Newcastle, NSW, Australia
| | - Lynda Spelman
- Queensland Institute of Dermatology, Brisbane, Australia
- Specialist Connect Services, Brisbane, Australia
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Non-Invasive Analysis of Actinic Keratosis before and after Topical Treatment Using a Cold Stimulation and Near-Infrared Spectroscopy. ACTA ACUST UNITED AC 2020; 56:medicina56090482. [PMID: 32967260 PMCID: PMC7560046 DOI: 10.3390/medicina56090482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022]
Abstract
Background and objectives: The possible evolution of actinic keratoses (AKs) into invasive squamous cell carcinomas (SCC) makes their treatment and monitoring essential. AKs are typically monitored before and after treatment only through a visual analysis, lacking a quantitative measure to determine treatment effectiveness. Near-infrared spectroscopy (NIRS) is a non-invasive measure of the relative change of oxy-hemoglobin and deoxy-hemoglobin (O2Hb and HHb) in tissues. The aim of our study is to determine if a time and frequency analysis of the NIRS signals acquired from the skin lesion before and after a topical treatment can highlight quantitative differences between the AK skin lesion area. Materials and Methods: The NIRS signals were acquired from the skin lesions of twenty-two patients, with the same acquisition protocol: baseline signals, application of an ice pack near the lesion, removal of ice pack and acquisition of vascular recovery. We calculated 18 features from the NIRS signals, and we applied multivariate analysis of variance (MANOVA) to compare differences between the NIRS signals acquired before and after the therapy. Results: The MANOVA showed that the features computed on the NIRS signals before and after treatment could be considered as two statistically separate groups, after the ice pack removal. Conclusions: Overall, the NIRS technique with the cold stimulation may be useful to support non-invasive and quantitative lesion analysis and regression after a treatment. The results provide a baseline from which to further study skin lesions and the effects of various treatments.
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