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Bordeaux ZA, Choi J, Braun G, Davis C, Marani M, Lee K, Samuel C, Adams J, Windom R, Pollizzi A, Kambala A, Cornman H, Reddy SV, Lu W, Oladipo OO, Alphonse MP, West CE, Kwatra SG, Kwatra MM. Topical GZ21T Inhibits the Growth of Actinic Keratoses in a UVB-Induced Model of Skin Carcinogenesis. JID INNOVATIONS 2023; 3:100206. [PMID: 37533581 PMCID: PMC10392087 DOI: 10.1016/j.xjidi.2023.100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 08/04/2023] Open
Abstract
Actinic keratoses (AKs) are premalignant intraepidermal neoplasms that occur as a result of cumulative sun damage. AKs commonly relapse, and up to 16% undergo malignant transformation into cutaneous squamous cell carcinoma. There is a need for novel therapies that reduce the quantity and surface area of AKs as well as prevent malignant transformation to cutaneous squamous cell carcinomas. We recently showed that GZ17-6.02, an anticancer agent composed of curcumin, haramine, and isovanillin, inhibited the growth of H297.T cells. This study evaluated the efficacy of a topical formulation of GZ17-6.02, known as GZ21T, in a murine model of AK generated by exposing SKH1 mice to UVR. Treatment of mice with topical GZ21T inhibited the growth of AKs by decreasing both lesion count (P = 0.012) and surface area occupied by tumor (P = 0.002). GZ21T also suppressed the progression of AKs to cutaneous squamous cell carcinoma by decreasing the count (P = 0.047) and surface area (P = 0.049) of lesions more likely to represent cutaneous squamous cell carcinoma. RNA sequencing and proteomic analyses revealed that GZ21T suppressed several pathways, including MAPK (P = 0.025), phosphoinositide 3-kinase-protein kinase B (P = 0.04), HIF-1α (P = 0.016), Wnt (P = 0.025), insulin (P = 0.018), and ERBB (P = 0.016) signaling. GZ21T also upregulated the autophagy-promoting protein AMPK while suppressing proteins such as PD-L1, glutaminase, pAkt1 S473, and eEF2K.
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Affiliation(s)
- Zachary A. Bordeaux
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Gabriella Braun
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Cole Davis
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christeen Samuel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jackson Adams
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Reed Windom
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Anthony Pollizzi
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sriya V. Reddy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Weiying Lu
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olusola O. Oladipo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin P. Alphonse
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cameron E. West
- Genzada Pharmaceuticals, Hutchinson, Kansas, USA
- US Dermatology Partners, Dallas, Texas, USA
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, South Carolina, USA
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Stockfleth E, Jouary T, Farnetani F, Pascual AM, De Almeida Agudo C, Voisard JJ, Bégeault N, Delarue A. Severity of Local Skin Reactions with 4% 5-Fluorouracil Plus Emollient versus 4% 5-Fluorouracil Alone in Patients with Actinic Keratosis: A Single-Blind Randomised Trial. Dermatol Ther (Heidelb) 2023; 13:1013-1027. [PMID: 36856965 DOI: 10.1007/s13555-023-00902-6] [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: 01/06/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Topical 5-fluorouracil (5-FU)-containing treatments are effective for actinic keratosis (AK); however, they frequently lead to transient local skin reactions (LSRs), which often result in treatment non-adherence. METHODS The aim of this international, phase IV clinical trial was to investigate whether addition of an emollient to topical 4% 5-FU would reduce the frequency and severity of LSRs over 4 weeks of treatment (intervention group) compared with 4% 5-FU alone (control group) in patients with AK. The primary objective was to assess the severity of LSRs (i.e. erythema, flaking/scaling, crusting, swelling, vesiculation/pustulation and erosion/ulceration) at week 4 of treatment (or before, in case of a major local reaction). Key secondary objectives were LSR total scores at weeks 2 and 8, the scores of individual LSR items at each visit, and the proportions of patients with 100% and ≥ 75% AK lesion clearance at week 8. RESULTS In total, 141 patients were included in the efficacy analysis (71 in the intervention group and 70 in the control group). There were no statistically or clinically significant differences between the treatment groups in terms of LSR total score at week 4 (overall and by subgroups defined by the number of lesions and patient age at baseline), scores of individual LSR items at any time point, and AK lesion clearance rates at week 8. LSR scores with topical 4% 5-FU alone were lower than expected. Skin reactions were the most common treatment-emergent adverse events in both groups, leading to treatment discontinuation in nine patients (12.3%) in the intervention group and seven (9.9%) in the control group. No new safety signals were observed with the addition of an emollient to 4% 5-FU. CONCLUSIONS Daily emollient applications during the 4-week treatment course did not impact the safety and efficacy profile of 4% 5-FU.
