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Wan Y, Zeng Q, Jiang L, Fu C, Mao S, Zhang L, Zhang Y, Zhang X, Zhu L, Zhang F, Chen J, Lei L. Efficacy of Photodynamic Therapy in the Treatment of Actinic Keratosis: A Network Meta-Analysis. J Cutan Med Surg 2024:12034754241266177. [PMID: 39101280 DOI: 10.1177/12034754241266177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AK) and uses different light sources as well as photosensitizers. In addition, PDT is often combined with other physical therapies or drugs. OBJECTIVES This study was aimed to compare the efficacy of different PDTs against AK lesions based on Complete Response (CR) by conducting a network meta-analysis (NMA). METHODS Randomized controlled trials (RCTs) using PDT for AK were screened and a Bayesian model was developed to perform an NMA of CR at 3 months after the first treatment. RESULTS Twenty-six trials involving 2285 patients and 14 treatments were included. The treatments were broadly divided into mono-PDT and combination therapy. The photodynamic monotherapies included methyl 5-aminolevulinic acid (MAL)-daylight (DL)-PDT, MAL-light-emitting diode (LED)-PDT, 5-aminolevulinic acid (ALA)-LED-PDT, etc. Combination therapies included ablative fractional laser (AFL)-assisted MAL-LED-PDT, calcipotriol (CAL)-assisted MAL-LED-PDT, and 5-fluorouracil (5-Fu)-assisted MAL-DL-PDT. The results of the NMA showed that there is a high probability that AFL-MAL-LED-PDT is the most effective treatment option, followed by CAL-MAL-LED-PDT and ALA-LED-PDT. The subgroup analysis showed that MAL-based PDT had better efficacy when using LED versus other light sources, while LED-based PDT was likely to have better efficacy when using ALA versus other photosensitizers. CONCLUSIONS The results of this NMA suggest that AFL-MAL-LED-PDT may be the superior choice for achieving complete clearance of AK lesions. PDT using LED as the light source and ALA as the photosensitizer may be more effective for the treatment of AK. However, more RCTs are needed to verify the results of this analysis.
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Affiliation(s)
- Yuanyuan Wan
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Qinghai Zeng
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Ling Jiang
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Chuhan Fu
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Shunmin Mao
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Lan Zhang
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Yushan Zhang
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Xiaolin Zhang
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Lu Zhu
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Fan Zhang
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Jing Chen
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
| | - Li Lei
- Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China
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Soare C, Cozma EC, Celarel AM, Rosca AM, Lupu M, Voiculescu VM. Digitally Enhanced Methods for the Diagnosis and Monitoring of Treatment Responses in Actinic Keratoses: A New Avenue in Personalized Skin Care. Cancers (Basel) 2024; 16:484. [PMID: 38339236 PMCID: PMC10854727 DOI: 10.3390/cancers16030484] [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: 12/03/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Non-melanocytic skin cancers represent an important public health problem due to the increasing incidence and the important local destructive potential. Thus, the early diagnosis and treatment of precancerous lesions (actinic keratoses) is a priority for the dermatologist. In recent years, non-invasive skin imaging methods have seen an important development, moving from simple observational methods used in clinical research, to true diagnostic and treatment methods that make the dermatologist's life easier. Given the frequency of these precancerous lesions, their location on photo-exposed areas, as well as the long treatment periods, with variable, imprecise end-points, the need to use non-invasive imaging devices is increasingly evident to complete the clinical observations in the diagnosis and treatment of these lesions, with the aim of increasing accuracy and decreasing the adverse effects due to long treatment duration. This is the first review that brings together all skin imaging methods (dermoscopy, reflectance confocal microscopy, ultrasonography, dermoscopy-guided high frequency ultrasonography, and optical coherence tomography) used in the evaluation of actinic keratoses and their response to different treatment regimens.
