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Shugar AL, Konger RL, Rohan CA, Travers JB, Kim YL. Mapping cutaneous field carcinogenesis of nonmelanoma skin cancer using mesoscopic imaging of pro-inflammation cues. Exp Dermatol 2024; 33:e15076. [PMID: 38610095 PMCID: PMC11034840 DOI: 10.1111/exd.15076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/24/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024]
Abstract
Nonmelanoma skin cancers remain the most widely diagnosed types of cancers globally. Thus, for optimal patient management, it has become imperative that we focus our efforts on the detection and monitoring of cutaneous field carcinogenesis. The concept of field cancerization (or field carcinogenesis), introduced by Slaughter in 1953 in the context of oral cancer, suggests that invasive cancer may emerge from a molecularly and genetically altered field affecting a substantial area of underlying tissue including the skin. A carcinogenic field alteration, present in precancerous tissue over a relatively large area, is not easily detected by routine visualization. Conventional dermoscopy and microscopy imaging are often limited in assessing the entire carcinogenic landscape. Recent efforts have suggested the use of noninvasive mesoscopic (between microscopic and macroscopic) optical imaging methods that can detect chronic inflammatory features to identify pre-cancerous and cancerous angiogenic changes in tissue microenvironments. This concise review covers major types of mesoscopic optical imaging modalities capable of assessing pro-inflammatory cues by quantifying blood haemoglobin parameters and hemodynamics. Importantly, these imaging modalities demonstrate the ability to detect angiogenesis and inflammation associated with actinically damaged skin. Representative experimental preclinical and human clinical studies using these imaging methods provide biological and clinical relevance to cutaneous field carcinogenesis in altered tissue microenvironments in the apparently normal epidermis and dermis. Overall, mesoscopic optical imaging modalities assessing chronic inflammatory hyperemia can enhance the understanding of cutaneous field carcinogenesis, offer a window of intervention and monitoring for actinic keratoses and nonmelanoma skin cancers and maximise currently available treatment options.
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Affiliation(s)
- Andrea L. Shugar
- Department of Pharmacology & Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Raymond L. Konger
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Pathology, Richard L. Roudebush Veterans Administration Hospital, Indianapolis, Indiana, USA
| | - Craig A. Rohan
- Department of Pharmacology & Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Dermatology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Medicine, Dayton Veterans Affairs Medical Center, Dayton, Ohio, USA
| | - Jeffrey B. Travers
- Department of Pharmacology & Toxicology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Dermatology, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
- Department of Medicine, Dayton Veterans Affairs Medical Center, Dayton, Ohio, USA
| | - Young L. Kim
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
- Purdue Institute for Cancer Research, Purdue University, West Lafayette, Indiana, USA
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2
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Kaur K, Ai R, Perry AG, Riley B, Roberts EL, Montano EN, Han J, Roacho J, Lopez BG, Skelsey MK, Childs MV, Childs JN, Dobak J, Ibarra C, Jansen B, Clarke LE, Stone S, Whitaker JW. Skin Cancer Risk Is Increased by Somatic Mutations Detected Noninvasively in Healthy-Appearing Sun-Exposed Skin. J Invest Dermatol 2024:S0022-202X(24)00176-3. [PMID: 38513819 DOI: 10.1016/j.jid.2024.02.017] [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: 10/04/2023] [Revised: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024]
Abstract
Skin cancer risk is increased by exposure to ultraviolet radiation (UVR). Because UVR exposure accumulates over time and lighter skin is more susceptible to UVR, age and skin tone are risk factors for skin cancer. However, measurements of somatic mutations in healthy-appearing skin have not been used to calculate skin cancer risk. In this study, we developed a noninvasive test that quantifies somatic mutations in healthy-appearing sun-exposed skin and applied it to a 1038-subject cohort. Somatic mutations were combined with other known skin cancer risk factors to train a model to calculate risk. The final model (DNA-Skin Cancer Assessment of Risk) was trained to predict personal history of skin cancer from age, family history, skin tone, and mutation count. The addition of mutation count significantly improved model performance (OR = 1.3, 95% confidence interval = 1.14-1.48; P = 5.3 × 10-6) and made a more significant contribution than skin tone. Calculations of skin cancer risk matched the known United States population prevalence, indicating that DNA-Skin Cancer Assessment of Risk was well-calibrated. In conclusion, somatic mutations in healthy-appearing sun-exposed skin increase skin cancer risk, and mutations capture risk information that is not accounted for by other risk factors. Clinical utility is supported by the noninvasive nature of skin sample collection through adhesive patches.