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Affiliation(s)
- Eggert Stockfleth
- Kath. Klinikum Bochum St. Josef-Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Thomas Jouary
- CH Pau, Service de Dermatologie, 4 Bd Hauterive, 64000, Pau, France
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | | | | | | | | | - Alain Delarue
- Pierre Fabre SA, Les Cauquillous, 81500, Lavaur, France
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Veronese F, Seoni S, Tarantino V, Buttafava M, Airoldi C, Meiburger KM, Zavattaro E, Savoia P. AKASI and Near-Infrared Spectroscopy in the combined effectiveness evaluation of an actinic keratoses preventive product in immunocompetent and immunocompromised patients. Front Med (Lausanne) 2022; 9:987696. [PMID: 36160127 PMCID: PMC9489998 DOI: 10.3389/fmed.2022.987696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The high incidence of actinic keratoses among both the elderly population and immunocompromised subjects and the considerable risk of progression from in situ to invasive neoplasms makes it essential to identify new prevention, treatment, and monitoring strategies. Objective The aim of this study was to evaluate the efficacy on AKs of a topical product (®Rilastil AK Repair 100 +) containing high-protection sunscreens, a DNA Repair Complex with antioxidant and repairing action against UV-induced DNA damage, and nicotinamide, a water-soluble derivative of vitamin B3 that demonstrated several photoprotective effects both in vitro and in vivo. Methods The study enrolled 74 Caucasian patients, which included 42 immunocompetent and 32 immunosuppressed subjects. The efficacy of the treatment has been evaluated through the clinical index AKASI score and the non-invasive Near-Infrared Spectroscopy method. Results The AKASI score proved to be a valid tool to verify the efficacy of the product under study, highlighting an average percentage reduction at the end of treatment of 31.37% in immunocompetent patients and 22.76% in organ transplant recipients, in comparison to the initial values, with a statistically significant reduction also in the single time intervals (T0 vs. T1 and T1 vs. T2) in both groups. On the contrary, the Near-Infrared Spectroscopy (a non-invasive technique that evaluates hemoglobin relative concentration variations) did not find significant differences for O2Hb and HHb signals before and after the treatment, probably because the active ingredients of the product under study can repair the photo-induced cell damage, but do not significantly modify the vascularization of the treated areas. Conclusion The results deriving from this study demonstrate the efficacy of the product under study, confirming the usefulness of the AKASI score in monitoring treated patients. Near-Infrared Spectroscopy could represent an interesting strategy for AK patients monitoring, even if further large-scale studies will be needed.
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Affiliation(s)
| | - Silvia Seoni
- Biolab, PolitoBIOMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | | | - Matteo Buttafava
- School of Medicine, University of Eastern Piedmont, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Kristen M. Meiburger
- Biolab, PolitoBIOMed Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Elisa Zavattaro
- SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- *Correspondence: Elisa Zavattaro,
| | - Paola Savoia
- SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy
- School of Medicine, University of Eastern Piedmont, Novara, Italy
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
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Martin-Gorgojo A, Gilaberte Y, Nagore E. Vitamin D and Skin Cancer: An Epidemiological, Patient-Centered Update and Review. Nutrients 2021; 13:4292. [PMID: 34959844 PMCID: PMC8709188 DOI: 10.3390/nu13124292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The current vitamin D deficiency epidemic is accompanied by an increase in endemic skin cancer. There are still multiple controversies. This review aims to give practical recommendations regarding vitamin D among people at risk or with a personal history of skin cancer. METHODS Narrative review including human research articles published between 2011 and 2021, elaborated bearing in mind an epidemiological, patient-centered approach. RESULTS Ultraviolet (UV) exposure (neither artificial nor natural) is not the ideal source to synthesize vitamin D. There is conflicting epidemiological evidence regarding vitamin D, non-melanoma skin cancer (NMSC), and cutaneous melanoma (CMM), confounded by the effect of sun exposure and other factors. CONCLUSIONS Current evidence is controversial, and there are no widely applicable strategies. We propose three practical recommendations. Firstly, sun protection recommendations should be kept among people at risk or with a personal history of skin cancer. Secondly, vitamin D should preferably be sourced through diet. In patients with melanoma or at risk of cutaneous cancer, serum vitamin D checks are warranted to detect and avoid its insufficiency.
