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Zhao HJ, Ushcatz I, Tadrous M, Aoki V, Chang AY, Levell NJ, Von Schuckmann L, Drucker AM. International time trends and differences in topical actinic keratosis therapy utilization. JAAD Int 2024; 16:18-25. [PMID: 38764482 PMCID: PMC11099316 DOI: 10.1016/j.jdin.2024.03.013] [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] [Accepted: 03/16/2024] [Indexed: 05/21/2024] Open
Abstract
Background Actinic Keratoses (AK) are precancerous lesions that can lead to Squamous Cell Carcinoma. International differences in the utilization of topical medications to treat AK are not well described. Objectives To describe international differences in topical AK medication utilization, including associations of countries' economic status with AK medication utilization. Methods We used IQVIA MIDAS pharmaceutical sales data for 65 countries (42 high-income, 24 middle-income) from April 2011 to December 2021. We calculated each country's quarterly utilization of medications in grams per 1000 population. We used univariable linear regression to assess the association between country economic status and AK medication utilization. Results High-income countries used 15.37 more grams per 1000 population of 5-fluorouracil (95% CI: 9.68, 21.05), 4.64 more grams per 1000 population of imiquimod (95% CI: 3.45, 5.83), and 0.32 more grams per 1000 population of ingenol mebutate (95% CI: 0.05, 0.60). Limitations Missing medication utilization data for some countries. Conclusion High-income countries use more topical AK therapies than middle-income countries.
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Affiliation(s)
- Heather J. Zhao
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Inna Ushcatz
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mina Tadrous
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Valeria Aoki
- Department of Dermatology, University of São Paulo School of Medicine, São Paulo, São Paulo Estado, Brazil
| | - Aileen Y. Chang
- Department of Dermatology, University of California, San Francisco, San Francisco, California
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Nick J. Levell
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Aaron M. Drucker
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Brown M, Williams A, Chilcott RP, Brady B, Lenn J, Evans C, Allen L, McAuley WJ, Beebeejaun M, Haslinger J, Beuttel C, Vieira R, Guidali F, Miranda M. Topically Applied Therapies for the Treatment of Skin Disease: Past, Present, and Future. Pharmacol Rev 2024; 76:689-790. [PMID: 38914467 DOI: 10.1124/pharmrev.123.000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
The purpose of this review is to summarize essential biological, pharmaceutical, and clinical aspects in the field of topically applied medicines that may help scientists when trying to develop new topical medicines. After a brief history of topical drug delivery, a review of the structure and function of the skin and routes of drug absorption and their limitations is provided. The most prevalent diseases and current topical treatment approaches are then detailed, the organization of which reflects the key disease categories of autoimmune and inflammatory diseases, microbial infections, skin cancers, and genetic skin diseases. The complexity of topical product development through to large-scale manufacturing along with recommended risk mitigation approaches are then highlighted. As such topical treatments are applied externally, patient preferences along with the challenges they invoke are then described, and finally the future of this field of drug delivery is discussed, with an emphasis on areas that are more likely to yield significant improvements over the topical medicines in current use or would expand the range of medicines and diseases treatable by this route of administration. SIGNIFICANCE STATEMENT: This review of the key aspects of the skin and its associated diseases and current treatments along with the intricacies of topical formulation development should be helpful in making judicious decisions about the development of new or improved topical medicines. These aspects include the choices of the active ingredients, formulations, the target patient population's preferences, limitations, and the future with regard to new skin diseases and topical medicine approaches.
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Affiliation(s)
- Marc Brown
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Adrian Williams
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Robert P Chilcott
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Brendan Brady
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Jon Lenn
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Charles Evans
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Lynn Allen
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - William J McAuley
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Mubinah Beebeejaun
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Jasmin Haslinger
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Claire Beuttel
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Raquel Vieira
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Florencia Guidali
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Margarida Miranda
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
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3
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Bordeaux ZA, Choi J, Braun G, Davis C, Marani M, Lee K, Samuel C, Adams J, Windom R, Pollizzi A, Kambala A, Cornman H, Reddy SV, Lu W, Oladipo OO, Alphonse MP, West CE, Kwatra SG, Kwatra MM. Topical GZ21T Inhibits the Growth of Actinic Keratoses in a UVB-Induced Model of Skin Carcinogenesis. JID INNOVATIONS 2023; 3:100206. [PMID: 37533581 PMCID: PMC10392087 DOI: 10.1016/j.xjidi.2023.100206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 08/04/2023] Open
Abstract
Actinic keratoses (AKs) are premalignant intraepidermal neoplasms that occur as a result of cumulative sun damage. AKs commonly relapse, and up to 16% undergo malignant transformation into cutaneous squamous cell carcinoma. There is a need for novel therapies that reduce the quantity and surface area of AKs as well as prevent malignant transformation to cutaneous squamous cell carcinomas. We recently showed that GZ17-6.02, an anticancer agent composed of curcumin, haramine, and isovanillin, inhibited the growth of H297.T cells. This study evaluated the efficacy of a topical formulation of GZ17-6.02, known as GZ21T, in a murine model of AK generated by exposing SKH1 mice to UVR. Treatment of mice with topical GZ21T inhibited the growth of AKs by decreasing both lesion count (P = 0.012) and surface area occupied by tumor (P = 0.002). GZ21T also suppressed the progression of AKs to cutaneous squamous cell carcinoma by decreasing the count (P = 0.047) and surface area (P = 0.049) of lesions more likely to represent cutaneous squamous cell carcinoma. RNA sequencing and proteomic analyses revealed that GZ21T suppressed several pathways, including MAPK (P = 0.025), phosphoinositide 3-kinase-protein kinase B (P = 0.04), HIF-1α (P = 0.016), Wnt (P = 0.025), insulin (P = 0.018), and ERBB (P = 0.016) signaling. GZ21T also upregulated the autophagy-promoting protein AMPK while suppressing proteins such as PD-L1, glutaminase, pAkt1 S473, and eEF2K.