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Affiliation(s)
| | - Rizi Ai
- DermTech, San Diego, California, USA
| | | | - Bae Riley
- DermTech, San Diego, California, USA
| | | | | | | | | | | | - Maral K Skelsey
- Department of Dermatology, School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Maria V Childs
- Department of Dermatology, Texas A&M University College of Medicine, Temple, Texas, USA
| | - James N Childs
- Department of Dermatology, Texas A&M University College of Medicine, Temple, Texas, USA
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3
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Patel P, Wang J, Bitterman D, Mineroff J, Austin E, Jagdeo J. Systematic review of randomized controlled trials of topicals for actinic keratosis field therapy. Arch Dermatol Res 2024; 316:108. [PMID: 38498070 DOI: 10.1007/s00403-024-02839-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/20/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Abstract
Cutaneous field cancerization in dermatology describes the anatomic region of photodamaged skin with actinic keratoses (AKs) or cutaneous squamous cell carcinoma (cSCC) that is surrounded by cellular atypia, forming a dysplastic field. The concept of field cancerization is especially relevant in dermatology, as actinic keratoses and the surrounding dysplastic region can progress to carcinomas, necessitating the treatment of the field. Recent research has focused on field-directed therapy using topical agents. This study aims to systematically review randomized controlled trials on topical treatments for actinic keratosis field cancerization, following the PRISMA guidelines. Clinical recommendations were based on the Oxford Centre for Evidence-Based Medicine. We identified 20 original randomized controlled trials for topical cutaneous field therapy. 0.5% 5-Fluorouracil/salicylic acid and 0.5% 5-fluorouracil received a clinical recommendation grade of A, while diclofenac sodium received a clinical recommendation grade of B. Calcipotriol/5-fluorouracil, Imiquimod, sunscreen combination therapies, and tirbanibulin received a recommendation grade of C. This review provides a framework for clinicians when considering topical treatments for patients with field cancerization.
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Affiliation(s)
- Paras Patel
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Jennifer Wang
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
- Department of Dermatology, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, 8 Floor, Brooklyn, NY, 11203, USA
| | - David Bitterman
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Jessica Mineroff
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
- Department of Dermatology, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, 8 Floor, Brooklyn, NY, 11203, USA
| | - Evan Austin
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
- Department of Dermatology, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, 8 Floor, Brooklyn, NY, 11203, USA
| | - Jared Jagdeo
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA.
- Department of Dermatology, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, 8 Floor, Brooklyn, NY, 11203, USA.