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Affiliation(s)
- Cristina Soare
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Elena Codruta Cozma
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Celarel
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Rosca
- Department of Dermatology, University Military Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania;
| | - Mihai Lupu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Vlad Mihai Voiculescu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
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Zhang C, Zhong J, Jiang JJ, Hou Q, Ren H, Silverman M, Li G. Office-Based Photodynamic Therapy Using Locally Applied 5-aminolevulinic Acid and 635 nm Laser for Laryngeal Leukoplakia. Otolaryngol Head Neck Surg 2023; 168:805-813. [PMID: 36939544 DOI: 10.1002/ohn.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/24/2022] [Accepted: 09/10/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Photodynamic therapy (PDT) is a minimally invasive method with strong tissue selectivity and nonthermal effects. We aim to investigate the efficacy of an in-office method utilizing PDT with local application of 5-aminolevulinic acid (ALA) and 635 nm diode laser for treating laryngeal leukoplakia. STUDY DESIGN Retrospective cohort study. SETTING Outpatient clinic-tertiary medical center. METHODS This study reviewed 32 patients with laryngeal leukoplakia, including 11 recurrent cases after surgery. All the procedures were performed in an office setting under topical anesthesia. Fifteen percent ALA solution was locally applied to the lesion through a flexible laryngoscope. Light illumination was performed using a 635 nm diode laser through a 400 μm optic fiber. The power density was 165 mW/cm2 to reach 100 J/cm2 . Results of laryngostroboscopy and voice evaluation during follow-up were collected. RESULTS The mean follow-up was 7.91 ± 4.83 (3-18) months. Thirty-nine procedures were performed, including 1 session for 27 patients, 2 sessions for 3 patients, and 3 sessions for 2 patients. The total response rate was 96.875% (31/32), including complete responses in 26 (81.25%) patients, partial responses in 5 patients (15.625%), and no response in 1 patient (3.125%). It appeared that PDT selectively eliminated the leukoplakia without affecting lamina propria and the surrounding normal mucosa remained unharmed. Scores of Voice Handicap Index-10, jitter, shimmer, and harmonic-to-noise ratio were significantly improved after PDT. CONCLUSION Office-based PDT is an effective, repeatable, and practical method for treating laryngeal leukoplakia. Local application of ALA is sufficient to achieve photodynamic reactions. PDT could eliminate laryngeal leukoplakia selectively while protecting the normal laryngeal structure.
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Affiliation(s)
- Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingting Zhong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Qian Hou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Ren
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Matthew Silverman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gelin Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Del Regno L, Catapano S, Di Stefani A, Cappilli S, Peris K. A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions. Am J Clin Dermatol 2022; 23:339-352. [PMID: 35182332 PMCID: PMC9142445 DOI: 10.1007/s40257-022-00674-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 01/17/2023]
Abstract
Actinic keratosis (AK) is a chronic skin disease in which clinical and subclinical cutaneous lesions coexist on sun-exposed areas such as the head and neck region and the extremities. The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. Evidence indicates that AK may progress into invasive cutaneous squamous cell carcinoma, so the European guidelines recommend treatment of any AK regardless of clinical severity. Given the aging population and therefore the increasing incidence of AK and cutaneous field carcinogenesis, further updates on the long-term efficacy of current therapies and new investigational agents are critical to guide treatment choice. Patients often have difficulty adequately applying topical treatments and coping with adverse local skin reactions, leading to less than optimum treatment adherence. The development of associated local skin symptoms and cosmetic outcomes for the area of interest are also relevant to the choice of an appropriate therapeutic strategy. Treatment is always individually tailored according to the characteristics of both patients and lesions. This review focuses on the therapeutic approaches to AK and illustrates the currently available home-based and physician-managed treatments.
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Stockfleth E, Bégeault N, Delarue A. The Overall Number of Actinic Keratosis Lesions Is Not Predictable by the Number of Visible Lesions: Consequences for Field-Directed Therapies. Curr Ther Res Clin Exp 2022; 96:100661. [PMID: 35035632 PMCID: PMC8752874 DOI: 10.1016/j.curtheres.2021.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Actinic keratoses are keratotic lesions occurring on skin areas extensively damaged by sunlight. Using data from a previously published Phase III randomized, controlled clinical trial in patients with at least 5 actinic keratoses, we explored the potential link between the number of visible actinic keratosis lesions before any treatment and the total number of lesions of the field cancerization as revealed by 5-fluorouracil cream. Our analysis suggests that the baseline number of visible actinic keratoses is a poor indicator of the real number of lesions in the field of cancerization, reinforcing the need to explain the field cancerization concept to patients. (Curr Ther Res Clin Exp. 2022; 82:XXX-XXX) © 2022 Elsevier HS Journals, Inc.