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Affiliation(s)
| | - Yolanda Gilaberte
- Dermatology Department, Hospital Universitario Miguel Servet, IIS Aragon, 50009 Zaragoza, Spain;
| | - Eduardo Nagore
- Dermatology Department, Universidad Catolica de Valencia, 46001 Valencia, Spain;
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Metabolomic Analysis of Actinic Keratosis and SCC Suggests a Grade-Independent Model of Squamous Cancerization. Cancers (Basel) 2021; 13:cancers13215560. [PMID: 34771721 PMCID: PMC8582912 DOI: 10.3390/cancers13215560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Actinic keratoses (AKs) are the most common sun-induced precancerous lesions that can progress to squamocellular carcinoma (SCC). AK I have been considered low-risk lesions, often evolving into AK II, the AK grade II and III have the potential to evolve to SCC. This research has assessed the metabolomic fingerprints of AK I, AK II, AK III and SCC by HR-MAS NMR spectroscopy, with the aim of evaluating the hypothesis of grade-association AK to SCC. The association between AKs and SCCs has also been evaluated by histopathology. Our findings support the notion that AK I are different from healthy skin and share different features with SCCs, indeed, they are metabolically active lesions with metabolic profiles similar to high-grade AKs and to SCC. The negative association of AKs with parakeratosis and the positive association with hypertrophy also suggested a similar behavior between AKs and SCCs. Therefore, all AKs should be treated independently from their clinical appearance or histological grade, since it is not possible to predict their potential evolution to SCC. Abstract Background—Actinic keratoses (AKs) are the most common sun-induced precancerous lesions that can progress to squamocellular carcinoma (SCC). Recently, the grade-independent association between AKs and SCC has been suggested; however, the molecular bases of this potential association have not been investigated. This study has assessed the metabolomic fingerprint of AK I, AK II, AK III and SCC using high resolution magic angle spinning (HR-MAS) nuclear magnetic resonance (NMR) spectroscopy in order to evaluate the hypothesis of grade-independent association between AK and SCC. Association between AKs and SCCs has also been evaluated by histopathology. Methods—Metabolomic data were obtained through HR-MAS NMR spectroscopy. The whole spectral profiles were analyzed through multivariate statistical analysis using MetaboAnalyst 5.0. Histologic examination was performed on sections stained with hematoxylin and eosin; statistical analysis was performed using STATA software version 14. Results—A group of 35 patients affected by AKs and/or SCCs and 10 healthy controls were enrolled for metabolomics analysis. Histopathological analysis was conducted on 170 specimens of SCCs and AKs (including the ones that underwent metabolomic analysis). SCCs and AK I were found to be significantly associated in terms of the content of some metabolites. Moreover, in the logistic regression model, the presence of parakeratosis in AKs appeared to be less frequently associated with SCCs, while AKs with hypertrophy had a two-fold higher risk of being associated with SCC. Conclusions—Our findings, derived from metabolomics and histopathological data, support the notion that AK I are different from healthy skin and share some different features with SCCs. This may further support the expanding notion that all AKs should be treated independently from their clinical appearance or histological grade because they may be associated with SCC.