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4
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Maxwell Regester R, Cannella AC, Hirz J, Sayles B, Schlange S, Rau A, Sayles HR, Griess AJ. Combination therapy with imiquimod and 5-fluorouracil cream for the treatment of actinic keratoses, a prospective open-label nonrandomized uncontrolled pilot trial. J Am Acad Dermatol 2024:S0190-9622(24)00214-7. [PMID: 38316257 DOI: 10.1016/j.jaad.2024.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Affiliation(s)
| | | | | | - Brian Sayles
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Amy Rau
- Dermatology Specialists of Omaha, Omaha, Nebraska
| | | | - Anthony J Griess
- University of Nebraska Medical Center, Omaha, Nebraska; Dermatology Specialists of Omaha, Omaha, Nebraska
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5
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Li Pomi F, Vaccaro M, Pallio G, Rottura M, Irrera N, Borgia F. Tirbanibulin 1% Ointment for Actinic Keratosis: Results from a Real-Life Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:225. [PMID: 38399512 PMCID: PMC10890708 DOI: 10.3390/medicina60020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Tirbanibulin 1% ointment is a novel synthetic anti-proliferative agent that inhibits tubulin polymerization. It is approved for treating actinic keratosis (AK) on the face and scalp in adults. It has demonstrated good efficacy, an adequate safety profile and excellent patient adherence in the phase 3 clinical trials, however data about its real-life efficacy and safety are lacking. Here we report the experience of the dermatology unit of the University Hospital of Messina. Materials and Methods: We performed a spontaneous open-label, prospective non-randomized study to assess the effectiveness and safety of tirbanibulin 1% ointment for the treatment of 228 AKs in 38 consecutive patients-28 males (73%) and 10 females (26%)-aged between 52 and 92 years (mean age: 72 ± 8.92 years). Results: Total clearance was recorded in 51% of lesions, while partial clearance was recorded in 73% of lesions. An excellent tolerability profile and high compliance rate were observed, with no treatment discontinuation due to the onset of adverse events. Conclusion: Our real-life experience confirms the effectiveness and safety of tirbanibulin ointment for the treatment of AKs.
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Affiliation(s)
- Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
| | - Giovanni Pallio
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy;
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Messina, 98125 Messina, Italy; (M.R.); (N.I.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Messina, 98125 Messina, Italy; (M.R.); (N.I.)
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
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Baker C, James A, Supranowicz M, Spelman L, Shumack S, Cole J, Weightman W, Sinclair R, Foley P. Method of Assessing Skin Cancerization and Keratoses TM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization. Clin Exp Dermatol 2022; 47:1144-1153. [PMID: 35150158 PMCID: PMC9313559 DOI: 10.1111/ced.15136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A range of 'field-directed' treatments is available for the management of extensive skin field cancerization (ESFC), but to date, the only validated objective quantitative tools are limited to assessment of actinic keratoses (AKs) affecting the head. AIMS To develop a versatile quantitative instrument for objective clinical assessment of ESFC and perform initial internal validation across multiple anatomical zones. METHODS The study comprised instrument development, pilot testing and instrument refinement and two rounds of reliability and inter-rater validation testing. The study was noninterventional and used a convenience sample of de-identified patient photographs selected based on preset criteria. An expert panel developed the instrument and scoring system via a modified Delphi voting process. A sample of 16 healthcare professionals from multiple specialties undertook the pilot testing, and a panel of seven dermatologists were involved in validation testing. Validation was determined by assessment of overall inter-rater agreement using Gwet chance-corrected agreement coefficients (ACs). RESULTS The instrument produced, called the Method for Assessing Skin Cancer and Keratoses™ (MASCK™), comprises the Skin Field Cancerization Index (SFCIndex), derived from area of skin involvement and AKs (number and thickness), a global assessment score and a cancer-in-zone score, and uses Likert scales for quantitative scoring. The SFCIndex is a composite score comprising the number and thickness of AKs multiplied by area of skin involvement. ACs for the SFCIndex components, the overall SFCIndex score and the global assessment score were > 0.80 (rated 'almost perfect') while the AC for the cancer-in-zone metric was lower (0.33, rated 'fair'). Internal consistency was demonstrated via positive correlation between the overall SFCIndex score and the global assessment score. CONCLUSIONS Our study found near-perfect agreement in inter-rater reliability when using MASCK to assess the severity of ESFC in multiple anatomical sites. Further validation of this novel instrument is planned to specifically assess its reliability, utility and feasibility in clinical practice.
