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Emran TB, Shahriar A, Mahmud AR, Rahman T, Abir MH, Siddiquee MFR, Ahmed H, Rahman N, Nainu F, Wahyudin E, Mitra S, Dhama K, Habiballah MM, Haque S, Islam A, Hassan MM. Multidrug Resistance in Cancer: Understanding Molecular Mechanisms, Immunoprevention and Therapeutic Approaches. Front Oncol 2022; 12:891652. [PMID: 35814435 PMCID: PMC9262248 DOI: 10.3389/fonc.2022.891652] [Citation(s) in RCA: 128] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022] Open
Abstract
Cancer is one of the leading causes of death worldwide. Several treatments are available for cancer treatment, but many treatment methods are ineffective against multidrug-resistant cancer. Multidrug resistance (MDR) represents a major obstacle to effective therapeutic interventions against cancer. This review describes the known MDR mechanisms in cancer cells and discusses ongoing laboratory approaches and novel therapeutic strategies that aim to inhibit, circumvent, or reverse MDR development in various cancer types. In this review, we discuss both intrinsic and acquired drug resistance, in addition to highlighting hypoxia- and autophagy-mediated drug resistance mechanisms. Several factors, including individual genetic differences, such as mutations, altered epigenetics, enhanced drug efflux, cell death inhibition, and various other molecular and cellular mechanisms, are responsible for the development of resistance against anticancer agents. Drug resistance can also depend on cellular autophagic and hypoxic status. The expression of drug-resistant genes and the regulatory mechanisms that determine drug resistance are also discussed. Methods to circumvent MDR, including immunoprevention, the use of microparticles and nanomedicine might result in better strategies for fighting cancer.
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Affiliation(s)
- Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Asif Shahriar
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX, United States
| | - Aar Rafi Mahmud
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Tanjilur Rahman
- Department of Biochemistry and Molecular Biology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Mehedy Hasan Abir
- Faculty of Food Science and Technology, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
| | | | - Hossain Ahmed
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Dhaka, Bangladesh
| | - Nova Rahman
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Dhaka, Bangladesh
| | - Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Elly Wahyudin
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Saikat Mitra
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
| | - Mahmoud M Habiballah
- Medical Laboratory Technology Department, Jazan University, Jazan, Saudi Arabia
- SMIRES for Consultation in Specialized Medical Laboratories, Jazan University, Jazan, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan, Saudi Arabia
- Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | | | - Mohammad Mahmudul Hassan
- Queensland Alliance for One Health Sciences, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
- Department of Physiology, Biochemistry and Pharmacology, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
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Keshavarz-Fathi M, Rezaei N. Cancer Immunoprevention: Current Status and Future Directions. Arch Immunol Ther Exp (Warsz) 2021; 69:3. [PMID: 33638703 DOI: 10.1007/s00005-021-00604-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/06/2021] [Indexed: 12/24/2022]
Abstract
Cancer is one of the most serious diseases affecting health and the second leading cause of death worldwide. Despite the development of various therapeutic modalities to deal with cancer, limited improvement in overall survival of patients has been yielded. Since there is no certain cure for cancer, detection of premalignant lesions, and prevention of their progression are vital to the decline of high morbidity and mortality of cancer. Among approaches to cancer prevention, immunoprevention has gained further attention in recent years. Deep understanding of the tumor/immune system interplay and successful prevention of virally-induced malignancies by vaccines have paved the way toward broadening cancer immunoprevention application. The identification of tumor antigens in premalignant lesions was the turning point in cancer immunoprevention that led to designing preventive vaccines for various malignancies including multiple myeloma, colorectal, and breast cancer. In addition to vaccines, immune checkpoint inhibitors are also being tested for the prevention of oral squamous cell carcinoma (SCC), and imiquimod which is an established drug for the prevention of skin SCC, is a non-specific immunomodulator. Herein, to provide a bench-to-bedside understanding of cancer immunoprevention, we will review the role of the immune system in suppression and promotion of tumors, immunoprevention of virally-induced cancers, identification of tumor antigens in premalignant lesions, and clinical advances of cancer immunoprevention.