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Affiliation(s)
- Zachary A. Bordeaux
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Gabriella Braun
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Cole Davis
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Lee
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christeen Samuel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jackson Adams
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Reed Windom
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Anthony Pollizzi
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sriya V. Reddy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Weiying Lu
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olusola O. Oladipo
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Martin P. Alphonse
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cameron E. West
- Genzada Pharmaceuticals, Hutchinson, Kansas, USA
- US Dermatology Partners, Dallas, Texas, USA
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madan M. Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, South Carolina, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, South Carolina, USA
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Ortner VK, Johansen B, Kilov K, Castillo Mondragón A, Duvold T, Kihl J, Ashcroft FJ, Feuerherm AJ, Pind Laugesen C, Marcker Espersen ML, Manole I, Isberg AP, Andersen AD, Rakvaag E, Zibert JR, Haedersdal M. The Copenhagen Actinic Keratosis Study (COAKS). A decentralised clinical trial to evaluate tolerability, safety and efficacy of daily field-directed topical treatment with cytosolic phospholipase A 2 inhibitor, AVX001, in participants with actinic keratosis: protocol for a randomised controlled phase I/IIa trial. BMJ Open 2022; 12:e061012. [PMID: 36198452 PMCID: PMC9535213 DOI: 10.1136/bmjopen-2022-061012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Actinic keratosis (AK) is the most common precancerous skin condition caused by long-term UV exposure. Given the high recurrence rate of 15%-53%, identifying safe and effective treatment options is warranted. AVX001, a cytosolic phospholipase A2α (cPLA2α) enzyme inhibitor, is a novel anti-inflammatory drug for field-directed, self-administered, topical therapy of AK. METHODS AND ANALYSIS This study is a single-centre, randomised, vehicle-controlled, double-blind, parallel-group hybrid clinical trial in adults with multiple AK lesions Olsen grade 1 or 2. The hybrid design combines decentralised participant tasks and assessments with conventional in-clinic visits. Recruitment using targeted advertising on social media and eligibility prescreening are conducted via the Studies&Me online recruitment platform. Participants (n=60) are randomly assigned to 1 of 3 treatment arms: AVX001 gel 1%, AVX001 gel 3% or vehicle gel. The trial consists of a 4-week treatment period with daily field-directed topical application of the gel and an 8-week follow-up period. Participants attend in-clinic visits at baseline, week 4 and week 12. The remote participant trial tasks include questionnaires and upload of smartphone-obtained photos of the treated skin area using a study-specific web-based app. Both remote and in-clinic assessments of safety and efficacy will be performed. The primary objective is to evaluate the local tolerability of daily application of AVX001 gel (1% or 3%) compared with vehicle gel. Secondary objectives include safety, efficacy, dose-response efficacy relationship, treatment satisfaction and cosmetic outcome. Exploratory objectives include evaluations of tolerability and efficacy assessed by dermatologists using smartphone photos uploaded by participants, comparisons of in-clinic and remote assessments and assessment of AK-related skin changes by non-invasive optical imaging. ETHICS AND DISSEMINATION Approved by the Ethics Committee of the Capital Region of Denmark (H-21018064) and the Danish Medicines Agency (2021032485). Results will be submitted for publication in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBERS 2021-000934-32; NCT05164393.
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Affiliation(s)
- Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark
| | - Berit Johansen
- Clinical Operations, Coegin Pharma AB, Lund, Sweden
- Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Tore Duvold
- Clinical Operations, Coegin Pharma AB, Lund, Sweden
| | - Jesper Kihl
- Clinical Operations, Coegin Pharma AB, Lund, Sweden
| | - Felicity J Ashcroft
- Clinical Operations, Coegin Pharma AB, Lund, Sweden
- Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid J Feuerherm
- Clinical Operations, Coegin Pharma AB, Lund, Sweden
- Department of Biology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Ionela Manole
- Second Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | | | - John R Zibert
- Clinical Operations, Coegin Pharma AB, Lund, Sweden
- Studies&Me, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, 2400 Copenhagen, Denmark
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5
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Hammadi R, Kúsz N, Dávid CZ, Behány Z, Papp L, Kemény L, Hohmann J, Lakatos L, Vasas A. Ingol and Ingenol-Type Diterpenes from Euphorbia trigona Miller with Keratinocyte Inhibitory Activity. PLANTS 2021; 10:plants10061206. [PMID: 34198524 PMCID: PMC8231945 DOI: 10.3390/plants10061206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/11/2022]
Abstract
Ingenol mebutate, isolated from Euphorbia peplus, is an ingenane-type diterpenoid, primarily used for the topical treatment of actinic keratosis, a premalignant skin condition. The aim of our work was to investigate other Euphorbia species to find structurally similar diterpenes that can be used as alternatives to ingenol mebutate. Pharmacological investigation of Euphorbia candelabrum, Euphorbia cotinifolia, Euphorbia ramipressa, and Euphorbia trigona revealed the potent keratinocyte (HPV-Ker cell line) inhibitory activity of these spurge species. From the methanolic extract of the aerial parts of Euphorbia trigona Miller, the most active species, five ingol (1–5) and four ingenane-type diterpenoids (6–9) were isolated by various chromatographic separation techniques, including open column chromatography, vacuum liquid chromatography, thin-layer chromatography, and high-performance liquid chromatography. The structures of the compounds were determined by NMR spectroscopic analysis and by comparison of the assignations with the literature data. The cytotoxic activity of the compounds against keratinocytes was tested in vitro by using ingenol mebutate as a positive control. Among the isolated compounds, two ingenane derivatives (6 and 7) exhibited remarkably stronger cytotoxic activity (IC50 values 0.39 μM and 0.32 μM, respectively) on keratinocytes than ingenol mebutate (IC50 value 0.84 μM). These compounds could serve as starting materials for further investigations to find alternatives to Picato® (with active substance ingenol mebutate), which was withdrawn from marketing authorization in the European Union.
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Affiliation(s)
- Reham Hammadi
- Department of Pharmacognosy, Interdisciplinary Excellence Centre, University of Szeged, Eötvös u. 6, 6720 Szeged, Hungary; (R.H.); (N.K.); (C.Z.D.); (J.H.)
| | - Norbert Kúsz
- Department of Pharmacognosy, Interdisciplinary Excellence Centre, University of Szeged, Eötvös u. 6, 6720 Szeged, Hungary; (R.H.); (N.K.); (C.Z.D.); (J.H.)
| | - Csilla Zsuzsanna Dávid
- Department of Pharmacognosy, Interdisciplinary Excellence Centre, University of Szeged, Eötvös u. 6, 6720 Szeged, Hungary; (R.H.); (N.K.); (C.Z.D.); (J.H.)
| | - Zoltán Behány
- Department of Dermatology and Allergology, University of Szeged, Korányi fasor 6, 6720 Szeged, Hungary; (Z.B.); (L.K.)
| | - László Papp
- Botanical Garden, Eötvös Loránd University, Illés u. 25, 1083 Budapest, Hungary;
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Korányi fasor 6, 6720 Szeged, Hungary; (Z.B.); (L.K.)
| | - Judit Hohmann
- Department of Pharmacognosy, Interdisciplinary Excellence Centre, University of Szeged, Eötvös u. 6, 6720 Szeged, Hungary; (R.H.); (N.K.); (C.Z.D.); (J.H.)
- Interdisciplinary Centre of Natural Products, University of Szeged, Eötvös u. 6, 6720 Szeged, Hungary
| | - Lóránt Lakatos
- Department of Dermatology and Allergology, University of Szeged, Korányi fasor 6, 6720 Szeged, Hungary; (Z.B.); (L.K.)