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Affiliation(s)
- Christopher Baker
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia
| | - Amelia James
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia
| | | | | | - Stephen Shumack
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia,Department of DermatologyRoyal North Shore HospitalSydneyNSWAustralia
| | - Judith Cole
- Department of DermatologySt John of God HospitalSubiacoWAAustralia
| | - Warren Weightman
- Department of Dermatology Queen Elizabeth HospitalWoodvilleSAAustralia
| | | | - Peter Foley
- Department of DermatologySt Vincent's Hospital MelbourneFitzroyVic.Australia,Department of MedicineThe University MelbourneMelbourneVic.Australia,Probity Medical ResearchSkin Health InstituteMelbourneVic.Australia
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7
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Pariser DM. Approaches to Field Therapy for Actinic Keratoses: Relating Clinical Trial Results to Real-world Practice-A Commentary. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:40-43. [PMID: 35465033 PMCID: PMC9017667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There have been multiple direct and indirect comparison studies evaluating different field therapies used in the treatment of actinic keratosis (AK). A recent clinical trial directly compared 5% fluorouracil (5-FU), imiquimod, ingenol mebutate, and methyl aminolevulinate photodynamic therapy (MAL-PDT), reporting that 5-FU was superior to the other treatments in achieving sustained clearance of 75 percent or greater of AK lesions compared to baseline. In this commentary, the author reviews and discusses the methods and results of this comparison study and propose these results are limited by a number of factors, such as the selected primary % clearance endpoint, grade range of included AKs, and treatments included in the comparison, when considered in the context of other clinical and real-world comparison studies evaluating AK field therapies. The author postulates that patient acceptance of and adherence to field therapy regimens for the treatment of AK may be better evaluated in a real-world setting. Additionally, the author suggests that selection of field therapy in the treatment of AK should be driven by consideration of relevant patient-, disease-, and treatment-related factors, and what is considered best may differ from patient to patient, depending on each patient's individual needs and expectations.
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Affiliation(s)
- David M Pariser
- Dr. Pariser is with the Department of Dermatology at Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
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8
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Brambullo T, Azzena GP, Toninello P, Masciopinto G, De Lazzari A, Biffoli B, Vindigni V, Bassetto F. Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review. Front Oncol 2021; 11:783257. [PMID: 34950589 PMCID: PMC8690035 DOI: 10.3389/fonc.2021.783257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.
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Affiliation(s)
- Tito Brambullo
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Gian Paolo Azzena
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Paolo Toninello
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Giuseppe Masciopinto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alberto De Lazzari
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Bernardo Biffoli
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
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9
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Er O, Ag S, Ha M, Mb R, Mmc M, Mr G, Lpf A. RANDOMIZED CONTROLLED TRIAL FOR EVALUATION OF EFFICACY AND PAIN DURING PHOTODYNAMIC THERAPY FOR ACTINIC KERATOSIS OF FACE AND SCALP COMPARING TWO IRRADIATION PROTOCOLS. Photodiagnosis Photodyn Ther 2021; 37:102623. [PMID: 34775065 DOI: 10.1016/j.pdpdt.2021.102623] [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: 08/14/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is a frequent adverse event during photodynamic therapy, which can limit treatment acceptance. This study aimed to evaluate the efficacy and pain during photodynamic therapy with two irradiation protocols in patients with actinic keratosis on the face and scalp. METHODS In this intra-patient randomized controlled trial, participants were randomly allocated to receive photodynamic therapy with methyl aminolevulinate and red light on the right or left side with protocol 1 (irradiation device in contact with the skin) and protocol 2 (device 3 cm away from the skin). There was a 15-day interval between the protocols. The primary outcome was the frequency of mean intensity of moderate or severe pain during photodynamic therapy. Secondary outcomes were actinic keratosis clearance rate, protoporphyrin IX consumption, participant preference, skin appearance, and adverse events. RESULTS Forty-one participants were included, yielding 47 and 50 randomized sites for protocols 1 and 2. There was no difference in the frequency of moderate and severe pain, with a relative risk of 1.09 (95% CI 0.70-1.70), p>0.05. An actinic keratosis count reduction >60% was observed in both protocols (p<0.01), with no difference between them. There was no difference in protoporphyrin IX consumption. Most treated sites were of good to excellent quality. There was a greater patient preference for protocol 2 (p<0.01). CONCLUSIONS The pain intensity was similar between the protocols, and the protocols were equally effective for actinic keratosis clearance, protoporphyrin IX consumption, and improvement in the quality of the treated areas. Both protocols can be considered safe.