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Affiliation(s)
- Mahsa Keshavarz-Fathi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Stockholm, Sweden.
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Kopera D. Earliest stage treatment of actinic keratosis with imiquimod 3.75% cream: Two case reports-Perspective for non melanoma skin cancer prevention. Dermatol Ther 2020; 33:e13517. [PMID: 32378272 PMCID: PMC7507202 DOI: 10.1111/dth.13517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/26/2020] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
Abstract
Imiquimod 3.75% cream is licensed for the treatment of actinic keratosis (AK). Two case reports on the treatment of facial UV-exposed skin shall open the discussion if subclinical AKs can be detected by the use of imiquimod cream in UV-exposed areas even if no lesions can be found clinically. A 87-year old female showing small scaly AK lesions on her right cheek was treated with imiquimod 3.75% cream. A 59-year old female without obvious clinical signs of UV-damage on the face experimentally applied imiquimod 3.75% cream twice daily on the entire face for 2 weeks. In the 87-year old, inflammatory reaction developed from day 3 onward and showed field cancerization, the lesions healed without scarring. In the 59-year old at the end of the treatment phase, distinct signs of inflammation appeared, then taking 2 weeks for healing without sequalae. These results open the discussion if the use of imiquimod 3.75% cream could be recommended preventively in UV-exposed skin areas to obviate a later development of AKs/squamous cell carcinoma/nonmelanoma skin cancer.
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Affiliation(s)
- Daisy Kopera
- Department of Dermatology, Medical University Graz, Graz, Austria
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Benati E, Longhitano S, Pampena R, Mirra M, Raucci M, Pellacani G, Longo C. Digital follow‐up by means of dermatoscopy and reflectance confocal microscopy of actinic keratosis treated with Imiquimod 3.75% cream. J Eur Acad Dermatol Venereol 2020; 34:1471-1477. [DOI: 10.1111/jdv.16143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022]
Affiliation(s)
- E. Benati
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - S. Longhitano
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - R. Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - M. Mirra
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - M. Raucci
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - G. Pellacani
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - C. Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
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Voiculescu VM, Lisievici CV, Lupu M, Vajaitu C, Draghici CC, Popa AV, Solomon I, Sebe TI, Constantin MM, Caruntu C. Mediators of Inflammation in Topical Therapy of Skin Cancers. Mediators Inflamm 2019; 2019:8369690. [PMID: 30766448 PMCID: PMC6350587 DOI: 10.1155/2019/8369690] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/28/2018] [Accepted: 11/26/2018] [Indexed: 12/24/2022] Open
Abstract
Taking into consideration that the immune system plays a very important role in the development of melanoma and non-melanoma skin cancers, which have a high prevalence in immunosuppressed patients and after prolonged ultraviolet radiation, the interest in developing novel therapies, in particular targeting the inflammation in cancer, has increased in the past years. The latest data suggest that therapies such as imiquimod (IMQ), ingenol mebutate (IM), 5-fluorouracil (5-FU), retinoids, and nonsteroidal anti-inflammatory drugs (NSAIDs) have been used with success in the topical treatment of some cancers. Herein, we review the topical treatment targeting the inflammation in skin cancer and the mechanisms involved in these processes. Currently, various associations have shown a superior success rate than monotherapy, such as systemic acitretin and topical IMQ, topical 5-FU with tretinoin cream, or IMQ with checkpoint inhibitor cytotoxic T lymphocyte antigen 4. Novel therapies targeting Toll-like receptor-7 (TLR-7) with higher selectivity than IMQ are also of great interest.