- Photo- and Chronobiology Group Eötvös Loránd Research Network (ELKH), Institute of Plant Biology, Biological Research Center Szeged, Temesvári krt. 62, 6726 Szeged, Hungary
- Correspondence: (L.L.); (A.V.); Tel.: +36-62546451 (A.V.)
| | - Andrea Vasas
- Department of Pharmacognosy, Interdisciplinary Excellence Centre, University of Szeged, Eötvös u. 6, 6720 Szeged, Hungary; (R.H.); (N.K.); (C.Z.D.); (J.H.)
- Correspondence: (L.L.); (A.V.); Tel.: +36-62546451 (A.V.)
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6
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de Andrade FAG, Isoldi FC, Ferreira LM. Skin field cancerisation: A systematic review of the literature regarding its treatment. Eur J Cancer Care (Engl) 2020; 30:e13366. [PMID: 33174657 DOI: 10.1111/ecc.13366] [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: 08/19/2019] [Revised: 07/25/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Skin neoplasms are the most frequent malignant lesions, increasing patient's morbidity when associated with skin field cancerisation. There is a need to understand the current therapies, both clinical and surgical. METHODS A systematic review was performed according to the PRISMA guideline, registered in PROSPERO: CRD42018114826, including studies from 2012 to 2019. RESULTS Seven hundred and eighty-two studies were found, of which 21 were included. Of these, 8 primary studies were randomised controlled trials: fractional CO2 laser-assisted photodynamic therapy (PDT) vs. PDT (no significance), daylight PDT vs. PDT (no significance, daylight PDT had less adverse effects), trichloroacetic acid peel vs. 5-aminolaevulinic acid PDT (clinical improvement of aminolaevulinic acid PDT), 5-Fluorouracil 0.5%/Salicylic Acid 10% vs. vehicle (clinical improvement of 5-Fluorouracil 0.5%/Salicylic Acid 10%), photolyase vs. sun filters (no significance), sunscreens vs. sunscreens plus DNA repair enzymes (DNA Repair Enzymes was more effective in reducing field cancerisation). Only one systematic review was included in which there was effectiveness of daylight PDT in the treatment of actinic keratoses. The other 12 included studies had a lower level of evidence including surgical studies. CONCLUSION Clinical studies are more relevant in the treatment of the field cancerisation. There is a lack of surgical studies.
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Affiliation(s)
- Fernando Antônio G de Andrade
- Plastic Surgery Service of Universidade Federal de Alagoas (UFAL), Discipline of Plastic Surgery of the Faculty of Medicine of UFAL, Maceió, Brazil
| | - Felipe C Isoldi
- Universidade Federal de São Paulo - Unifesp, Plastic Surgery Division, São Paulo, Brazil
| | - Lydia M Ferreira
- Universidade Federal de São Paulo - Unifesp, Plastic Surgery Division, São Paulo, Brazil
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Salehi Farid A, Niknam S, Gholami K, Tavakolpour S, Teimourpour A, Daneshpazhooh M, Nili A, Azizpour A, Nasimi M, Mahmoudi H. Comparing efficacy and safety of potassium hydroxide 5% solution with 5-fluorouracil cream in patients with actinic keratoses: a randomized controlled trial. J DERMATOL TREAT 2020; 33:1376-1382. [DOI: 10.1080/09546634.2020.1817839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ali Salehi Farid
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Niknam
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Dana Farber Cancer Institute, Harvard Medical school, Boston, MA, USA
| | - Amir Teimourpour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Nili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arghavan Azizpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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8
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Caminiti MF, El-Rabbany M, Jeon J, Bradley G. 5-Fluorouracil Is Associated With a Decreased Recurrence Risk in Odontogenic Keratocyst Management: A Retrospective Cohort Study. J Oral Maxillofac Surg 2020; 79:814-821. [PMID: 32866486 DOI: 10.1016/j.joms.2020.07.215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The antimetabolite drug, 5-fluorouracil (5-FU), has been suggested as an adjunctive treatment to reduce the recurrence rates of odontogenic keratocysts (OKCs). We report on the use of 5-FU in the management of patients with OKCs as a postenucleation intracavity topical dressing. METHODS For this retrospective cohort study, we collected all data of sequentially treated cases presenting to the University of Toronto's hospital clinics for the management of biopsy-proven OKCs. Chart reviews were conducted to identify all patients treated with 5-FU cream, and compare them to patients treated with modified Carnoy's solution (MCS). In the treatment group, all patients were treated in an identical manner with enucleation and peripheral ostectomy followed by the application of 5% 5-FU cream for 24 hours. Preoperative and postoperative radiographs were collected to determine the time to recurrence of the disease, and the techniques were compared via a multivariate Cox regression analysis. RESULTS Seventy patients were found to be eligible for inclusion in this study. Of these, 34 patients were treated with 5% topical 5-FU, and 36 patients were managed with MCS. The median follow-up time in the 5-FU group was 22 months (interquartile range, 36), compared with 27 months (interquartile range, 37) for the MCS group (P = .40). No recurrences were identified in the 5-FU group, compared with 9 recurrences (25%) in patients treated with MCS. 5-FU was shown to be significantly negatively associated with time to disease resolution (P < .01). CONCLUSIONS Results from this study suggest that when used topically, 5-FU effectively lowers the recurrence rates of OKCs. Further large scale, case-controlled studies are being investigated at our center and are warranted to make definitive conclusions regarding the effectiveness of this novel technique when compared with conventional therapies.
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Affiliation(s)
- Marco F Caminiti
- Assistant Professor Head and Program Director, Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Mohamed El-Rabbany
- Resident and PhD Student, Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Jeon
- Dental Student, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Grace Bradley
- Professor, Program Director Oral Pathology, University of Toronto, Toronto, Ontario, Canada
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Abdalla BMZ, Simas Pedreiro B, Garcia Morales A, Krutman Zveibil D, Paschoal FM. Clinical, histopathological and immunohistochemical evaluation of daylight photodynamic therapy in the treatment of field cancerization: a study of 30 cases. J DERMATOL TREAT 2020; 33:878-884. [PMID: 32628053 DOI: 10.1080/09546634.2020.1789042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Actinic keratosis (AK) are pre-malignant lesions, precursors of squamous cell carcinoma (SCC). Normal skin adjacent to AK, may present initial mutations with potential risk for new neoplasms, currently known today as field cancerization (FC). OBJECTIVES To evaluate the effectiveness of daylight photodynamic therapy (PDT) with methyl amino levulinate (MAL) based on clinical evaluation, histological examination and immunohistochemical expression of p53 and Ki67. MATERIAL AND METHODS Thirty patients, over 35 years old, phototypes between I and III, presenting non-hypertrophic AK on the face or scalp. Two biopsies with 2 mm punch of the lesion and adjacent skin before and 60 days after daylight PDT were performed. Results: Improvement was seen in lesion thickness and Ki67. 19 (63.33%) lesions had atypia improvement with a p-value <.05, showing efficacy in treatment. After daylight PDT, 22 (73.33%) patients showed satisfactory esthetic improvement. CONCLUSION The study shows that PDT has cellular and molecular effects that support its indication in the control of carcinogenesis, as it decreases atypia and controls the expression of Ki67, reducing the proliferation of atypical cells. However, its indication following this study is still mainly aimed at clinical improvement of the skin, at this moment, probably due to the sample size.