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Affiliation(s)
- Oliveira Er
- Skin Department of Amaral Carvalho Hospital, Jahu, SP, Brazil
| | - Salvio Ag
- Skin Department of Amaral Carvalho Hospital, Jahu, SP, Brazil
| | - Miot Ha
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Requena Mb
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Medeiros Mmc
- Skin Department of Amaral Carvalho Hospital, Jahu, SP, Brazil
| | - Garcia Mr
- Sao Carlos Institute of Physics, University of Sao Paulo, São Carlos, SP, Brazil
| | - Abbade Lpf
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.
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10
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Zeitouni NC, Bhatia N, Ceilley RI, Cohen JL, Del Rosso JQ, Moore AY, Munavalli G, Pariser DM, Schlesinger T, Siegel DM, Willey A, Goldman MP. Photodynamic Therapy with 5-aminolevulinic Acid 10% Gel and Red Light for the Treatment of Actinic Keratosis, Nonmelanoma Skin Cancers, and Acne: Current Evidence and Best Practices. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:E53-E65. [PMID: 34976292 PMCID: PMC8711613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Photodynamic therapy (PDT) can be an effective treatment for actinic keratosis (AK) as well as selected non-melanoma skin cancers (NMSCs), such as Bowen's disease and superficial basal cell carcinoma. PDT has also demonstrated effectiveness in the management of acne vulgaris. Results from controlled clinical trials have shown the safety and efficacy of PDT for these conditions with the use of different photosensitizers and a wide range of light sources. PDT has been employed effectively as monotherapy and in combination with other topicals and alternate light or laser energy therapies. This article provides expert practical guidance for the use of the newest 5-aminolevulinic acid (ALA) product (ALA 10% gel) plus red light as monotherapy for AKs, NMSC, and acne. Here, information from clinical guidelines and a summary of supporting evidence is provided for each cutaneous condition. The authors also provide detailed guidance for employing ALA 10% gel, a photosensitizer precursor, for each of these applications.
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Affiliation(s)
- Nathalie C Zeitouni
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Neal Bhatia
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Roger I Ceilley
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Joel L Cohen
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - James Q Del Rosso
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Angela Y Moore
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Gilly Munavalli
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - David M Pariser
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Todd Schlesinger
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Daniel M Siegel
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Andrea Willey
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
| | - Mitchel P Goldman
- Dr. Zeitouni is with Medical Dermatology Specialists, University of Arizona COM Phoenix in Phoenix, Arizona
- Dr. Bhatoa is with Therapeutics Clinical Research in San Diego, California
- Dr. Ceilley is with Dermatology PC in West Des Moines, Iowa
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village, Colorado
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Moore is with Arlington Research Center in Arlington, Texas, and Baylor University Medical Center in Dallas, Texas
- Dr. Munavalli is with Dermatology, Laser, & Vein Specialists of the Carolinas in Charlotte, North Carolina
- Dr. Pariser is with the Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc. in Norfolk, Virginia
- Dr. Schlesinger is with the Dermatology and Laser Center of Charleston and the Clinical Research Center of the Carolinas in Charleston, South Carolina, and the Department of Dermatology, SUNY Downstate Health Sciences University and the Brooklyn VA Medical Center in Brooklyn, New York
- Dr. Siegel is with Long Island Skin Cancer and Dermatologic Surgery in New York, New York
- Dr. Willey is with Surgical and Aesthetic Dermatology in Sacramento, California
- Dr. Goldman is with Cosmetic Laser Dermatology, A West Dermatology Company in San Diego, California
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11