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Affiliation(s)
- Vlad Mihai Voiculescu
- Department of Dermatology, “ELIAS” University Emergency Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
| | | | - Mihai Lupu
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- Dermatology Clinic, MedAs Medical Center, Bucharest, Romania
| | - Cristina Vajaitu
- Department of Dermatology, “ELIAS” University Emergency Hospital, Bucharest, Romania
| | | | | | - Iulia Solomon
- Department of Dermatology, “ELIAS” University Emergency Hospital, Bucharest, Romania
| | - Teona Ioana Sebe
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- The Clinic of Plastic Surgery Reconstructive Microsurgery, Emergency Hospital Bucharest, Romania
| | - Maria Magdalena Constantin
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- 2nd Department of Dermatology, “Colentina” Clinical Hospital, Bucharest, Romania
| | - Constantin Caruntu
- Carol Davila University of Medicine and Pharmacy Bucharest, Romania, Bucharest, Romania
- Department of Dermatology, Prof. “N Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
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Del Rosso J, Swanson N, Berman B, Martin GM, Lin T, Rosen T. Imiquimod 2.5% and 3.75% Cream for the Treatment of Photodamage: A Meta-analysis of Efficacy and Tolerability in 969 Randomized Patients. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2018; 11:28-31. [PMID: 30319728 PMCID: PMC6169597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background: Ad-hoc reports within clinical studies of imiquimod for the treatment of actinic keratosis (AK) have suggested the drug can improve both skin texture and overall signs of photodamage. Objective: We sought to assess the efficacy and tolerability of imiquimod 3.75% and 2.5% cream for the treatment of photodamage in patients with AK of the full face or balding scalp. Methods: A meta-analysis of four identical multicenter, randomized, double-blind, vehicle-controlled studies was conducted. The studies included a total of 969 adult subjects (aged 33-91 years) with 5 to 20 visible lesions or palpable AKs in an area exceeding 25cm2 on either the face or balding scalp. Patients were randomized to imiquimod 3.75%, imiquimod 2.5%, or vehicle cream (1:1:1). Up to two packets (250mg each) were applied per dose once daily for two two-week treatment cycles, separated by a two-week no-treatment interval. Photodamage improvement was assessed at study end based on subjects' baseline assessments using a seven-point scale. Local skin reactions were recorded throughout the study. Results: Combined Investigator's Global Integrated Photodamage (IGIP) score was "significantly" or "much" improved in 57.6 percent (n=175) of patients treated with imiquimod 2.5% cream and in 69.6 percent (n=208) of patients treated with imiquimod 3.75% cream versus in 25.7 percent (n=76) of patients treated with the vehicle. Mean IGIP scores at end of study were 1.67, 1.98, and 0.73, respectively (both actives P<0.0001 versus vehicle). Conclusion: Both imiquimod 2.5% and 3.75% creams showed a positive effect on photodamage when compared with the vehicle cream.
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Affiliation(s)
- James Del Rosso
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada
- Dr. Swanson is with the Department of Dermatology at Oregon Health and Science University in Portland, Oregon
- Dr. Berman is with the Department of Dermatology and Cutaneous Surgery at the Miller School of Medicine, University of Miami in Miami, Florida and the Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Martin is with the Dermatology and Laser Center of Maui in Maoi, Hawaii
- Dr. Lin is with Valeant Pharmaceuticals in Bridgewater, New Jersey
- Dr. Rosen is with the Department of Dermatology at Baylor College of Medicine in Houston, Texas
| | - Neil Swanson
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada
- Dr. Swanson is with the Department of Dermatology at Oregon Health and Science University in Portland, Oregon
- Dr. Berman is with the Department of Dermatology and Cutaneous Surgery at the Miller School of Medicine, University of Miami in Miami, Florida and the Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Martin is with the Dermatology and Laser Center of Maui in Maoi, Hawaii
- Dr. Lin is with Valeant Pharmaceuticals in Bridgewater, New Jersey
- Dr. Rosen is with the Department of Dermatology at Baylor College of Medicine in Houston, Texas