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10
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Segura S, Gadea A, Nonell L, Andrades E, Sánchez S, Pujol R, Hernández-Muñoz I, Toll A. Identification of differentially expressed genes in actinic keratosis samples treated with ingenol mebutate gel. PLoS One 2020; 15:e0232146. [PMID: 32413042 PMCID: PMC7228095 DOI: 10.1371/journal.pone.0232146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Actinic keratosis is a common skin disease that may progress to invasive squamous cell carcinoma if left untreated. Ingenol mebutate has demonstrated efficacy in field treatment of actinic keratosis. However, molecular mechanisms on ingenol mebutate response are not yet fully understood. In this study, we evaluated the gene expression profiles of actinic keratosis lesions before and after treatment with ingenol mebutate using microarray technology. Actinic keratoses on face/scalp of 15 immunocompetent patients were identified and evaluated after treatment with topical ingenol mebutate gel 0.015%, applied once daily for 3 consecutive days. Diagnostic and clearance of lesions was determined by clinical, dermoscopic, and reflectance confocal microscopy criteria. Lesional and non-lesional skin biopsies were subjected to gene expression analysis profiled by Affymetrix microarray. Differentially expressed genes were identified, and enrichment analyses were performed using STRING database. At 8 weeks post-treatment, 60% of patients responded to ingenol mebutate therapy, achieving complete clearance in 40% of cases. A total of 128 differentially expressed genes were identified following treatment, and downregulated genes (114 of 128) revealed changes in pathways important to epidermal development, keratinocyte differentiation and cornification. In responder patients, 388 downregulated genes (of 450 differentially expressed genes) were also involved in development/differentiation of the epidermis, and immune system-related pathways, such as cytokine and interleukin signaling. Cluster analysis revealed two relevant clusters showing upregulated profile patterns in pre-treatment actinic keratoses of responders, as compared to non-responders. Again, differentially expressed genes were mainly associated with cornification, keratinization and keratinocyte differentiation. Overall, the present study provides insight into the gene expression profile of actinic keratoses after treatment with ingenol mebutate, as well as identification of genetic signatures that could predict treatment response.
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Affiliation(s)
- Sonia Segura
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Alejandra Gadea
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Paul Pascal (CRPP), Université de Bordeaux, Pessac, France
| | - Lara Nonell
- MARGenomics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Evelyn Andrades
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Sánchez
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ramon Pujol
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Inmaculada Hernández-Muñoz
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Nourmohammad Pour P, Esmaili N, Ehsani A, Hamzelou S, Nasimi M. Nonablative fractional laser therapy for treatment of actinic keratosis with 3-months follow-up. J Cosmet Dermatol 2020; 19:2893-2897. [PMID: 32115821 DOI: 10.1111/jocd.13350] [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: 09/28/2019] [Revised: 12/14/2019] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a common skin disorder that is treated with different treatment modalities. AIMS The aim of this study was to assess the therapeutic effect of a 1540-nm nonablative fractional laser on the AK. METHODS Ten patients with 31 AK were included in the study according to the inclusion and exclusion criteria. Treatment with nonablative fractional laser (1540 nm) 3 times at 4 weeks intervals in a noncontact mode was applied. Clinical severity was assessed at each session and 3 months after the last session. It is pertinent to mention that the patients were also involved in the assessment of improvement. RESULTS The results of present study showed that in comparison to the baseline, 3-session AK therapy with nonablative fractional laser significantly not only improved the AK severity by 79%, but also reduced the AK counts (from 31 to 17). On the other hand, the patients consented to the therapeutic effect. CONCLUSION According to the obtained results and available studies, it seems that therapy with a 1540-nm nonablative fractional laser could be considered as a safe and effective alternative therapeutic option for the treatment of AK.
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Affiliation(s)
| | - Nafise Esmaili
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhooshang Ehsani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Hamzelou
- Department of Dermatology, Imam-Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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12
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Dianzani C, Conforti C, Giuffrida R, Corneli P, di Meo N, Farinazzo E, Moret A, Magaton Rizzi G, Zalaudek I. Current therapies for actinic keratosis. Int J Dermatol 2020; 59:677-684. [PMID: 32012240 DOI: 10.1111/ijd.14767] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 12/31/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022]
Abstract
Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp, neck, hands, and forearms. AKs must be considered an early squamous cell carcinoma (SCC) for their probable progression into invasive SCC. For this reason, all AK should be treated, and clinical follow-up is recommended. The aims of treatment are: (i) to clinically eradicate evident and subclinical lesions, (ii) to prevent their evolution into SCC, and (iii) to reduce the number of relapses. Among available treatments, it is possible to distinguish lesion-directed therapies and field-directed therapies. Lesion-directed treatments include: (i) cryotherapy; (ii) laser therapy; (iii) surgery; and (iv) curettage. Whereas, field-directed treatments are: (i) 5-fluorouracil (5-FU); (ii) diclofenac 3% gel; (iii) chemical peeling; (iv) imiquimod; and (v) photodynamic therapy (PDT). Prevention plays an important role in the treatment of AKs, and it is based on the continuous use of sunscreen and protective clothing. This review shows different types of available treatments and describes the characteristics and benefits of each medication, underlining the best choice.
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Affiliation(s)
- Caterina Dianzani
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Claudio Conforti
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Paola Corneli
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Nicola di Meo
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Eleonora Farinazzo
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Anna Moret
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | - Iris Zalaudek
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
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13
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Todorova K, Mandinova A. Novel approaches for managing aged skin and nonmelanoma skin cancer. Adv Drug Deliv Rev 2020; 153:18-27. [PMID: 32526451 DOI: 10.1016/j.addr.2020.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 12/29/2022]
Abstract
The process of aging influences every bodily organ and tissue, and those with rapid epithelial cell turnover, are particularly affected. The most visible of these, however, is the skin (including the epidermis), the largest human organ that provides a barrier to external insults, structure to the body and its movements, facilitates thermoregulation, harbors immune cells, and incorporates sensory neurons (including mechanoreceptors, nociceptors, and thermoreceptors). Skin aging has traditionally been categorized into intrinsic and extrinsic, with the latter nearly exclusively restricted to "photoaging," (i.e., aging due to exposure to solar or artificial ultraviolet radiation). However, both intrinsic and extrinsic aging share similar causes, including oxidative damage, telomere shortening, and mitochondrial senescence. Also, like other malignancies, the risk of malignant and nonmalignant lesions increases with age. Herein, we review the most recent findings in skin aging and nonmelanoma skin cancer, including addition to traditional and developing therapies.