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Intensity of Local Skin Reactions During 5-Fluorouracil Treatment Related to the Number of Actinic Keratosis Lesions: A Post Hoc, Exploratory Analysis. Dermatol Ther (Heidelb) 2021; 12:467-479. [PMID: 34954811 PMCID: PMC8850465 DOI: 10.1007/s13555-021-00668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/10/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Actinic keratoses (AK) are epithelial lesions caused by chronic skin exposure to ultraviolet light that can progress into squamous cell carcinoma. Although several treatments are effective, they are associated with severe skin reactions, which might be related to the extent of the disease. This study aimed to examine the relationship between the severity of local skin reactions during treatment with 5-fluorouracil 4% cream and the number of AK lesions at baseline. METHODS This post hoc analysis pooled data from two multicentre randomised phase III studies (HD-FUP3B-048, HD-FUP3B-049) in patients with AK treated with topical 5-fluorouracil 4% once daily (OD) or 5% twice daily (BID) for 4 weeks. First, we compared the severity, assessed using a numerical rating scale, of the local skin reactions between 5-fluorouracil 4% and 5%. Then, we investigated the relationship between the number of lesions at baseline and severe skin reactions with 5-fluorouracil 4% OD. RESULTS Safety data were included from 397 patients who had received 5-fluorouracil 4% (348 in study HD-FUP3B-048, 49 in study HD-FUP3B-049) OD and 342 (HD-FUP3B-048) who had received 5-fluorouracil 5% BID. For most skin reactions, severe ones were more common in patients treated with 5-fluorouracil 5% cream BID than in those treated with 5-fluorouracil 4% cream OD (P < 0.05). With 5-fluorouracil 4% OD, the incidence of severe erythema was significantly higher in patients with at least 10 lesions (46%) than in patients with 5-10 lesions (28%; P < 0.001). Similar results were observed for the other local skin reactions. CONCLUSION Treatment with 5-fluorouracil 4% cream OD was associated with less severe local skin reactions than 5-fluorouracil 5% BID. The number of AK lesions at baseline seems to have predictive value regarding the severity of local skin reactions that appear during treatment.
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Camillo L, Gironi LC, Zavattaro E, Esposto E, Savoia P. Nicotinamide Attenuates UV-Induced Stress Damage in Human Primary Keratinocytes from Cancerization Fields. J Invest Dermatol 2021; 142:1466-1477.e1. [PMID: 34695410 DOI: 10.1016/j.jid.2021.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022]
Abstract
UVB radiation directly damages DNA, increases ROS and nitric oxide (NO) release, and promotes inflammation leading to genomic instability and cell death. Nicotinamide (NAM) is the precursor of NAM adenine dinucleotide, essential for cell energy production and DNA damage repair. NAM protects HaCat cells from UV-induced impairment; however, little is known about its effects on human primary keratinocytes and those isolated from field cancerization (i.e., field cancerization human primary keratinocytes [FC-HPKs]). We examined the role of NAM against UV-induced oxidative stress damages in FC-HPKs, isolated from precancerous lesions and skin cancers, and in normal human epidermal keratinocytes. Cells were treated for 18, 24, and 48 hours with NAM (5, 25, and 50 μM, respectively) before UVB irradiation. FC-HPK showed four-fold higher basal ROS levels than normal human epidermal keratinocytes; NAM downregulated ROS production only in irradiated FC-HPKs, which showed a greater sensibility to UV rays. UV exposure increased OGG1, inducible nitric oxide synthase, and IL-1β expression, an effect counteracted by NAM pretreatment. Intracellular nitric oxide production and DNA damages were inhibited by NAM exposure before irradiation. Collectively, our findings indicate that pretreatment with 25 μM NAM 24 hours before UVB irradiation effectively prevents oxidative stress formation, DNA damage, and inflammation in both normal human epidermal keratinocytes and FC-HPKs.