| | - Brian Berman
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada
- Dr. Swanson is with the Department of Dermatology at Oregon Health and Science University in Portland, Oregon
- Dr. Berman is with the Department of Dermatology and Cutaneous Surgery at the Miller School of Medicine, University of Miami in Miami, Florida and the Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Martin is with the Dermatology and Laser Center of Maui in Maoi, Hawaii
- Dr. Lin is with Valeant Pharmaceuticals in Bridgewater, New Jersey
- Dr. Rosen is with the Department of Dermatology at Baylor College of Medicine in Houston, Texas
| | - George M Martin
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada
- Dr. Swanson is with the Department of Dermatology at Oregon Health and Science University in Portland, Oregon
- Dr. Berman is with the Department of Dermatology and Cutaneous Surgery at the Miller School of Medicine, University of Miami in Miami, Florida and the Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Martin is with the Dermatology and Laser Center of Maui in Maoi, Hawaii
- Dr. Lin is with Valeant Pharmaceuticals in Bridgewater, New Jersey
- Dr. Rosen is with the Department of Dermatology at Baylor College of Medicine in Houston, Texas
| | - Tina Lin
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada
- Dr. Swanson is with the Department of Dermatology at Oregon Health and Science University in Portland, Oregon
- Dr. Berman is with the Department of Dermatology and Cutaneous Surgery at the Miller School of Medicine, University of Miami in Miami, Florida and the Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Martin is with the Dermatology and Laser Center of Maui in Maoi, Hawaii
- Dr. Lin is with Valeant Pharmaceuticals in Bridgewater, New Jersey
- Dr. Rosen is with the Department of Dermatology at Baylor College of Medicine in Houston, Texas
| | - Ted Rosen
- Dr. Del Rosso is with JDR Dermatology Research/Thomas Dermatology in Las Vegas, Nevada
- Dr. Swanson is with the Department of Dermatology at Oregon Health and Science University in Portland, Oregon
- Dr. Berman is with the Department of Dermatology and Cutaneous Surgery at the Miller School of Medicine, University of Miami in Miami, Florida and the Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Martin is with the Dermatology and Laser Center of Maui in Maoi, Hawaii
- Dr. Lin is with Valeant Pharmaceuticals in Bridgewater, New Jersey
- Dr. Rosen is with the Department of Dermatology at Baylor College of Medicine in Houston, Texas
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de Oliveira ECV, da Motta VRV, Pantoja PC, Ilha CSDO, Magalhães RF, Galadari H, Leonardi GR. Actinic keratosis - review for clinical practice. Int J Dermatol 2018; 58:400-407. [PMID: 30070357 DOI: 10.1111/ijd.14147] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 12/18/2022]
Abstract
Actinic keratosis (AK) is a lesion that arises as a result of excessive exposure to solar radiation and appearing predominantly on Fitzpatrick phototype I and II skin. Given that some AKs evolve into squamous cell carcinoma, these lesions are considered premalignant in nature, occurring mostly in elderly men and immunosuppressed individuals chronically exposed to ultraviolet (UV) radiation. There are several mechanisms for the formation of AKs; among them are oxidative stress, immunosuppression, inflammation, altered proliferation and dysregulation of cell growth, impaired apoptosis, mutagenesis, and human papillomavirus (HPV). Through the understanding of these mechanisms, several treatments have emerged. Among the options for AK treatment, the most commonly used include 5-fluorouracil (5-FU), cryotherapy, diclofenac, photodynamic therapy (PDT), imiquimod (IQ), retinoids, and ingenol mebutate (IM). There have been recent advances in the treatment options that have seen the emergent use of newer agents such as resiquimod, betulinic acid, piroxicam, and dobesilate. The combination between therapies has presented relevant results with intention to reduce duration of therapy and side effects. All AK cases must be treated because of their propensity to transform into malignancy and further complicate treatment. In addition to medical or surgical care, education about sun exposure prevention remains the best and most cost-effective method for AK prevention. The objective of this article is to conduct a literature review of the clinical presentation of AK including advances in treatment options available.