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How to Assess the Efficacy of Interventions for Actinic Keratosis? A Review with a Focus on Long-Term Results. J Clin Med 2021; 10:jcm10204736. [PMID: 34682859 PMCID: PMC8538594 DOI: 10.3390/jcm10204736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Actinic keratoses (AK) are common lesions of the skin caused by cumulative sun exposure. Since AK may progress to invasive cutaneous squamous cell carcinoma (cSCC), guidelines uniformly recommend early and consequent treatment. A variety of interventions are available; however, most randomized controlled trials, meta-analyses, and guidelines focus on outcomes that are usually evaluated 8–12 weeks after the end of treatment. Importantly, these assessments can capture the short-term, transient outcomes, but do not allow any conclusions about long-term results to be drawn and do not reflect the probability of transition towards cSCC. Until now, few studies have assessed the long-term results of interventions for AK. Indeed, finding the most appropriate end-point and adjunct time point for determining the long-term results of interventions for AK remains a challenge. Here, we provide an overview of the different ways of measuring the efficacy of AK treatments, such as using recurrence rates or sustained clearance rates, and discuss methodological aspects. Furthermore, we highlight the importance of evidence from post-marketing surveillance trials for the detection of efficacy values and safety signals. Additionally, we emphasize that a follow-up period of 12 months might not be sufficient to reflect the long-term results and stress the urgent need for a longer follow-up period and regular risk-stratified surveillance.
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Choi J, West CE, Roh YS, Sutaria N, Kwatra SG, Kwatra MM. Mouse models for actinic keratoses. J Pharmacol Toxicol Methods 2021; 110:107071. [PMID: 33933627 DOI: 10.1016/j.vascn.2021.107071] [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: 10/03/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
Actinic keratoses (AKs) represent a premalignant skin condition due to chronic sun damage that dramatically increases in prevalence in the aging population. Currently, animal models of AKs utilize photocarcinogenesis, chemical carcinogens, or targeted gene modulation, and each method possesses unique strengths and weaknesses. Models using photodamage most comprehensively describe methods for preferentially selecting AK lesions, while replicating the pathogenesis of AKs with greater fidelity than models utilizing other carcinogenic methods. The following review of current murine models of AKs will aid in the selection of mouse models appropriate for future in vivo studies to test the efficacy of novel therapeutic agents for the treatment of AKs.
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Affiliation(s)
- Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | | | - Youkyung S Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
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Multimodality imaging and treatment strategy for malignant scalp neoplasms in adults. Clin Imaging 2021; 77:48-57. [PMID: 33640791 DOI: 10.1016/j.clinimag.2021.02.036] [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: 06/13/2020] [Revised: 12/30/2020] [Accepted: 02/21/2021] [Indexed: 11/22/2022]
Abstract
Malignant scalp masses deserve much attention as they have the potential to destroy local structures, recur and metastasize to distant organs. Moreover, malignant scalp lesions are known to be more aggressive in behavior than their counterparts elsewhere in the body. Multimodality imaging is essential in narrowing the differential diagnoses of scalp masses, as well as in differentiating benign from malignant masses. Furthermore, imaging is important in (1) evaluating the extent of tumor invasion in the scalp, (2) staging the disease, (3) guiding surgical biopsy and/or resection of the tumor, (4) preoperative planning and post-treatment surveillance of scalp tumors. An interdisciplinary treatment approach is crucial for the management of scalp malignancies given their complex and aggressive nature. This review seeks to describe the unique clinical and imaging characteristics of various types of malignant scalp masses, as well as to review their current treatment strategies.