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Affiliation(s)
- Lara Camillo
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Laura C Gironi
- Maggiore della Carità University Hospital, Novara, Italy.
| | - Elisa Zavattaro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elia Esposto
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Paola Savoia
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
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8
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Dao DPD, Sahni VN, Sahni DR, Balogh EA, Grada A, Feldman SR. 1% Tirbanibulin Ointment for the Treatment of Actinic Keratoses. Ann Pharmacother 2021; 56:494-500. [PMID: 34301153 PMCID: PMC8899810 DOI: 10.1177/10600280211031329] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective Actinic keratoses (AKs) are cutaneous lesions that arise in sun-damaged skin.
AKs may transform into squamous cell carcinoma in situ. Tirbanibulin 1%
ointment is a new topical treatment for AKs, recently approved by the Food
and Drug Administration. Data Sources The PubMed database was searched for articles published from 1960 to March
31, 2021, using the keywords tirbanibulin and
Klisyri. Data Extraction Phase 2 and phase 3 clinical trials were reviewed. Data Synthesis In phase 2 clinical trials, 43% of patients treated with tirbanibulin
experienced complete clearance by day 57 (43% [95% CI = 32, 54]). Across two
phase 3 clinical trials (pooled data), complete (100%) clearance occurred in
49% of patients in tirbanibulin groups and in only 9% of the vehicle groups
(difference, 41% points; 95% CI = 35 to 47; P < 0.001).
Although no comparative studies are available, tirbanibulin is applied for a
shorter duration (5 days) compared with diclofenac 3% gel, fluorouracil 5%
cream, and imiquimod 3.75% cream. Adverse events were mild and included
pruritus, application site pain, and local skin reactions. Systemic adverse
events such as necrosis and angioedema, observed with other AK treatments
such as fluorouracil and imiquimod, were not observed with tirbanibulin,
thus giving tirbanibulin a favorable safety profile. Relevance to Patient Care and Clinical Practice Tirbanibulin effectively reduces AK burden and recurrence and has a favorable
safety profile with mild adverse events. In comparison, imiquimod,
5-flourouracil, and diclofenac can result in necrosis, angioedema, and
arthralgias. Conclusion With a favorable safety profile and short regimen, tirbanibulin is an
efficacious treatment for clinicians to utilize in their treatment toolbox
when treating AKs on the face and scalp.
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Affiliation(s)
- Diem-Phuong D Dao
- Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | | | - Dev Ram Sahni
- University of Utah Health, Department of Dermatology, Salt Lake City, UT, USA
| | - Esther A Balogh
- Wake Forest School of Medicine, Department of Dermatology Winston-Salem, NC, USA
| | - Ayman Grada
- R&D and Medical Affairs, Almirall US, Exton, PA, USA
| | - Steven R Feldman
- Wake Forest School of Medicine, Department of Dermatology Winston-Salem, NC, USA.,University of Southern Denmark, Odense, Denmark
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Philipp-Dormston WG, Aschoff R, von Braunmühl T, Eigentler T, Haalck T, Thoms KM. [Decision criteria and patient characteristics for patient-oriented treatment of field cancerization : Standardized algorithm for personalized treatment concepts]. Hautarzt 2021; 72:314-320. [PMID: 33263779 PMCID: PMC8016782 DOI: 10.1007/s00105-020-04731-y] [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] [Indexed: 11/30/2022]
Abstract