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14
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Krishnan V, Mitragotri S. Nanoparticles for topical drug delivery: Potential for skin cancer treatment. Adv Drug Deliv Rev 2020; 153:87-108. [PMID: 32497707 DOI: 10.1016/j.addr.2020.05.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022]
Abstract
Nanoparticles offer new opportunities for the treatment of skin diseases. The barrier function of the skin poses a significant challenge for nanoparticles to permeate into the tissue, although the barrier is partially compromised in case of injury or inflammation, as in the case of skin cancer. This may facilitate the penetration of nanoparticles. Extensive research has gone into developing nanoparticles for topical delivery; however, relatively little progress has been made in translating them to the clinic for treating skin cancers. We summarize the types of skin cancers and practices in current clinical management. The review provides a comprehensive outlook of the various nanoparticle technologies tested for topical therapy of skin cancers and summarizes the obstacles that impede its progress from the bench-to-bedside. The review also aims to provide an understanding of the pathways that govern nanoparticle penetration into the skin and a critical analysis of the approaches used to study nanoparticle interactions within the tissue.
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Affiliation(s)
- Vinu Krishnan
- John A. Paulson School of Engineering & Applied Sciences Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, United States of America
| | - Samir Mitragotri
- John A. Paulson School of Engineering & Applied Sciences Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, United States of America.
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15
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Croix J, Burge S, Chwalek J, Gmyrek R, Chapas A. Split-Sided Chest Study of Skin Rejuvenation Comparing Low-Energy, 1,927-nm Thulium Fractional Laser Treatment Prior to Photodynamic Therapy Versus Photodynamic Therapy Alone. Lasers Surg Med 2019; 52:53-60. [PMID: 31729052 PMCID: PMC7003803 DOI: 10.1002/lsm.23178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/30/2022]
Abstract
Background and Objectives Treatment of photoaging and intrinsic aging of the chest, with the associated concerns of skin roughness, uneven pigmentation, laxity, atrophy, and telangiectasias, can be problematic because of the potential for worsened esthetic outcomes with existing treatments. This study assessed the efficacy and safety of using nonablative fractional laser therapy (FLT) pretreatment with photodynamic therapy (PDT) versus PDT alone for chest rejuvenation. Study Design/Materials and Methods In a randomized, evaluator‐blinded, split‐sided study, adult female patients with photodamage to the chest received three treatment courses over an 8‐week period with follow‐up visits at Weeks 12 and 20. FLT was applied to one side of the chest, randomly assigned at baseline, followed by aminolevulinic acid‐based PDT, delivered using a thermal, short incubation, broad area technique, to both sides of the chest. In‐person and photographic assessments were conducted using five‐point scales to evaluate outcomes including rhytides, pigmentation, skin texture, and telangiectasias. Results Eleven adults completed the study, of whom 11 had improved scores for rhytides and 10 had improved scores for skin texture at Week 20. There was no significant difference in any efficacy outcome between FLT and PDT and standard PDT alone. The severity of adverse events was rated significantly greater with the combined FLT–PDT treatment vs PDT alone. Conclusions Significant improvements were observed vs baseline for both sides of the chest treated with FLT–PDT or standard PDT following three treatment sessions. No significant difference in efficacy was observed between treatment approaches, although adverse events were more severe on the FLT‐pretreated side. This study was not registered as it qualified as a nonsignificant risk study. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Jennifer Croix
- Union Square Laser Dermatology, 19 Union Square West, New York, New York, 10003
| | - Shannon Burge
- Union Square Laser Dermatology, 19 Union Square West, New York, New York, 10003
| | - Jennifer Chwalek
- Union Square Laser Dermatology, 19 Union Square West, New York, New York, 10003
| | - Robyn Gmyrek
- Union Square Laser Dermatology, 19 Union Square West, New York, New York, 10003
| | - Anne Chapas
- Union Square Laser Dermatology, 19 Union Square West, New York, New York, 10003
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16
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Nguyen M, Sandhu SS, Sivamani RK. Clinical utility of daylight photodynamic therapy in the treatment of actinic keratosis - a review of the literature. Clin Cosmet Investig Dermatol 2019; 12:427-435. [PMID: 31239746 PMCID: PMC6560187 DOI: 10.2147/ccid.s167498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/24/2019] [Indexed: 12/25/2022]
Abstract
Actinic keratosis (AK) is an early in situ squamous cell carcinoma that results from UV light exposure and has the potential to evolve into invasive tumor. Therefore, it is crucial that AKs are monitored and treated appropriately. Photodynamic therapy (PDT) is a treatment option that is minimally invasive and leaves patients with cosmetically superior results. However, disadvantages of PDT include pain and lengthy clinic visits. Accordingly, there has been much interest in the use of daylight photodynamic therapy (daylight-PDT) as a more convenient and less painful alternative to conventional photodynamic therapy (c-PDT). Current evidence shows that daylight-PDT is noninferior to c-PDT in the short and long term. Patients reported decreased pain with daylight-PDT and were more satisfied with the procedure (P<0.001). Current evidence suggests that 2 hrs of daylight exposure was sufficient for treatment, and its efficacy does not appear to be limited by weather conditions. Given the decreased intensity of treatment, daylight-PDT is better for mild disease, as it is less effective in moderate-to-thick AKs. Though further studies are still needed to refine the technique, daylight-PDT is a potential alternative to c-PDT for thin-to-moderate AKs and should be offered to patients with lower pain tolerance or busy schedules.