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Pinto D, Trink A, Giuliani G, Rinaldi F. Protective effects of sunscreen (50+) and octatrienoic acid 0.1% in actinic keratosis and UV damages. J Investig Med 2021; 70:92-98. [PMID: 34531252 PMCID: PMC8717479 DOI: 10.1136/jim-2021-001972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
Actinic keratosis is a form of dysplastic epidermal lesion resulting from chronic and excessive UV exposure with a certain risk of becoming cancerous. Current guidelines advocated the use of sunscreens to prevent photodamage. An efficient photoprotection must involve both primary protective factors such as UV filters and secondary factors (eg, antioxidants) able to disrupt the photochemical and genetic cascade triggered by UVs. An in vitro model of human skin (Phenion FT) was used to assess the photoprotective potential of a sunscreen containing inorganic sun-filters (50+ SPF) and 0.1% octatrienoic acid (KERA’+) after UVA (10 J/cm2) and UVB (25 mJ/cm2) by means of evaluation of the number of sunburn cells (SBCs) and apoptotic keratinocytes. Also resulting alterations in the gene expression of markers involved in apoptosis (Tumor protein 53), inflammation/immunosuppression (IL-6 and IL-8), oxidative stress (oxidative stress response enzyme heme oxygenase 1), remodeling (metalloproteinase 1) and cell-cell adhesion (E-cadherin) were investigated. Gene expression was investigated using quantitative real-time PCR. This work demonstrated that the sunscreen preparations under study (with and without 0.1% octatrienoic acid, respectively) can be distinguished about their ability to prevent UVs-induced damage. Synergism between the inorganic filters and 0.1% octatrienoic acid was found (KERA’+) on all end points analyzed and this effect was found to be statistically significant (p<0.05). Our data revealed that topical application of a sunscreen containing inorganic filters (50+SPF) and 0.1% octatrienoic acid can protect from SBC formation, reduce the number of apoptotic keratinocytes and protect from the main molecular alterations caused by UV radiations.
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Affiliation(s)
| | - Anna Trink
- Human Microbiome Advanced Project, Milan, Italy
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12
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Babino G, Caccavale S, Pinto D, Trink A, Giuliani G, Rinaldi F, Argenziano G. A Randomized Double-Blind Parallel-Group Study to Evaluate the Long-Term Effects of a Medical Device Containing 0.3% Octatrienoic Acid in the Treatment of Grade III Actinic Keratosis. Dermatol Ther (Heidelb) 2021; 11:1751-1762. [PMID: 34476756 PMCID: PMC8484398 DOI: 10.1007/s13555-021-00594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Actinic keratosis (AK) consists of skin lesions with a milder degree of keratinocytic atypia. It can be also referred to as "field of cancerization," which can potentially evolve to cutaneous squamous cell carcinoma (SCC). Several therapeutic options are currently available, but not all are indicated on hyperkeratotic lesions. This study aimed to test the efficacy and tolerability of a medical device containing 2,4,6-octatrienoic acid and urea for the treatment of hyperkeratotic AK lesions. METHODS Seventy male and female subjects with grade III AK were enrolled in this randomized double-blind parallel-group study. The product was applied once daily for three consecutive months. The primary efficacy endpoint was the reduction in the mean number of AK lesions per subject from baseline (T0) to the end of the trial (T1) and 3 months after the end of the treatment period (T2). Therefore, clearance of target AK lesions at the end of the treatment period and local skin reaction score (LSR) versus baseline were evaluated. RESULTS There was a decrease of mean values from baseline to visit T2 in both treatment groups, but the decrease (versus baseline values) was more evident in the Kerà K2 group than in the placebo group (-42.78, SD 26.53, versus -6.20, SD 31.57), and the difference was statistically significant (p < 0.001). For 70 subjects (56.7%) in the Kerà K2 group and 3 (11.54%) in the placebo group, a significant (p < 0.005) partial clearance was evidenced. The product was well tolerated, and no serious adverse events were reported during the duration of the trial. Subject self-assessment of acceptability, local tolerability, and the cosmetic result was good at both T1 and T2 for both groups. CONCLUSIONS The medical device has demonstrated good efficacy in the reduction of visible AKs, encouraging its use.