Hintergrund Aktinische Keratosen (AK) zeichnen sich durch einen chronischen Verlauf aus, und häufig ist ein ganzes Hautareal betroffen (Feldkanzerisierung). Die patientenindividuelle Abwägung therapiespezifischer Vor- und Nachteile einer feldgerichteten Therapie ist herausfordernd. Fragestellung Ziel der vorliegenden Arbeit war die Entwicklung und Evaluierung patientenorientierter Entscheidungskriterien, die sich für die pragmatische Einordnung einer AK-Feldtherapie im Behandlungsalltag bei Patienten mit besonderer Prädisposition zur Feldkanzerisierung eignen (Patiententyp 1 bis 3). Material und Methoden Die Entwicklung der Entscheidungskriterien und der Patiententypologie erfolgte im Rahmen eines nominalen bzw. strukturierten Multi-level-Gruppenprozesses. Anhand der patientenrelevanten Entscheidungskriterien, der verfügbaren Evidenz aus klinischen Studien und entlang der Patiententypologie wurde ein Bewertungsalgorithmus etabliert, und feldgerichtete AK-Therapieoptionen wurden systematisch evaluiert. Ergebnisse Als patientenrelevante Kriterien für die Therapieentscheidung wurden u. a. Effektivität, Sicherheit, Praktikabilität der Therapie, Adhärenz, Kosmetik, Patientenpräferenz und Komorbiditäten identifiziert und näher spezifiziert. In Bezug auf diese Entscheidungskriterien und Patiententypen, bei denen eine Feldtherapie vorrangig indiziert ist, erfüllte die photodynamische Therapie mit Tageslicht das therapiebezogene Anforderungsprofil in besonderem Maße. Schlussfolgerung Die Definition von patientenrelevanten und therapiebezogenen Entscheidungskriterien in der AK-Feldtherapie erlaubt eine strukturierte und gleichzeitig praxisorientierte Herangehensweise, um spezifische Therapieoptionen einzuordnen und individuelle Therapieentscheidungen herzuleiten.
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Affiliation(s)
- W G Philipp-Dormston
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland. .,Hautzentrum Köln, Klinik Links vom Rhein, Schillingsrotter Str. 39-41, 50996, Köln, Deutschland.
| | - R Aschoff
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - T von Braunmühl
- Praxis für Dermatologie und Allergologie im Isarklinikum München, München, Deutschland
| | - T Eigentler
- Zentrum für Dermatologische Onkologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Haalck
- Fachbereich Dermatologie, Ambulanzzentrum des UKE GmbH - Medizinisches Versorgungszentrum (MVZ) des Universitätsklinikums Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - K-M Thoms
- Hautkrebszentrum der UMG/Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen (UMG), Göttingen, Deutschland
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Moscarella E, Di Brizzi EV, Casari A, De Giorgi V, Di Meo N, Fargnoli MC, Lacarrubba F, Micali G, Pellacani G, Peris K, Piaserico S, Calzavara-Pinton P, Quaglino P, Sollena P, Zalaudek I, Zane C, Argenziano G. Italian expert consensus paper on the management of patients with actinic keratoses. Dermatol Ther 2020; 33:e13992. [PMID: 32648324 DOI: 10.1111/dth.13992] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023]
Abstract
Two round tables involving experts were organized in order to reach a consensus on the management of patients with actinic keratosis (AK). In the first, seven clinical questions were selected and analyzed by a systematic literature review, using a Population, Intervention, Control, and Outcomes framework; in the second, the experts discussed relevant evidences and a consensus statement for each question was developed. Consensus was reached among experts on how to best treat AK patients with respect to different clinical scenarios and special populations. Lesion-directed treatments are preferred in patients with few AKs. Patients with multiple AKs are challenging, with more than one treatment usually needed to achieve complete lesion clearance or a high lesion response rate, therapy should be personalized, based on previous treatments, patient, and lesion characteristics. Methyl aminolevulinate-PDT, DL (day light) PDT, and imiquimod cream were demonstrated to have the lowest percentage of new AKs after post treatment follow-up. For IMQ 5% and 3.75%, a higher intensity of skin reactions is associated with higher efficacy. Photodynamic therapy (PDT) is the most studied treatment for AKs on the arms. Regular sunscreen use helps preventing new AKs. Oral nicotinamide 500 mg twice daily, systemic retinoids and regular sunscreen use were demonstrated to reduce the number of new squamous cell carcinomas in patients with AKs. Limited evidence is available for the treatment of AKs in organ transplant recipients. There is no evidence in favor or against the use of any of the available treatments in patients suffering from hematological cancer.