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Affiliation(s)
- Mimi Nguyen
- Department of Dermatology, University of California - Davis, Sacramento, CA, USA
| | - Simran S Sandhu
- Department of Dermatology, University of California - Davis, Sacramento, CA, USA
| | - Raja K Sivamani
- Department of Dermatology, University of California - Davis, Sacramento, CA, USA.,Department of Biological Sciences, California State University Sacramento, Sacramento, CA, USA.,College of Medicine, California Northstate University, Elk Grove, CA, USA.,Department of Dermatology, Pacific Skin Institute, Sacramento, CA, USA
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17
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Mei X, Wang L, Zhang R, Zhong S. Daylight versus conventional photodynamic therapy for the treatment of actinic keratosis: A meta-analysis of randomized controlled trials. Photodiagnosis Photodyn Ther 2019; 25:23-28. [DOI: 10.1016/j.pdpdt.2018.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/28/2018] [Accepted: 11/05/2018] [Indexed: 01/23/2023]
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18
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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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19
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Ehret M, Velter C, Tebacher M, Bruant-Rodier C, Cribier B. Carcinome épidermoïde de croissance rapide après traitement par mébutate d’ingénol. Ann Dermatol Venereol 2018; 145:607-612. [DOI: 10.1016/j.annder.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/08/2017] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
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20
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Bobyr I, Campanati A, Offidani A. "SENECA" Sinecatechins 10% ointment: A green tea extract for the treatment of actinic keratosis. Case series. Dermatol Ther 2018; 31:e12634. [PMID: 30175472 DOI: 10.1111/dth.12634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/22/2018] [Accepted: 06/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ivan Bobyr
- Dermatological Clinic, Department of Clinical and Molecular sciences, Polytechnic Marche University, Ancona, Italy
| | - Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular sciences, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Clinic, Department of Clinical and Molecular sciences, Polytechnic Marche University, Ancona, Italy
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21
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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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22
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Saraiva MIR, Portocarrero LKL, Vieira MAHB, Swiczar BCC, Westin AT. Ingenol mebutate in the treatment of actinic keratoses: clearance rate and adverse effects. An Bras Dermatol 2018; 93:529-534. [PMID: 30066759 PMCID: PMC6063094 DOI: 10.1590/abd1806-4841.20186982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/22/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Actinic keratoses are benign intraepithelial skin neoplasms that develop in photoexposed areas and can progress to invasive carcinoma. They are seen frequently in dermatological practice, occurring in 5.1% of consultations. Ingenol mebutate (IM) was recently approved in Brazil as a topical therapy for field cancerization in actinic keratosis. OBJECTIVE To evaluate the clearance rate and adverse events in the treatment of actinic keratoses with ingenol mebutate. METHODS A longitudinal, prospective, non-randomized, interventional, open, single-center study was conducted. Patients with actinic keratoses applied ingenol mebutate on a 25cm2 area of the face and/or scalp for three consecutive days (0.015%) or on the forearm for two days (0.05%). RESULTS 27 patients completed the protocol, of whom 13 on the face and/or scalp and 14 on the forearm. Complete clearance occurred in 53.8% in the first group and 42.8% in the second. Partial response was observed in 15.4% and 35.7%, respectively. The most common side effects were erythema, edema, desquamation, pruritus, and local erosion. STUDY LIMITATIONS The study had a small sample and was not randomized, double-blind, placebo-controlled, or vehicle-controlled. CONCLUSION Ingenol mebutate is well-tolerated for the treatment of actinic keratosis, with good patient adherence thanks to the short treatment period.
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Affiliation(s)
- Maria Isabel Ramos Saraiva
- Dermatology Service, Hospital do Servidor Público Estadual
de São Paulo, São Paulo (SP), Brazil
- Dermatology Service, Hospital Alemão Oswaldo Cruz,
São Paulo (SP), Brazil
| | | | | | | | - Andrezza Telles Westin
- Dermatology Division, Hospital das Clínicas da Faculdade de
Medicina de Ribeirão Preto da Universidade de São Paulo, São
Paulo (SP), Brazil
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23
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Successful Treatment of Actinic Keratosis with Kanuka Honey. Case Rep Dermatol Med 2018; 2018:4628971. [PMID: 29955399 PMCID: PMC6000848 DOI: 10.1155/2018/4628971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/06/2018] [Indexed: 11/27/2022] Open
Abstract
Actinic keratoses form as rough, scaly plaques on sun-exposed areas; they can be an important step in premalignant progression to squamous cell cancer of the skin. Currently, pharmacological treatments consist of topical immunomodulatory agents with poor side effect profiles. Use of honey has been common in both ancient and modern medicine, where it is now a key therapy in the management of wound healing. In vitro studies show the New Zealand native Kanuka honey to have immunomodulatory and antimitotic effects, with recent evidence suggesting efficacy of topical application in a variety of dermatological contexts, including rosacea and psoriasis. Here, we present a case report of a 66-year-old gentleman with an actinic keratosis on his hand, which had been present for years. Regular application of Kanuka honey over three months resulted in remission immediately following the treatment period with no signs of recurrence at nine months.
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24
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Khan S, Chak M. A Rare Presentation of Actinic Keratosis Affecting the Tarsal Conjunctiva and Review of the Literature. Case Rep Ophthalmol Med 2018; 2018:4375354. [PMID: 29619263 PMCID: PMC5830276 DOI: 10.1155/2018/4375354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 11/30/2022] Open
Abstract
We report an unusual case of actinic keratosis (AK) of the tarsal conjunctiva in a 63-year-old man. Examination revealed a crusty, leukoplakic lesion prone to bleeding on the tarsal conjunctiva of the right upper eyelid. This was treated by surgical excisional biopsy. At 1-year follow-up, there was no evidence of recurrence and the surgical site was completely healed without conjunctival scarring. Current opinion cites excessive exposure to ultraviolet (UV) radiation, in particular UV-B in sunlight, as the causative agent in developing AK. In the case we present, the tarsal conjunctiva is an unusual place for actinic keratosis due to the lack of direct UV-light exposure. The key learning points are to evert the upper eyelid during examination especially if the lesion involves the eyelid margin and, secondly, to ensure risk factors are addressed during the history.
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Affiliation(s)
- Selina Khan
- Ophthalmology Department, Great Western Hospital, Swindon, UK
| | - Melanie Chak
- Ophthalmology Department, Great Western Hospital, Swindon, UK
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25
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Ishioka P, Maia M, Rodrigues S, Lellis R, Hirata S. In vivo Confocal Laser Microscopy for monitoring of actinic keratosis treatment: a comparison with histopathologic assessment after treatment with topical 5% 5-fluorouracil. J Eur Acad Dermatol Venereol 2018; 32:1155-1163. [DOI: 10.1111/jdv.14716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/08/2017] [Indexed: 12/19/2022]
Affiliation(s)
- P. Ishioka
- Universidade Federal de São Paulo; São Paulo SP Brazil
- Santa Casa de Misericórdia de São Paulo; São Paulo SP Brazil
| | - M. Maia
- Santa Casa de Misericórdia de São Paulo; São Paulo SP Brazil
| | - S.B. Rodrigues
- Santa Casa de Misericórdia de São Paulo; São Paulo SP Brazil
| | - R.F. Lellis
- Santa Casa de Misericórdia de São Paulo; São Paulo SP Brazil
| | - S.H. Hirata
- Universidade Federal de São Paulo; São Paulo SP Brazil
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26
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Ferrándiz-Pulido C, Lera-Imbuluzqueta M, Ferrándiz C, Plazas-Fernandez M. Prevalence of Actinic Keratosis in Different Regions of Spain: The EPIQA Study. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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27
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Ferrándiz-Pulido C, Lera-Imbuluzqueta M, Ferrándiz C, Plazas-Fernandez MJ. Prevalence of Actinic Keratosis in Different Regions of Spain: The EPIQA Study. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:83-86. [PMID: 29025692 DOI: 10.1016/j.ad.2017.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- C Ferrándiz-Pulido
- Servicio de Dermatología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - C Ferrándiz
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain.
