Spanish-Portuguese consensus statement on use of daylight-mediated photodynamic therapy with methyl aminolevulinate in the treatment of actinic keratosis

INTRODUCTION

Daylight-mediated photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in grade 1 and 2 actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol.

OBJECTIVE

We describe a protocol for the treatment of grade 1 and 2 actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries.

METHODS

Twelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol.

RESULTS

According to the recommendations adopted, patients with multiple grade 1 and 2 lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight-mediated PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours.

CONCLUSION

This consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight-mediated PDT with MAL in Spain and Portugal with minimal adverse effects.

Infantile hemangiomas treated by sequential application of pulsed dye laser and Nd:YAG laser radiation: a retrospective study

BACKGROUND AND OBJECTIVES

Infantile hemangiomas are the most common benign tumor in children. They have 3 phases of development: a proliferative phase, an involuting phase, and involution. Although active treatment is often not required, it is necessary in some cases. Of the possible treatments for hemangiomas, lasers have been shown to be effective in all phases of development. We report our experience with dual-wavelength sequential pulses from a pulsed dye laser and an Nd:YAG laser.

MATERIAL AND METHODS

This was a retrospective, descriptive study of patients with infantile hemangioma in different phases of development treated with pulsed dye laser pulses followed by Nd:YAG laser pulses. Four dermatologists assessed the effectiveness of treatment on a scale of 10 to 0. Adverse effects and incidents related to treatment were recorded. The median and interquartile range were calculated as descriptive statistics. Pretreatment and posttreatment comparisons were performed using the Wilcoxon test.

RESULTS

Twenty-two patients with hemangiomas in different phases of development were included. A statistically significant improvement was obtained both for the entire group and for different subgroups. Posttreatment events were reported in 4 patients, and included edema and ulceration, skin atrophy, and hyperpigmentation.

CONCLUSIONS

We believe that treatment with dual-wavelength light from a pulsed dye laser and a Nd:YAG laser is a viable treatment option for infantile hemangiomas when first-line therapies are ineffective or contraindicated.

Eosinophilic pustular folliculitis in infancy: report of a new case

We report a new case of eosinophilic pustular folliculitis in a 23-month-old boy. He presented with a seven-month history of recurrent episodes of pustular lesions on the scalp after having been treated with oral antifungal and topic antibiotics without response. The diagnosis was based on the clinical course and typical histopathological findings. Eosinophilic pustular folliculitis in infancy is an idiopathic and rare inflammatory disease characterized by recurrent crops of sterile pustules involving mainly the scalp. Because it is a benign, self-limiting condition an accurate diagnosis is essential to avoid unnecessary therapies.

[Plaque-phase mycosis fungoides treated with photodynamic therapy: results from 12 patients]

BACKGROUND

Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment.

OBJECTIVES

To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography.

MATERIALS AND METHODS

We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3 h, followed by 8 min of red light (630 nm, 37 J/cm2; Aktilite).

RESULTS

Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent.

CONCLUSIONS

Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions.

Enhancing dynamic scanning force microscopy in air: as close as possible

Frequency modulation dynamic scanning force microscopy has been implemented in ambient conditions using low oscillation amplitudes (<1 nm) to simultaneously record not only topographic but also additional channels of information, in particular contact potential images. The performance of this mode as compared to the conventional amplitude modulation mode is analyzed in detail using a biological molecule, turning yellow mosaic virus RNA, as the model sample. On the basis of scanning force microscopy imaging as well as spectroscopy experiments, we find that for such very small samples the frequency modulation mode is superior since it can be operated with smaller tip-sample interaction, smaller effective tip-sample distance and lower forces. Combined with Kelvin probe microscopy it results not only in considerably higher electrostatic resolution, but also in correct quantitative values for the contact potential as compared to traditional amplitude modulation scanning force microscopy.

Anisotropic chemical etching of semipolar [1011]/[101+1] ZnO crystallographic planes: polarity versus dangling bonds

ZnO thin films grown by metal-organic vapor phase epitaxy along the nonpolar [formula: see text] direction and exhibiting semipolar [formula: see text] facets have been chemically etched with HCl. In order to get an insight into the influence of the ZnO wurtzite structure in the chemical reactivity of the material, Kelvin probe microscopy and convergent beam electron diffraction have been employed to unambiguously determine the absolute polarity of the facets, showing that [formula: see text] facets are unstable upon etching in an HCl solution and transform into [formula: see text] planes. In contrast, [formula: see text] facets undergo homogeneous chemical etching perpendicular to the initial crystallographic plane. The observed etching behavior has been explained in terms of surface oxygen dangling bond density, suggesting that the macroscopic polarity plays a secondary role in the etching process.