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Affiliation(s)
- Elvira Moscarella
- Dermatology Unit, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Alice Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Nicola Di Meo
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Maria Concetta Fargnoli
- Dermatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli -IRCCS, Rome, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | | | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Sollena
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli -IRCCS, Rome, Italy
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Cristina Zane
- Department of Dermatology, Spedali Civili, Brescia, Italy
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11
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Nashan D, Hüning S, Heppt MV, Brehmer A, Berking C. [Actinic keratoses : Current guideline and practical recommendations]. Hautarzt 2020; 71:463-475. [PMID: 32472149 DOI: 10.1007/s00105-020-04619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The S3 guideline "Actinic keratosis and squamous cell carcinoma of the skin" was published on 30 June 2019. Subsequently, publications, reviews and meta-analyses appeared with new questions regarding the comparability of study data and heterogeneity of the evaluations, which are caused, among other things, by divergent measurement parameters as well as insufficient consideration of pretreatments and combined treatments. This concise overview was written in the context of criticism and in view of necessary developments and research. Topics include epidemiology, pathogenesis, prevention, clinical presentation, therapy and BK5103. Therapy is divided into local destructive procedures and topical applications. Recommendations with quotation marks are based on the actual guideline. Corresponding evidence levels are given. For the implementation in daily routine basic data, side effects and features of therapeutic options are mentioned. The current developments and questions concerning actinic keratoses become clear.
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Affiliation(s)
- D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - S Hüning
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - M V Heppt
- Hautklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Brehmer
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - C Berking
- Hautklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Deutschland
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12
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Foley K, Gupta AK, Martin G, Tweed JA, Villanueva E, Carviel J. Topical treatments and photodynamic therapy for actinic keratosis of the face and scalp. Hippokratia 2019. [DOI: 10.1002/14651858.cd013452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kelly Foley
- Mediprobe Research Inc.; 645 Windermere Road London ON Canada N5X 2P1
| | - Aditya K Gupta
- Mediprobe Research Inc.; 645 Windermere Road London ON Canada N5X 2P1
| | - George Martin
- Dr. George Martin Dermatology Associates; 41 East Lipoa St Suite 21 Kihei Hawaii USA 96753
| | - John A Tweed
- The University of Nottingham; c/o Cochrane Skin Group; King's Meadow Campus Lenton Lane Nottingham UK NG7 2NR
| | - Elmer Villanueva
- Xi'an Jiaotong-Liverpool University; Department of Public Health; 111 Ren'ai Road, Dushu Lake Higher Education Town Suzhou Industrial Park Suzhou Jiangsu China
| | - Jessie Carviel
- Mediprobe Research Inc.; 645 Windermere Road London ON Canada N5X 2P1
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13
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Yeung H, Baranowski ML, Swerlick RA, Chen SC, Hemingway J, Hughes DR, Duszak R. Use and Cost of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population, 2007 to 2015. JAMA Dermatol 2019; 154:1281-1285. [PMID: 30326488 DOI: 10.1001/jamadermatol.2018.3086] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Actinic keratosis is prevalent and has the potential to progress to keratinocyte carcinoma. Changes in the use and costs of actinic keratosis treatment are not well understood in the aging population. Objective To evaluate trends in the use and costs of actinic keratosis destruction in Medicare patients. Design, Setting, and Participants A billing claims analysis was performed of the Medicare Part B Physician/Supplier Procedure Summary Master Files and National Summary Data of premalignant skin lesion destructions performed from 2007 to 2015 among Medicare Part B fee-for-service beneficiaries. Main Outcomes and Measures Mean number of actinic keratosis lesions destroyed and associated treatment payments in 2015 US dollars estimated per 1000 Medicare Part B fee-for-service beneficiaries. Data analysis was performed from November 2017 to July 2018. Results More than 35.6 million actinic keratosis lesions were treated in 2015, increasing from 29.7 million in 2007. Treated actinic keratosis lesions per 1000 beneficiaries increased from 917 in 2007 to 1051 in 2015, while mean inflation-adjusted payments per 1000 patients decreased from $11 749 to $10 942 owing to reimbursement cuts. The proportion of actinic keratosis lesions treated by independently billing nurse practitioners and physician assistants increased from 4.0% in 2007 to 13.5% in 2015. Conclusions and Relevance This study's findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Marissa L Baranowski