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Affiliation(s)
- Erika C V de Oliveira
- Medical Clinic Post Graduation Program of the Medical Sciences Faculty, University of Campinas - UNICAMP- Brazil, Campinas, Brazil
| | - Valéria R V da Motta
- Medical Clinic Post Graduation Program of the Medical Sciences Faculty, University of Campinas - UNICAMP- Brazil, Campinas, Brazil
| | - Paola C Pantoja
- Faculty of Pharmaceutical Sciences, University of Campinas - UNICAMP- Brazil, Campinas, Brazil
| | - Carolina S de O Ilha
- Dermatology Medical Residence Program of the Medical Sciences Faculty, University of Campinas - UNICAMP- Brazil, Campinas, Brazil
| | - Renata F Magalhães
- Dermatology Department in the Medical Sciences Faculty, University of Campinas - UNICAMP- Brazil, Campinas, Brazil
| | - Hassan Galadari
- Department of Dermatology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Gislaine R Leonardi
- Faculty of Pharmaceutical Sciences, University of Campinas - UNICAMP- Brazil, Campinas, Brazil
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8
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Walker JL, Siegel JA, Sachar M, Pomerantz H, Chen SC, Swetter SM, Dellavalle RP, Stricklin GP, Qureshi AA, DiGiovanna JJ, Weinstock MA. 5-Fluorouracil for Actinic Keratosis Treatment and Chemoprevention: A Randomized Controlled Trial. J Invest Dermatol 2017; 137:1367-1370. [DOI: 10.1016/j.jid.2016.12.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/26/2022]
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9
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Khanna R, Bakshi A, Amir Y, Goldenberg G. Patient satisfaction and reported outcomes on the management of actinic keratosis. Clin Cosmet Investig Dermatol 2017; 10:179-184. [PMID: 28553130 PMCID: PMC5439540 DOI: 10.2147/ccid.s121323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Actinic keratosis (AK) is a common dermatologic condition in which hyperplastic epidermal lesions develop in response to excessive and chronic exposure to ultraviolet (UV) radiation. If left untreated, AK can progress to squamous cell carcinomas of the skin. Incidence is rising worldwide as a result of the progressive aging of populations and an increase in lifetime cumulative exposure to UV radiation. Currently, various treatment options exist, which range from topical medications to light-based therapies and procedural modalities. In this article, we will review the treatment options for AK with a focus on assessments of patient satisfaction with treatment.
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Affiliation(s)
- Raveena Khanna
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.,Creighton University School of Medicine, Omaha, NE
| | - Anshika Bakshi
- Rutgers Robert Wood Johnson Medical School, Piscataway Township, NJ, USA
| | - Yasmin Amir
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gary Goldenberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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10
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Oyama S, Funasaka Y, Tsuchiya SI, Kawana S, Saeki H. Increased number of mast cells in the dermis in actinic keratosis lesions effectively treated with imiquimod. J Dermatol 2017; 44:944-949. [PMID: 28342266 DOI: 10.1111/1346-8138.13821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 02/01/2017] [Indexed: 11/26/2022]
Abstract
Actinic keratosis (AK) is a cutaneous cancer in situ which develops as a result of excessive exposure to ultraviolet (UV). Toll-like receptor (TLR)7 agonist imiquimod is a topical immune response modifier and is effective for the treatment of non-melanoma skin cancers. Recently, the diagnostic role of the dermatoscope has been reported in the course of treatment of AK. In addition, mast cells are now considered to contribute to both the innate and adaptive immune systems in topical imiquimod therapy. We assessed the effect of imiquimod treatment by dermatoscopic and immunohistochemical findings in 14 patients with a total of 21 AK lesions. With the dermatoscope, though the mean erythema score was not significantly different between the cured lesions and the unresponsive lesions, the erythema/red pseudo-network ("strawberry") pattern was decreased significantly in the cured lesions. By immunohistochemistry, the number of Ki-67-positive proliferative cells in the epidermis was decreased and that of CD117-positive mast cells in the dermis was increased in the responding lesions. To the best of our knowledge, this is the first study demonstrating that the number of mast cells in the dermis was increased in AK lesions effectively treated with imiquimod. Our present result suggests that mast cells may contribute an antitumor effect in human skin treated with topical imiquimod.