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Affiliation(s)
- Graziella Babino
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefano Caccavale
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Daniela Pinto
- Human Microbiome Advanced Project, HMAP, Milan, Italy
| | - Anna Trink
- Human Microbiome Advanced Project, HMAP, Milan, Italy
| | | | - Fabio Rinaldi
- Human Microbiome Advanced Project, HMAP, Milan, Italy.
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13
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Persechino F, Ranieri D, Guttieri L, Nanni M, Torrisi MR, Belleudi F. Expression Profile of Fibroblast Growth Factor Receptors, Keratinocyte Differentiation Markers, and Epithelial Mesenchymal Transition-Related Genes in Actinic Keratosis: A Possible Predictive Factor for Malignant Progression? BIOLOGY 2021; 10:biology10040331. [PMID: 33920760 PMCID: PMC8071104 DOI: 10.3390/biology10040331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
Simple Summary In this work, we checked the modulation of Fibroblast Growth Factor Receptors (FGFRs) along with differentiation-related and epithelial-to-mesenchymal transition (EMT)-related markers to identify expression profiles that could be predictive for actinic keratosis (AK) progression through the “differentiated” pathway. We found that the downregulation of the analyzed differentiation markers, but not the modulation of the EMT-related markers, correlated with the canonical progression of AK. In addition, the observed modulation of FGFR2 mesenchymal/epithelial isoforms compatible with FGFR2 isoform switch, as well as the upregulation of FGFR4 suggested their correlation with early steps of AK pathogenesis. In contrast, the increase of mesenchymal FGFR3c isoform expression appeared to suggest that this event correlated with late steps of AK progression. In addition, the strong modulation of filaggrin (FIL), Snail1, as well as of FGFR2c, FGFR4, and their ligand Fibroblast Growth Factor 2 (FGF2), observed in some of the keratinocytic intraepithelial neoplasia grade I (KIN I) samples, may indicate that they could be molecular markers predictive for those KIN I lesions destined to a direct progression to squamous cell carcinoma (SCC) through the “differentiated” pathway. Abstract Actinic keratosis (AK) is the ultra violet (UV)-induced preneoplastic skin lesion clinically classified in low (KIN I), intermediate (KIN II), and high (KIN III) grade lesions. In this work we analyzed the expression of Fibroblast Growth Factor Receptors (FGFRs), as well as of keratinocyte differentiation and epithelial-to-mesenchymal transition (EMT)-related markers in differentially graded AK lesions, in order to identify specific expression profiles that could be predictive for direct progression of some KIN I lesions towards squamous cell carcinoma (SCC). Our molecular analysis showed that the keratinocyte differentiation markers keratin 1 (K1), desmoglein-1 (DSG1), and filaggrin (FIL) were progressively downregulated in KIN I, II, and III lesions, while the modulation of epithelial/mesenchymal markers and the induction of the transcription factors Snail1 and Zinc finger E-box-binding homeobox 1 (ZEB1) compatible with pathological EMT, even if observable, did not appear to correlate with AK progression. Concerning FGFRs, a modulation of epithelial isoform of FGFR2 (FGFR2b) and the mesenchymal FGFR2c isoform compatible with an FGFR2 isoform switch, as well as FGFR4 upregulation were observed starting from KIN I lesions, suggesting that they could be events involved in early steps of AK pathogenesis. In contrast, the increase of FGFR3c expression, mainly appreciable in KIN II and KIN III lesions, suggested a correlation with AK late progression. Interestingly, the strong modulation of FIL, Snail1, as well as of FGFR2c, FGFR4, and of their ligand FGF2, observed in some of the KIN I samples, may indicate that they could be molecular markers predictive for those low graded lesions destined to a direct progression to SCC. In conclusion, our data point on the identification of molecular markers predictive for AK rapid progression through the “differentiated” pathway. Our results also represent an important step that, in future, will help to clarify the molecular mechanisms underlying FGFR signaling deregulation in epithelial tissues during the switch from the pre-neoplastic to the oncogenic malignant phenotype.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Danilo Ranieri
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Luisa Guttieri
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
| | - Monica Nanni
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital, CH–8032 Zurich, Switzerland;
| | - Maria Rosaria Torrisi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
- S. Andrea University Hospital, 00100 Rome, Italy
| | - Francesca Belleudi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (F.P.); (D.R.); (L.G.); (M.R.T.)
