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Morelló Vicente A, Oteiza Rius I, Aguado Gil L. Actinic Keratosis in Solid Organ Transplant Recipients: A Medical Literature Review. Actas Dermosifiliogr 2024; 115:368-373. [PMID: 37925069 DOI: 10.1016/j.ad.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
Pharmacological immunosuppression in solid organ transplant recipients is a significant risk factor in the occurrence of actinic keratosis (AK) and later progression into squamous cell carcinomas (SCC). Treating clinical and preclinical lesions is mandatory in this group of patients due to the high changes of progression into SCC. On the other hand, prevention of AK should be considered because it plays a crucial role. Several studies have been published on immunocompetent patients, as well as on the management and prevention of AK, but not on immunosuppressed patients. This review aims to summarize the current knowledge on the management and prevention measures of AK in solid organ transplant recipients.
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Affiliation(s)
- A Morelló Vicente
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - I Oteiza Rius
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - L Aguado Gil
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Morelló Vicente A, Oteiza Rius I, Aguado Gil L. [Translated article] Actinic Keratosis in Solid Organ Transplant Recipients: A Medical Literature Review. Actas Dermosifiliogr 2024; 115:T368-T373. [PMID: 38336247 DOI: 10.1016/j.ad.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/16/2023] [Indexed: 02/12/2024] Open
Abstract
Pharmacological immunosuppression in solid organ transplant recipients is a significant risk factor in the occurrence of actinic keratosis (AK) and later progression into squamous cell carcinomas (SCC). Treating clinical and preclinical lesions is mandatory in this group of patients due to the high changes of progression into SCC. On the other hand, prevention of AK should be considered because it plays a crucial role. Several studies have been published on immunocompetent patients, as well as on the management and prevention of AK, but not on immunosuppressed patients. This review aims to summarize the current knowledge on the management and prevention measures of AK in solid organ transplant recipients.
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Affiliation(s)
- A Morelló Vicente
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - I Oteiza Rius
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
| | - L Aguado Gil
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Serra-Guillén C, Nagore E, Llombart B, Sanmartín O, Requena C, Calomarde L, Guillén C. A 12-Day Course of Imiquimod 5% for the Treatment of Actinic Keratosis: Effectiveness and Local Reactions. Actas Dermosifiliogr (Engl Ed) 2017; 109:248-253. [PMID: 29246367 DOI: 10.1016/j.ad.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/08/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Imiquimod is an excellent option for patients with actinic keratosis, although its use may be limited by the long course of treatment required (4 weeks) and the likelihood of local skin reactions. The objectives of the present study were to demonstrate the effectiveness of a 12-day course of imiquimod 5% for the treatment of actinic keratosis and to examine the association between treatment effectiveness and severity of local reactions. PATIENTS AND METHODS We included patients with at least 8 actinic keratoses treated with imiquimod 5% cream for 12 consecutive days. Local reactions were classified as mild, moderate, or severe. The statistical analysis of the association between local reactions and clinical response was based on the Pearson χ2 test and the Spearman rank correlation test. RESULTS Sixty-five patients completed the study. Complete response was recorded in 52.3% and partial response in 75.4%. We found a statistically significant association between severity of the local reaction and response to treatment in both the Pearson χ2 test and the Spearman rank correlation test. CONCLUSIONS A 12-day course of imiquimod 5% proved effective for the treatment of actinic keratosis. Severity of local reactions during treatment was correlated with clinical response.
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Affiliation(s)
- C Serra-Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Piel y Órganos de los Sentidos, Facultad de Medicina, Universidad CEU Cardenal Herrera, Valencia, España.