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Segura S, Gadea A, Nonell L, Andrades E, Sánchez S, Pujol R, Hernández-Muñoz I, Toll A. Identification of differentially expressed genes in actinic keratosis samples treated with ingenol mebutate gel. PLoS One 2020; 15:e0232146. [PMID: 32413042 PMCID: PMC7228095 DOI: 10.1371/journal.pone.0232146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Actinic keratosis is a common skin disease that may progress to invasive squamous cell carcinoma if left untreated. Ingenol mebutate has demonstrated efficacy in field treatment of actinic keratosis. However, molecular mechanisms on ingenol mebutate response are not yet fully understood. In this study, we evaluated the gene expression profiles of actinic keratosis lesions before and after treatment with ingenol mebutate using microarray technology. Actinic keratoses on face/scalp of 15 immunocompetent patients were identified and evaluated after treatment with topical ingenol mebutate gel 0.015%, applied once daily for 3 consecutive days. Diagnostic and clearance of lesions was determined by clinical, dermoscopic, and reflectance confocal microscopy criteria. Lesional and non-lesional skin biopsies were subjected to gene expression analysis profiled by Affymetrix microarray. Differentially expressed genes were identified, and enrichment analyses were performed using STRING database. At 8 weeks post-treatment, 60% of patients responded to ingenol mebutate therapy, achieving complete clearance in 40% of cases. A total of 128 differentially expressed genes were identified following treatment, and downregulated genes (114 of 128) revealed changes in pathways important to epidermal development, keratinocyte differentiation and cornification. In responder patients, 388 downregulated genes (of 450 differentially expressed genes) were also involved in development/differentiation of the epidermis, and immune system-related pathways, such as cytokine and interleukin signaling. Cluster analysis revealed two relevant clusters showing upregulated profile patterns in pre-treatment actinic keratoses of responders, as compared to non-responders. Again, differentially expressed genes were mainly associated with cornification, keratinization and keratinocyte differentiation. Overall, the present study provides insight into the gene expression profile of actinic keratoses after treatment with ingenol mebutate, as well as identification of genetic signatures that could predict treatment response.
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Affiliation(s)
- Sonia Segura
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Alejandra Gadea
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Paul Pascal (CRPP), Université de Bordeaux, Pessac, France
| | - Lara Nonell
- MARGenomics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Evelyn Andrades
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Sánchez
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ramon Pujol
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Inmaculada Hernández-Muñoz
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Steeb T, Wessely A, Leiter U, French L, Berking C, Heppt M. The more the better? An appraisal of combination therapies for actinic keratosis. J Eur Acad Dermatol Venereol 2020; 34:727-732. [DOI: 10.1111/jdv.15998] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/25/2019] [Indexed: 12/30/2022]
Affiliation(s)
- T. Steeb
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
| | - A. Wessely
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
| | - U. Leiter
- Department of Dermatology Center for Dermatooncology University Hospital Tübingen Tübingen Germany
| | - L.E. French
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
| | - C. Berking
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
| | - M.V. Heppt
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
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Reinehr CPH, Bakos RM. Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects. An Bras Dermatol 2019; 94:637-657. [PMID: 31789244 PMCID: PMC6939186 DOI: 10.1016/j.abd.2019.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023] Open
Abstract
Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.
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Affiliation(s)
| | - Renato Marchiori Bakos
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Lozzi F, Lanna C, Mazzeo M, Garofalo V, Palumbo V, Mazzilli S, Diluvio L, Terrinoni A, Bianchi L, Campione E. Investigational drugs currently in phase II clinical trials for actinic keratosis. Expert Opin Investig Drugs 2019; 28:629-642. [PMID: 31232099 DOI: 10.1080/13543784.2019.1636030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Actinic keratoses (AKs) are limited areas of irregular epidermal growth on a background of excessive solar exposure. The entire sun-damaged skin is considered a field of cancerization with multiple visible and subclinical lesions. AK management requires field-directed therapies to block lesion relapse and prevent squamous cell carcinoma (SCC). AREAS COVERED In this review, we focused on phase II clinical trials for AKs, involving well-known agents and newer molecules such as proapoptotic drugs (VDA-1102, SR-T100, oleogel-S10, ICVT, eflornithine), immunomodulants (isotretinoin, tretinoin) and chemopreventive agents (nicotinamide, perillyl alcohol, liposomal T4N5). We used the website 'ClinicalTrials.Gov' as main reference. We selected and discussed completed and ongoing trials and analysed chemical structure and mechanism of action of the investigated molecules. EXPERT OPINION AK therapy should be tailored on the patient's profile considering first of all the age and site of the AKs, which are relevant parameters for local immune response. The new molecules could be combined to obtain a synergic effect blocking the different steps of skin tumorigenesis. Phase II trials highlight a new therapeutic opportunity to block selectively cell proliferation regulators and work both on the field of cancerization and on the AKs currently present.