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28
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Conforti C, Beninati E, Dianzani C. Are actinic keratoses really squamous cell cancer? How do we know if they would become malignant? Clin Dermatol 2017; 36:430-432. [PMID: 29908585 DOI: 10.1016/j.clindermatol.2017.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Actinic keratosis (AK) is a very common skin disease caused by chronic sun exposure. AKs have historically been characterized as being "precancerous" or "premalignant." It is true that these lesions do not possess metastatic potential, because they are confined to the epidermis, but it is not accurate to deem them "premalignant." AK qualifies as a malignant neoplasm, because it also fulfills criteria for malignancy in classic pathology, namely, the capability, or potential, to kill by either destruction of tissue locally or by metastasis widely. In this context, AK is considered now by many a carcinoma in situ and can persist or progress to invasive squamous cell carcinoma (iSCC), which rarely metastasizes. Through this controversy, which speaks to an issue we have been debating for at least a century, we should like to start a constructive debate to reach a unanimous conclusion considering the various theories and points of view in the literature.
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Affiliation(s)
- Claudio Conforti
- Institute of Dermatology, Campus Bio-Medico University, Rome, Italy.
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29
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Damps T, Laskowska AK, Kowalkowski T, Prokopowicz M, Puszko AK, Sosnowski P, Czuwara J, Konop M, Różycki K, Borkowska JK, Misicka A, Rudnicka L. The effect of wool hydrolysates on squamous cell carcinoma cells in vitro. Possible implications for cancer treatment. PLoS One 2017; 12:e0184034. [PMID: 28859143 PMCID: PMC5578621 DOI: 10.1371/journal.pone.0184034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
Squamous cell carcinoma of the skin is the second most common cutaneous malignancy. Despite various available treatment methods and advances in noninvasive diagnostic techniques, the incidence of metastatic cutaneous squamous cell carcinoma is rising. Deficiency in effective preventive or treatment methods of transformed keratinocytes leads to necessity of searching for new anticancer agents. The present study aims to evaluate the possibility of using wool hydrolysates as such agents. Commercially available compounds such as 5-fluorouracil, ingenol mebutate, diclofenac sodium salt were also used in this study. The process of wool degradation was based on chemical pre-activation and enzymatic digestion of wool. The effect of mentioned compounds on cell viability of squamous carcinoma cell line and healthy keratinocytes was evaluated. The obtained data show a significantly stronger effect of selected wool hydrolysates compared to commercial compounds (p<0.05) on viability of cells. The wool hydrolysates decreased squamous cell carcinoma cells viability by up to 67% comparing to untreated cells. These results indicate bioactive properties of wool hydrolysates, which affect the viability of squamous carcinoma cells and decrease their number. We hypothesize that these agents may be used topically for treatment of transformed keratinocytes in actinic keratosis and invasive squamous skin cancer in humans.
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Affiliation(s)
- Tatsiana Damps
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- * E-mail:
| | - Anna Katarzyna Laskowska
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Kowalkowski
- Chair of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Toruń, Poland
- Interdisciplinary Centre of Modern Technology, Nicolaus Copernicus University, Toruń, Poland
| | - Monika Prokopowicz
- Laboratory of Chemical Synthesis, CePT, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | | | - Piotr Sosnowski
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Konop
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Różycki
- Laboratory of Chemical Synthesis, CePT, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Joanna Karolina Borkowska
- Department of Human Epigenetics, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Aleksandra Misicka
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Neuropeptides, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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30
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Reinhold U. A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis. Future Oncol 2017; 13:2413-2428. [PMID: 28805092 DOI: 10.2217/fon-2017-0247] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BF-200 ALA is a combination of a nanoscale-lipid vesicle formulation and the prodrug 5-aminolevulinic acid (5-ALA). The nanoemulsion stabilizes the prodrug and enhances its penetration through the stratum corneum. It has shown excellent therapeutic results in both lesion and field-directed photodynamic therapy of actinic keratosis (AK). AK is an early form of epidermal neoplasia and a precursor of invasive cutaneous squamous cell carcinoma. It is characterized by the combination of visible neoplastic lesions and surrounding tissue also harboring tumorigenic UV-induced mutations: a concept called field cancerization. A selective, field-directed treatment is ideal to meet the requirements of field change. Here, we review the clinical data on BF-200 ALA for AK along with a summary of molecular mechanisms and future perspectives.
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Affiliation(s)
- Uwe Reinhold
- Dermatological Center Bonn Friedensplatz, Bonn, Germany
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31
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32
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Fleming P, Zhou S, Bobotsis R, Lynde C. Comparison of the Treatment Guidelines for Actinic Keratosis: A Critical Appraisal and Review. J Cutan Med Surg 2017; 21:408-417. [DOI: 10.1177/1203475417708166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There are currently several reputable guidelines on the treatment of actinic keratosis (AK) from groups in Canada, the United Kingdom, and Europe. These recommendations, based on evidence or expert consensus, offer clinicians a variety of treatment options for the different clinical presentations of AKs. Although the guidelines are similar in some regards, variations exist in treatment options, duration, and strength of recommendation. Some guidelines also lack input on specific therapies and certain types of AK, such as hypertrophic or thin presentations. The purpose of this article is to review and compare guidelines published by Canadian, UK, and European groups for the management of AKs in patients.
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Affiliation(s)
- Patrick Fleming
- Division of Dermatology, University of Toronto, Toronto, Canada
| | - Stephanie Zhou
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert Bobotsis
- Schulich School of Medicine, Western University, London, Canada
| | - Charles Lynde
- Division of Dermatology, University of Toronto, Toronto, Canada
- Lynde Dermatology (Private Practice), Markham, Canada
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33
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Khlebnikova AN, Obydenova KV, Sedova TG, Andrukhina VV. Diagnosis of actinic keratosis by dermatoscopy. VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-2-45-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Actinic keratosis (AK) is a local introepidermal atypia of keratinocytes, formed as a result of intense and prolonged exposure to sunlight. AK lesions located on exposed areas of skin, mostly on the face, in this regard, a more relevant non-invasive diagnostic techniques, primarily dermatoscopy. Material and methods: We examined 35 patients and revealed they have 204 hearth. Results: Of the 204 lesions erythematous form was found in 160 (78, 4%) cases, keratotic - 24 (11,8%), pigmental (9.8 %). Patients with AK most private dermatoscopic signs were erythema (90,2%), vascular structures (67,65%), keratin scales (51,47%), pseudonetwork (23,04%). Discussion: Analyzing dermoscopic picture of the most common forms of AK met the characteristics for each shape. A detailed study of vascular structures allows for the differential diagnosis of cancer in situ. While AK watched point and the glomerular vessels of not more than 10% of cases, which helped to differentiate AK from cancer in situ, in which such vessels were found in 40%. Glomerular vessels are not met in our study and the points were only 2.45% of the cases. Keratotic AK was characterized in 100% of cases the presence of keratin scales. In pigment form, we revealed the dark brown streaks (80%), dark brown points (50%), brown globules (30%), dark brown blots (10%) and slate-grey dots (10%). But the gold standard for the differential diagnosis with maligna lentigo is a morphological study. Conclusion: AK has specific characteristics in treatment research, which helps to differentiate it from other benign and malignant tumors of the skin, and to diagnose it in its earliest stages without resorting to invasive procedures. Effective diagnosis of AK reduces the risk of malignant transformation and contribute to the selection of adequate and necessary treatment tactics.