[Retrospective, descriptive, observational study of treatment of multiple actinic keratoses with topical methyl aminolevulinate and red light: results in clinical practice and correlation with fluorescence imaging]

BACKGROUND

Actinic keratosis (AK) is one of the most common skin diseases seen in clinical practice. In the last 5 years, several studies assessing the efficacy of photodynamic therapy in the treatment of multiple AKs have been published.

OBJECTIVE

We aimed to assess the clinical outcomes of photodynamic therapy in patients with multiple AKs and the correlation of those outcomes with fluorescence imaging.

MATERIAL AND METHODS

In this retrospective, descriptive, observational study of 57 patients treated in our hospital with photodynamic therapy for multiple AKs, we recorded age, sex, and lesion site (face, scalp, and dorsum of the hands). All patients were treated in the same way: methyl aminolevulinic acid (Metvix) was applied for 3 hours and the skin then irradiated with red light at 630 nm, 37 J/cm(2), for 7.5 minutes (Aktilite). The response, remission duration, tolerance, number of sessions, and fluorescence images were recorded by site. The chi(2) test was used to assess between-site differences and the correlation between fluorescence imaging and clinical response.

RESULTS

The greatest improvements were obtained for facial lesions; these required fewer sessions and remission lasted longer than lesions at other sites. The treatment was best tolerated on the dorsum of the hands. The fluorescence area and the reduction in intensity on applying treatment were found to be strongly and significantly correlated with the extent of clinical response.

CONCLUSIONS

Overall, the outcomes of treatment of multiple AKs with photodynamic therapy are better for the face than for the scalp and dorsum of the hands. Fluorescence imaging may be an effective tool for predicting response to treatment.

Surface potential domains on lamellar P3OT structures

In this work the electrostatic properties of poly(3-octylthiophene) thin films have been studied on a nanometer scale by means of electrostatic force microscopy and Kelvin probe microscopy (KPM). The KPM images reveal that different surface contact potential domains coexist on the polymer surface. This result, together with additional capacitance measurements, indicates that the potential domains are related to the existence of dipoles due to different molecular arrangements. Finally, capacitance measurements as a function of the tip-sample bias voltage show that in all regions large band bending effects take place.

[Photodynamic therapy: new indications]

Photodynamic therapy (PDT) is approved for the treatment of actinic keratoses, superficial and nodular basal cell carcinomas, and recently, Bowen's disease. In the last decade the advances experienced in the study of the photodynamic reaction have expanded the spectrum of application to other cutaneous diseases, neoplastic as well as inflammatory and infectious ones. The experience in psoriasis, acne, common warts and cutaneous T cell lymphoma starts to be broad and interesting, which permits to define its use in these entities. Photodynamic therapy is also been tested for a great variety of dermatoses with different photosensitizers and light sources with variable results. In this paper we review the treatment of Bowen's disease and other indications different from non melanoma skin cancer with PDT, providing our experience.

[Morphogenesis of the sexual phase of six Mexican species of the Dryopteris (Dryopteridaceae), Part II]

The development of the sexual phase of six Mexican species of Dryopteris is described and compared. Spores of all studied species are monolete, ellipsoid and have a rugose surface; the perine is folded, brown to dark brown, with a tubercled outline. Germination pattern is of the Vittaria-type and the development pattern of the prothallia is of the Aspidium-type. Gametangia are of the common type for the leptosporangiate advanced ferns. First leaves of the sporophytes appear 258-265 after sowing and apparently in Dryopteris pseudo-filix-mas the sporophyte have an apogamic origin (80 days). To make a comparative analysis of gametophytic characteristics in the twelve Mexican species and conclude of germination is of the Vittaria-type and development pattern prothallial is of the Aspidium-type, and unicelular trichomes on margin and superficial gametophytic to yield irregular aspect are characteristics to yield unit and characteristic to genera to conform Dryopteridaceae family (sensu Moran 1995) with the exception of Didymochlaena genus.