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Dermatología, Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Dermatología, Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - L Calomarde
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Piel y Órganos de los Sentidos, Facultad de Medicina, Universidad CEU Cardenal Herrera, Valencia, España
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Tomás-Velázquez A, Redondo P. Switching From Conventional Photodynamic Therapy to Daylight Photodynamic Therapy For Actinic Keratoses: Systematic Review and Meta-analysis. Actas Dermosifiliogr 2017; 108:282-292. [PMID: 28063524 DOI: 10.1016/j.ad.2016.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/02/2016] [Accepted: 09/17/2016] [Indexed: 01/08/2023] Open
Abstract
Actinic keratosis is a precursor lesion to the most common nonmelanoma skin cancer. Conventional photodynamic therapy (PDT) has been shown to be effective, but the procedure is time-consuming, can be very painful, and requires infrastructure. These shortcomings led to the emergence of daylight PDT. To obtain a global estimate of efficacy, we undertook a systematic literature review and performed a meta-analysis of the available evidence on the efficacy and safety of daylight PDT as compared to conventional PDT in the treatment of actinic keratosis and/or field cancerization. The conclusion is that the difference in efficacy is clinically negligible (global estimate of the mean response rate difference, -3.69%; 95% CI, -6.54% to -0.84%). The adverse effects of daylight PDT are mild and localized (79% of patients report no discomfort), and patients report less pain (P<.001). Daylight PDT gives good to excellent cosmetic results in more than 90% of patients, and patient satisfaction is greater (P<.001).
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Affiliation(s)
- A Tomás-Velázquez
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, España.
| | - P Redondo
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, España
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Salas-García T, López-Gómez A, Dorado-Fernández M, Ruiz-Martínez J. Daylight photodynamic therapy. Actas Dermosifiliogr 2015; 106:672-3. [PMID: 26138286 DOI: 10.1016/j.ad.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/03/2015] [Accepted: 05/05/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- T Salas-García
- Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España.
| | - A López-Gómez
- Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España
| | - M Dorado-Fernández
- Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España
| | - J Ruiz-Martínez
- Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, España
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Gilaberte Y, Aguilar M, Almagro M, Correia O, Guillén C, Harto A, Pérez-García B, Pérez-Pérez L, Redondo P, Sánchez-Carpintero I, Serra-Guillén C, Valladares LM. Spanish-Portuguese consensus statement on use of daylight-mediated photodynamic therapy with methyl aminolevulinate in the treatment of actinic keratosis. Actas Dermosifiliogr 2015; 106:623-31. [PMID: 26115793 DOI: 10.1016/j.ad.2015.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 10/24/2022] Open
Abstract
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.
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Affiliation(s)
- Y Gilaberte
- Unidad de Dermatología, Hospital San Jorge, Huesca, España.
| | - M Aguilar
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
| | - M Almagro
- Servicio de Dermatología, Complejo Hospitalario Universitario, La Coruña, España
| | - O Correia
- Centro de Dermatología Epidermis, Instituto CUF, Oporto y Facultad de Medicina, Universidad de Oporto, Oporto, Portugal
| | - C Guillén
- Servicio de Dermatología, Instituto Valencia de Oncología, Valencia, España
| | - A Harto
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - B Pérez-García
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - L Pérez-Pérez
- Servicio de Dermatología, Estructura Organizativa de Gestión Integrada (EOXI) de Vigo, Clínica Pérez & Gavín dermatólogos, Vigo, España
| | - P Redondo
- Servicio de Dermatología, Clínica Universitaria de Navarra, Pamplona, España
| | | | - C Serra-Guillén
- Servicio de Dermatología, Instituto Valencia de Oncología, Valencia, España
| | - L M Valladares
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
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Ferrándiz C, Fonseca-Capdevila E, García-Diez A, Guillén-Barona C, Belinchón-Romero I, Redondo-Bellón P, Moreno-Giménez JC, Senán R. Spanish adaptation of the European guidelines for the evaluation and treatment of actinic keratosis. Actas Dermosifiliogr 2014; 105:378-93. [PMID: 24725552 DOI: 10.1016/j.adengl.2013.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/29/2013] [Indexed: 11/19/2022] Open
Abstract
Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway.
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Affiliation(s)
- C Ferrándiz
- Servicio de Dermatología, Hospital Universitario Germans Trías i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - E Fonseca-Capdevila
- Servicio de Dermatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - A García-Diez
- Servicio de Dermatología, Hospital Universitario de la Princesa, Madrid, Spain
| | - C Guillén-Barona
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - I Belinchón-Romero
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
| | - P Redondo-Bellón
- Servicio de Dermatología, Clínica Universidad de Navarra, Pamplona, Spain
| | - J C Moreno-Giménez
- Servicio de Dermatología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - R Senán
- Centro de Atención Primaria El Clot, Barcelona, Spain
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