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34
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Calzavara-Pinton P, Hædersdal M, Barber K, Basset-Seguin N, Del Pino Flores ME, Foley P, Galimberti G, Gerritsen R, Gilaberte Y, Ibbotson S, Peris K, Sapra S, Sotiriou E, Torezan L, Ulrich C, Guillemot J, Hendrich J, Szeimies RM. Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT. J Cutan Med Surg 2017; 21:3S-16S. [PMID: 28406719 DOI: 10.1177/1203475417702994] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). Objectives: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. Methods: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options. Results: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation. Conclusions: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician’s clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.
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Affiliation(s)
| | - Merete Hædersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirk Barber
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Basset-Seguin
- Department of Dermatology, Hospital Saint-Louis, Université Paris 7, Paris, France
| | | | - Peter Foley
- Department of Medicine (Dermatology), University of Melbourne; St Vincent’s Hospital Melbourne, Fitzroy, and Skin & Cancer Foundation, Carlton, Australia
| | - Gaston Galimberti
- Department of Dermatology, School of Medicine, Hospital Italiano, Buenos Aires, Argentina
| | - Rianne Gerritsen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sally Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Ketty Peris
- Catholic University of Rome, Fondazione Policlinico Gemelli, Rome, Italy
| | - Sheetal Sapra
- Institute of Cosmetic and Laser Surgery, Oakville, Ontario, Canada
| | - Elena Sotiriou
- First Dermatology Department, Aristotle University, Thessaloniki, Greece
| | - Luis Torezan
- Hospital das Clinicas Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | | | - Jonathan Guillemot
- Amaris, London, UK
- Universidad San Francisco de Quito USFQ, Escuela de Medicina, Quito, Ecuador
| | | | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
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35
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Cervantes J, Verne SH, Magno RJ, Perper M, Eber AE, ALharbi M, Nouri K. Cells to Surgery Quiz: March 2017. J Invest Dermatol 2017; 137:e29. [PMID: 30487077 DOI: 10.1016/j.jid.2017.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jessica Cervantes
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sebastian H Verne
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert J Magno
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Perper
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ariel E Eber
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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36
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Campione E, Di Prete M, Diluvio L, Bianchi L, Orlandi A. Efficacy of ingenol mebutate gel for actinic keratosis in patients treated by thiazide diuretics. Clin Cosmet Investig Dermatol 2016; 9:405-409. [PMID: 27853385 PMCID: PMC5106182 DOI: 10.2147/ccid.s111305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Actinic keratosis (AK) is considered as superficial squamous cell carcinoma. Chronic sun exposure plays a central role in its pathogenesis. In particular, ultraviolet B radiation causes direct damage to the DNA, producing pyrimidine dimers that suppress the protective role of p53. Other risk factors include advanced age, male sex, and fair skin type. Even some drugs used for treating blood hypertension, such as thiazide diuretics, can increase the risk of developing AK. Their photosensitizing action seems to be connected with reactive oxygen species production. We report our experience with ten patients affected by multiple AK, in therapy with thiazide diuretics, treated by ingenol mebutate gel. AK was clinically and dermoscopically evaluated at baseline and after 30 days from the beginning of the treatment. Moreover, patients were screened for vitamin D3 values and reported a general hypovitaminosis status. To our knowledge, we report for the first time the efficacy of ingenol mebutate gel in this group of patients, particularly at risk of developing AK.
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Affiliation(s)
| | | | | | | | - Augusto Orlandi
- Department of Pathology, University of Rome Tor Vergata, Rome, Italy
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Eber AE, Magno RJ, Tsatalis JP, Perper M, Aldahan AS, Nouri K. Cells to Surgery Quiz: October 2016. J Invest Dermatol 2016; 136:e107. [PMID: 30477728 DOI: 10.1016/j.jid.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ariel E Eber
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert J Magno
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John P Tsatalis
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Perper
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adam S Aldahan
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Abstract
Aktinic Keratosis is common and if left untreated may develop into life threatening squamous cell carcinoma. Therefore early intervention is the standard of care. While many treatments are available PDT continues to move to the for - front for this indication (Brito et al., 2016 [31]). Topical PS is commercially available that are able to reliably ablate these lesions. Innovative protocols including sunlight, large volume LED arrays and maneuvers to improve treatment parameters and cosmesis continue to make this a worldwide treatment of choice for AK.
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Emre S. Actinic keratosis and field cancerization. World J Dermatol 2016; 5:115-124. [DOI: 10.5314/wjd.v5.i2.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/06/2016] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
While actinic keratoses (AKs) have been considered precancerous until recently for being able to turn into squamous cell carcinomas (SCCs), it is now agreed that it would be more appropriate to call them cancerous. Although not all AKs turn into SCC and some of them may even have a spontaneous regression, there is an obvious association between SCC and AK. Approximately 90% of SCs have been reported to develop from AKs and AKs are the preinvasive form of SCCs. The presence of two or more AKs on a photodamaged skin is an indicator of field cancerization and represents an increased risk of invasive SCC. All lesions should be treated since it cannot be foreseen which of the lesions will regress and which will progress to SCC. AK can be a single lesion or it can involve multiple lesions in a field of cancerization; thus, AK treatment is grouped under two headings: (1) Lesion-specific treatment; and (2) Field-targeted treatment. Lesion-specific treatments are practicable in patients with a small number of clinically visible and isolated lesions. These treatments including cryotherapy, surgical excision, shave excision, curettage and laser are based on physical destruction of the visible lesions. Field-targeted treatments are effective in the treatment of visible lesions, subclinical lesions and keratinocyte changes in the areas surrounding the visible lesions. Field targeted treatment options are topical imiquimod cream, 5% 5-fluorouracil cream, ingenol mebutate, diclofenac gel, resimiquimod and photodynamic therapy.
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