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Affiliation(s)
- Satomi Oyama
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yoko Funasaka
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | | | - Seiji Kawana
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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11
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Abstract
Conjunctival actinic keratosis is rare and difficult to treat, as recurrences are common. Imiquimod, an immune response modulator, is currently Food and Drug Administration-approved for cutaneous actinic keratosis and superficial basal cell carcinomas. Emerging reports have shown it to be effective in treating some periocular and conjunctival lesions. The authors present a case of a 68-year-old white man with recurrent actinic keratosis involving the pretarsal conjunctiva, which was successfully treated with 5% topical imiquimod following previous failure with cryotherapy and interferon α-2b. The patient had ocular irritation that resolved on cessation of treatment. To the authors' knowledge, this is the first report of conjunctival actinic keratosis being treated with and successfully eradicated by topical imiquimod.
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Dirschka T, Gupta G, Micali G, Stockfleth E, Basset-Séguin N, Del Marmol V, Dummer R, Jemec GBE, Malvehy J, Peris K, Puig S, Stratigos AJ, Zalaudek I, Pellacani G. Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology. J DERMATOL TREAT 2016; 28:431-442. [DOI: 10.1080/09546634.2016.1254328] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Dirschka
- Centroderm Clinic, Wuppertal, and Faculty of Health, University of Witten-Herdecke, Witten, Germany
| | - Girish Gupta
- Department of Dermatology, Monklands Hospital, Lanarkshire, and University of Glasgow, Glasgow, UK
| | | | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Véronique Del Marmol
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles, Bruxelles, Belgium
| | - Reinhard Dummer
- Department of Dermatology Skin Cancer Unit, University Hospital Zürich, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Ketty Peris
- Department of Dermatology, Catholic University of Rome, Largo A. Gemelli 8, Rome, Italy
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Alexander J. Stratigos
- First Department of Dermatology-Venereology, University of Athens Medical School, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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13
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Gracia-Cazaña T, González S, Gilaberte Y. Resistance of Nonmelanoma Skin Cancer to Nonsurgical Treatments. Part I: Topical Treatments. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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14
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Kopera D, Goswami N, Kerl H. AK progressing to NMSC: at what stage? J Eur Acad Dermatol Venereol 2016; 30:e172-e173. [PMID: 26872901 DOI: 10.1111/jdv.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- D Kopera
- Department of Dermatology, Medical University of Graz, Graz, Austria.
| | - N Goswami
- Department of Physiology, Medical University of Graz, Graz, Austria
| | - H Kerl
- Department of Dermatology, Medical University of Graz, Graz, Austria
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15
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Siegel JA, Korgavkar K, Weinstock MA. Current perspective on actinic keratosis: a review. Br J Dermatol 2016; 177:350-358. [PMID: 27500794 DOI: 10.1111/bjd.14852] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 02/05/2023]
Abstract
Actinic keratoses (AKs) are common, with prevalence in the U.S.A. estimated at almost 40 million in 2004 and annual costs of > $1 billion (U.S.D.). However, there is no universally accepted definition of AK and thus it is difficult to identify reliably. AKs are lesions of epidermal keratinocytic dysplasia that result from chronic sun exposure and have the ability to progress to invasive squamous cell carcinoma (SCC), but clinicians disagree about whether AKs are premalignant lesions, superficial SCCin situ or epiphenomena of chronically sun-damaged skin. Yearly AK to SCC progression rates of 0·6% were reported in an elderly population with multiple prior keratinocyte carcinomas (KCs); and rates of spontaneous AK regression have been reported to be > 50%, but regressed lesions often reappear. As AKs have both cosmetic consequences and potential for malignant transformation, there are multiple reasons for treatment. There is no current agreement on the most efficacious treatment, but 5-fluorouracil has been shown to both prevent and treat AKs, and imiquimod and photodynamic therapy may have the best cosmetic outcomes. AKs may be treated to improve appearance and relieve symptoms, but the keratinocytic dysplasia that gives rise to malignancy, and sometimes appears as an AK, may be what actually threatens patient health. Thus, treatments should aim to decrease the risk of KC or facilitate KC diagnosis by reducing the potential for misidentification created when a KC appears in a field of AKs. Improved agreement among clinicians on AK definition may improve management.