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Affiliation(s)
- Flavia Lozzi
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Caterina Lanna
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Mauro Mazzeo
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Virginia Garofalo
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Vincenzo Palumbo
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Sara Mazzilli
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Laura Diluvio
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Alessandro Terrinoni
- b Department of Experimental Medicine and Biochemical Sciences , University of Rome "Tor Vergata" , Rome , Italy
| | - Luca Bianchi
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
| | - Elena Campione
- a Department of Systems Medicine , University of Rome "Tor Vergata" , Rome , Italy
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Heppt M, Steeb T, Leiter U, Berking C. Efficacy of photodynamic therapy combined with topical interventions for the treatment of actinic keratosis: a meta‐analysis. J Eur Acad Dermatol Venereol 2019; 33:863-873. [DOI: 10.1111/jdv.15459] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/19/2018] [Indexed: 12/14/2022]
Affiliation(s)
- M.V. Heppt
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
| | - T. Steeb
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
| | - U. Leiter
- Department of Dermatology Center for Dermatooncology University Hospital Tübingen Tübingen Germany
| | - C. Berking
- Department of Dermatology and Allergy University Hospital LMU Munich Munich Germany
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14
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Skroza N, Bernardini N, Proietti I, Potenza C. Clinical utility of ingenol mebutate in the management of actinic keratosis: perspectives from clinical practice. Ther Clin Risk Manag 2018; 14:1879-1885. [PMID: 30323610 PMCID: PMC6174892 DOI: 10.2147/tcrm.s145779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Actinic keratoses (AKs) are epidermal cutaneous neoplasia observed predominantly in middle-aged and older subjects with mainly photo type I and photo type II on sun-exposed surfaces as a result of DNA damage. AKs have historically been characterized as being "precancerous"; however, now it is considered by many authors a carcinoma in situ that can persist or progress to invasive squamous cell carcinoma (SCC) with metastatic potential. Despite the advances in the recognition of typical clinic, dermoscopic and histologic patterns, currently it is not yet possible to predict which AKs will progress to SCC. For this reason, early diagnosis and effective therapy are recommended based on cost/risk/benefit analysis. Current treatment consists of lesion-directed or field-directed therapies or a combination of both. Among the topical field therapies, ingenol mebutate stands out for its therapeutic efficacy, both as directed lesion therapy and as field directed therapy. The aim of this review is to demonstrate the utility of ingenol mebutate in the management of AK in daily clinical practice and to highlight data from real world in order to confirm evidence from pivotal studies. In order to explore clinical data from real world, PubMed searches were performed with the search terms "clinical data ingenol mebutate" and "real world ingenol mebutate". The hits were examined for relevant articles using defaults criteria. The timeframe for the sample search started from the first publication on this topic in 2008 up to now. A total of 23 articles were found using the keywords specified above. The overview points out a low number of real-life studies on the effectiveness and tolerability of this novel treatment due to short period of clinical experience for its recent approval. Further real-life studies are required in order to better identify the efficacy, safety and adherence of the drug on a larger population.
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Affiliation(s)
- Nevena Skroza
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, 04019 Terracina, Italy,
| | - Nicoletta Bernardini
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, 04019 Terracina, Italy,
| | - Ilaria Proietti
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, 04019 Terracina, Italy,
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, 04019 Terracina, Italy,
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15
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Prodinger CM, Koller J, Laimer M. Scalp tumors. J Dtsch Dermatol Ges 2018; 16:730-753. [DOI: 10.1111/ddg.13546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Christine Maria Prodinger
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Josef Koller
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Martin Laimer
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
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16
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Weishaupt C, Emmert S. Connecting basic cold plasma technology to dermato-oncology. CLINICAL PLASMA MEDICINE 2018. [DOI: 10.1016/j.cpme.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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17
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Prodinger CM, Koller J, Laimer M. Tumoren der Kopfhaut. J Dtsch Dermatol Ges 2018; 16:730-754. [DOI: 10.1111/ddg.13546_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Maria Prodinger
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Josef Koller
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
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18
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Bagatin E. Treating actinic keratosis: assessment of effectiveness, discomfort, costs and follow-up. Br J Dermatol 2018; 178:322-323. [DOI: 10.1111/bjd.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E. Bagatin
- Department of Dermatology; Escola Paulista de Medicina - Universidade Federal de Sao Paulo; 508, Borges Lagoa St - 04038-000 Sao Paulo SP Brazil
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