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Swerlick
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.,Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia.,School of Economics, Georgia Institute of Technology Ivan Allen College of Liberal Arts, Atlanta
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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14
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Salam A, Peleva E, Wain EM. Management of skin cancer in recipients of solid organ transplants. Br J Hosp Med (Lond) 2019; 80:331-336. [PMID: 31180778 DOI: 10.12968/hmed.2019.80.6.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent improvements in post-transplant care have led to an increased life expectancy for recipients of organ transplants. These patients require lifelong immunosuppression, which is associated with an increased incidence of malignant disease. Skin cancers are the most common malignancies seen in recipients of organ transplants and are associated with significant morbidity and mortality. This review describes factors pertaining to the development and prognosis of skin cancers in recipients of organ transplants, as well as outlining prevention and management strategies in this cohort.
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Affiliation(s)
- Amr Salam
- Dermatology Registrar, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London
| | - Emilia Peleva
- Senior House Officer, Department of Medicine, University College London Hospitals NHS Foundation Trust, London
| | - E Mary Wain
- Consultant Dermatologist, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT
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15
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Noels EC, Hollestein LM, van Egmond S, Lugtenberg M, van Nistelrooij LPJ, Bindels PJE, van der Lei J, Stern RS, Nijsten T, Wakkee M. Healthcare utilization and management of actinic keratosis in primary and secondary care: a complementary database analysis. Br J Dermatol 2019; 181:544-553. [PMID: 30636037 PMCID: PMC6850060 DOI: 10.1111/bjd.17632] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 12/25/2022]
Abstract
Background The high prevalence of actinic keratosis (AK) requires the optimal use of healthcare resources. Objectives To gain insight in to the healthcare utilization of people with AK in a population‐based cohort, and the management of AK in a primary and secondary care setting. Methods A retrospective cohort study using three complementary data sources was conducted to describe the use of care, diagnosis, treatment and follow‐up of patients with AK in the Netherlands. Data sources consisted of a population‐based cohort study (Rotterdam Study), routine general practitioner (GP) records (Integrated Primary Care Information) and nationwide claims data (DRG Information System). Results In the population‐based cohort (Rotterdam Study), 69% (918 of 1322) of participants diagnosed with AK during a skin‐screening visit had no previous AK‐related visit in their GP record. This proportion was 50% for participants with extensive AK (i.e. ≥ 10 AKs; n = 270). Cryotherapy was the most used AK treatment by both GPs (78%) and dermatologists (41–56%). Topical agents were the second most used treatment by dermatologists (13–21%) but were rarely applied in primary care (2%). During the first AK‐related GP visit, 31% (171 of 554) were referred to a dermatologist, and the likelihood of being referred was comparable between low‐ and high‐risk patients, which is inconsistent with the Dutch general practitioner guidelines for ‘suspicious skin lesions’ from 2017. Annually, 40 000 new claims representing 13% of all dermatology claims were labelled as cutaneous premalignancy. Extensive follow‐up rates (56%) in secondary care were registered, while only 18% received a claim for a subsequent cutaneous malignancy in 5 years. Conclusions AK management seems to diverge from guidelines in both primary and secondary care. Underutilization of field treatments, inappropriate treatments and high referral rates without proper risk stratification in primary care, combined with extensive follow‐up in secondary care result in the inefficient use of healthcare resources and overburdening in secondary care. Efforts directed to better risk differentiation and guideline adherence may prove useful in increasing the efficiency in AK management. What's already known about this topic? The prevalence of actinic keratosis (AK) is high and, in particular, multiple AKs are a strong skin cancer predictor. The high prevalence of AK requires optimal use of healthcare resources. Nevertheless, (population based) AK healthcare utilization and management data are very rare.