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Affiliation(s)
- J A Siegel
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - K Korgavkar
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - M A Weinstock
- Center for Dermatoepidemiology-111D, Veterans Affairs Medical Center, Providence, RI, U.S.A.,Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
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16
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Gracia-Cazaña T, González S, Gilaberte Y. Resistance of Nonmelanoma Skin Cancer to Nonsurgical Treatments. Part I: Topical Treatments. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:730-739. [PMID: 27436800 DOI: 10.1016/j.ad.2016.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/22/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022] Open
Abstract
A wide range of treatments is now available for nonmelanoma skin cancer (NMSC), including 5-fluorouracil, ingenol mebutate, imiquimod, diclofenac, photodynamic therapy, methotrexate, cetuximab, vismodegib, and radiotherapy. All are associated with high clinical and histologic response rates. However, some tumors do not respond due to resistance, which may be primary or acquired. Study of the resistance processes is a broad area of research that aims to increase our understanding of the nature of each tumor and the biologic features that make it resistant, as well as to facilitate the design of new therapies directed against these tumors. In this article we review resistance to the authorized topical treatments for NMSC.
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Affiliation(s)
- T Gracia-Cazaña
- Unidad de Dermatología, Hospital de Barbastro, Barbastro, Huesca, España; Instituto Aragonés de Ciencias de la Salud, Zaragoza, España.
| | - S González
- Servicio de Dermatología, Memorial Sloan-Kettering Cancer Center. Nueva York, EE. UU.; Departmento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - Y Gilaberte
- Instituto Aragonés de Ciencias de la Salud, Zaragoza, España; Unidad de Dermatología, Hospital San Jorge, Huesca, España
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17
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Nisticò S, Torchia V, Gliozzi M, Bottoni U, Del Duca E, Muscoli C. Pharmacoeconomy of drugs used in the treatment of actinic keratoses. Int J Immunopathol Pharmacol 2016; 29:796-804. [PMID: 27207444 DOI: 10.1177/0394632016648707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/08/2016] [Indexed: 02/02/2023] Open
Abstract
Actinic keratosis (AK) represents an emerging issue in the area of skin diseases which undergo high risk for developing squamous cell carcinoma (SCC). Recently, evidence has been accumulated that 3% diclofenac sodium and ingenol mubetate may efficiently counteract the development of progressive AK even if the pharmacoeconomic impact of such a treatment remains poorly defined. With the objective of assessing the efficacy of 3% diclofenac sodium versus ingenol mebutate, a comparative cost-efficacy analysis was performed between both pharmacological treatments. In the present analysis, data of efficacy of clinical studies were combined with information on the quality of life associated with AK lesions based on available literature data. Furthermore, the cost associated with the management of these lesions in Italy has been taken into account. To this purpose, we carried out a literature survey on the clinical and economic data among clinical reports available in Italy based on the assessment of related expenditure of public resources and their relationship with the subsequent health benefits.
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Affiliation(s)
- S Nisticò
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Italy
| | - V Torchia
- Interregional Research Center for Food Safety & Health, Department of Health Sciences, University of Catanzaro "Magna Graecia", Italy
| | - M Gliozzi
- Interregional Research Center for Food Safety & Health, Department of Health Sciences, University of Catanzaro "Magna Graecia", Italy
| | - U Bottoni
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Italy
| | - E Del Duca
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Italy
| | - C Muscoli
- School of Pharmacy and Nutraceuticals, University of Catanzaro "Magna Graecia", Italy
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18