- Correspondence:
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14
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Cornejo CM, Jambusaria-Pahlajani A, Willenbrink TJ, Schmults CD, Arron ST, Ruiz ES. Field cancerization: Treatment. J Am Acad Dermatol 2020; 83:719-730. [PMID: 32387663 DOI: 10.1016/j.jaad.2020.03.127] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
The goal of field cancerization treatment is to reduce the risk of developing keratinocyte carcinoma. Selecting the appropriate therapy depends on the degree of field cancerization and the number of invasive cutaneous squamous cell carcinomas. Other considerations include treatment efficacy, cost, side effects, and patient preference. Field therapies are preferred because they address clinically visible disease and subclinical atypia. However, lesion-directed therapies are useful for lesions that are more difficult to treat or those where a histologic diagnosis is required. Patients with extensive field cancerization benefit from a combination of field-directed and lesion-directed treatments. The second article in this continuing medical education series provides a framework to guide evidence-based decision making for field cancerization treatment.
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Affiliation(s)
- Christine M Cornejo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anokhi Jambusaria-Pahlajani
- Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Tyler J Willenbrink
- Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah T Arron
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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15
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O'Mahoney P, Khazova M, Eadie E, Ibbotson S. Measuring Daylight: A Review of Dosimetry in Daylight Photodynamic Therapy. Pharmaceuticals (Basel) 2019; 12:E143. [PMID: 31547141 PMCID: PMC6958468 DOI: 10.3390/ph12040143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/05/2019] [Accepted: 09/17/2019] [Indexed: 01/28/2023] Open
Abstract
Successful daylight photodynamic therapy (DPDT) relies on the interaction of light, photosensitisers and oxygen. Therefore, the 'dose' of light that a patient receives during treatment is a clinically relevant quantity, with a minimum dose for effective treatment recommended in the literature. However, there are many different light measurement methods used in the published literature, which may lead to confusion surrounding reliable and traceable dose measurement in DPDT, and what the most appropriate method of light measurement in DPDT might be. Furthermore, for the majority of practitioners who do not carry out any formal dosimetry and for the patients receiving DPDT, building confidence in the evidence supporting this important treatment option is of key importance. This review seeks to clarify the methodology of DPDT and discusses the literature relating to DPDT dosimetry.
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Affiliation(s)
- Paul O'Mahoney
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK.
- The Scottish Photodynamic Therapy Centre, Dundee DD1 9SY, UK.
- School of Medicine, University of Dundee, Dundee DD1 9SY, UK.
| | | | - Ewan Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK.
- The Scottish Photodynamic Therapy Centre, Dundee DD1 9SY, UK.
| | - Sally Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY, UK.
- The Scottish Photodynamic Therapy Centre, Dundee DD1 9SY, UK.
- School of Medicine, University of Dundee, Dundee DD1 9SY, UK.
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