What does this study add? Although AK‐related care already consumes substantial resources, about 70% of the AK population has never received care. Primary care AK management demonstrated underutilization of topical therapies and high referral rates without proper risk stratification, while in secondary care the extensive follow‐up schedules were applied. This inefficient use of healthcare resources highlights the need for better harmonization and risk stratification to increase the efficiency of AK care.
Linked Comment: https://doi.org/10.1111/bjd.17862. https://doi.org/10.1111/bjd.18269 available online https://www.bjdonline.com/article/
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Affiliation(s)
- E C Noels
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - L M Hollestein
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - S van Egmond
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M Lugtenberg
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - P J E Bindels
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J van der Lei
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - R S Stern
- Department of Dermatology, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, U.S.A
| | - T Nijsten
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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16
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Zavattaro E, Veronese F, Landucci G, Tarantino V, Savoia P. Efficacy of topical imiquimod 3.75% in the treatment of actinic keratosis of the scalp in immunosuppressed patients: our case series. J DERMATOL TREAT 2019; 31:285-289. [DOI: 10.1080/09546634.2019.1590524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- E. Zavattaro
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - F. Veronese
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - G. Landucci
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - V. Tarantino
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - P. Savoia
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
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17
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Meier LS, Schubert M, Göksu Y, Esmann S, Vinding GR, Jemec GBE, Hofbauer GFL. Swiss (German) Version of the Actinic Keratosis Quality of Life questionnaire. Dermatology 2018; 234:51-59. [PMID: 29669340 DOI: 10.1159/000488053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Actinic keratosis (AK) is a sun-induced skin lesion that may progress to invasive squamous cell carcinoma of the skin. Recently, the Actinic Keratosis Quality of Life questionnaire (AKQoL) was designed for patients with AK in Denmark as a specific quality of life instrument for AK patients. OBJECTIVE The objective of this study was to adapt the AKQoL for the German language region of Switzerland and to evaluate its psychometric properties (validity, reliability). METHODS Translation and cultural adaptation of the questionnaire were assessed by using the technique of cognitive interviewing. During the translation process, 34 patients with AK from the Department of Dermatology, University Hospital Zurich, were interviewed in 3 sessions of cognitive interviewing. The translated questionnaire was then distributed together with the Dermatology Life Quality Index (DLQI) to a second group of 113 patients for validation and reliability testing. Within this group, we measured the internal consistency by the Cronbach coefficient α and Spearman correlation coefficient between the AKQoL and the DLQI. RESULTS The problems encountered during the translation process led to changes in 5 categories as described by Epstein: stylistic changes, change in breadth, change in actual meaning, change in frequency and time frame, change in intensity. We found a Cronbach α of 0.82, an acceptable internal consistency. The Spearman correlation coefficient between total scores of AKQoL and DLQI was 0.57. CONCLUSION We culturally adapted and validated a Swiss (German) version of the AKQoL questionnaire applicable for the population of a university center in Switzerland to measure and monitor the quality of life in patients with AK.
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Affiliation(s)
- Larissa S Meier
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Maria Schubert
- Nursing Science (INS), Department of Public Health, University of Basel, Basel, Switzerland
| | - Yasemin Göksu
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Solveig Esmann
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Gabrielle R Vinding
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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18
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Xiaoqin Y, Chan H, Long W, Yuting X, Keyal U, Guolong Z, Peiru W, Xiuli W. Dermoscopic Monitoring for Treatment and Follow-Up of Actinic Keratosis With 5-Aminolaevulinic Acid Photodynamic Therapy. Technol Cancer Res Treat 2018. [PMCID: PMC6311653 DOI: 10.1177/1533033818820091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yang Xiaoqin
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Hu Chan
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Wen Long
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Xu Yuting
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Uma Keyal
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Zhang Guolong
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Wang Peiru
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
| | - Wang Xiuli
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, People’s Republic of China
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