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Jubert-Esteve E, del Pozo-Hernando L, Izquierdo-Herce N, Bauzá-Alonso A, Martín-Santiago A, Jones-Caballero M. Quality of Life and Side Effects in Patients with Actinic Keratosis Treated With Ingenol Mebutate: A Pilot Study. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Jubert-Esteve E, Del Pozo-Hernando LJ, Izquierdo-Herce N, Bauzá-Alonso A, Martín-Santiago A, Jones-Caballero M. Quality of life and side effects in patients with actinic keratosis treated with ingenol mebutate: a pilot study. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:644-50. [PMID: 26130156 DOI: 10.1016/j.ad.2015.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Actinic keratosis (AK) lesions are in situ squamous cell carcinoma. These lesions have a low risk of progressing to invasive disease but significant impact on patients' quality of life (QoL). The aim of this study was to assess QoL and side effects in patients with AK receiving treatment with ingenol mebutate. MATERIAL AND METHODS This was a prospective, non-randomized pilot study carried out in Spain. The target population was adults with a clinical diagnosis of AK affecting any part of the body. Outcomes were assessed on the basis of a QoL questionnaire (Skindex-29), local skin response, the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), and clinical response. RESULTS A total of 19 patients were studied. Most of the participants were men (89.5%) and mean age was 76.2 years. After treatment with ingenol mebutate, significant improvement was observed in the Skindex-29 subscales relating to symptom severity (P=.041), the patients' emotional state (P=.026), and in the overall score (P=.014). Erythema, crusting, and flaking or scaling were the local skin responses with highest median score (2.0 in all 3 cases). Imiquimod 5% and ingenol mebutate achieved higher median scores for effectiveness and global satisfaction than any other previous treatments (as measured by TSQM 1.4). In the patients' assessment of convenience, ingenol mebutate had a higher median score than previous treatments. Over half of the patients (52.6%) had an improvement of at least 75% at month 3. CONCLUSIONS QoL in patients with AK improves after treatment with ingenol mebutate. The presence of side effects did not affect QoL or patient satisfaction with treatment.
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Affiliation(s)
- E Jubert-Esteve
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - L J Del Pozo-Hernando
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
| | - N Izquierdo-Herce
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A Bauzá-Alonso
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A Martín-Santiago
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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20
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Peris K, Stockfleth E, Gupta G, Aractingi S, Dakovic R, Dirschka T, Alomar A. Efficacy of imiquimod 3.75% from Lmax according to the number of actinic keratosis lesions. J Eur Acad Dermatol Venereol 2014; 29:2470-3. [PMID: 25351284 DOI: 10.1111/jdv.12782] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/19/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Imiquimod 3.75% reduces 92.2% of all actinic keratosis (AK) lesions, assumed to include both subclinical and clinical lesions, across a large sun-exposed field such as the full face or balding scalp. OBJECTIVE To evaluate the efficacy of imiquimod 3.75% using the reduction in lesions from Lmax (the maximum lesion count during treatment) in subgroups of patients with low and high AK lesion counts. METHODS Patients from two 14-week, placebo-controlled, double-blind studies were subgrouped according to whether they had ≤ 10 or >10 AK lesions at baseline. Treatment was applied to the full face or balding scalp during two 2-week treatment cycles separated by a 2-week treatment-free interval. RESULTS Overall, 167 patients had ≤ 10 lesions and 152 patients had >10 AK lesions at baseline. With imiquimod 3.75%, the median percentage reduction in AK lesions from Lmax to end of study was similar in patients with ≤ 10 and >10 baseline lesions (91.5% and 93.0% respectively). The median absolute reduction in AK lesions from Lmax to end of study was 24.0 for patients with >10 baseline lesions and 10.0 for those with ≤ 10 baseline lesions. The median percentage and absolute reductions in lesions from Lmax were significantly greater with imiquimod 3.75% vs. placebo (P < 0.0001). CONCLUSIONS Imiquimod 3.75% is effective regardless of disease severity as shown in this study by the reduction of over 90% of lesions from Lmax in patients with low or high AK lesion counts.
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Affiliation(s)
- K Peris
- Department of Dermatology, Catholic University of Rome, Rome, Italy
| | - E Stockfleth
- Department of Dermatology, Charité - University Medical Centre Berlin, Berlin, Germany
| | - G Gupta
- Department of Dermatology, Monklands Hospital, Airdrie, Lanarkshire, UK
| | - S Aractingi
- Service de Dermatologie Allergologie, Hôpital Cochin, Paris, France.,Université Paris 5 Descartes, Paris, France
| | - R Dakovic
- Meda Pharma GmbH & Co. KG, Bad Homburg, Germany
| | - T Dirschka
- Dermatological Practice Centre, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - A Alomar
- Department of Dermatology, Institut Universitari Quiron Dexeus, Barcelona, Spain
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