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Nkwetta DL, Fuen BR, Yenban NF, Mbiatong N, Nchanji GT, Bonekeh J, Ndzeshang BL, Gandjui NVT, Fombad FF, Klarmann-Schulz U, Esum ME, Njouendou AJ, Cho JF, Hoerauf A, Ritter M, Wanji S. Phenotypical characterization, and antibiotics susceptibility patterns of skin bacteria found in podoconiosis patients in the North West Region of Cameroon. BMC Microbiol 2023; 23:189. [PMID: 37460950 PMCID: PMC10351198 DOI: 10.1186/s12866-023-02923-9] [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: 01/27/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Podoconiosis, a non-infectious disease originating from long-term exposure of bare feet to irritant red clay soil is a lifelong, disabling disease with no specific diagnostic tool, classified into 5 stages based on the severity of leg swelling (lymphoedema). Secondary bacterial infections have been suggested to cause acute dermatolymphangioadenitis (ADLA) attacks and drive disease progression. Although the North West Region of Cameroon has a proven history of podoconiosis endemicity, the bacterial composition of lymphoedema due to this condition has not been studied. Thus, this study investigated the leg bacterial diversity of patients who suffered from the lymphoedema and their susceptibility pattern to selected antibiotics. METHODS A cross-sectional study was carried out in which podoconiosis affected and non-lymphoedema individuals living in the same community were purposively selected. Samples were collected by swabbing the skin between the toes and around the anklebone, then cultured and sub-cultured on nutrient agar to obtain pure isolates. The cultured isolates were then morphologically and biochemically classified using microscopy and analytic profile index test kits, respectively. The disk diffusion technique was used to determine antibiotic susceptibility. RESULTS Thirty-three participants were recruited, and 249 bacterial isolates were characterized into 29 genera, 60 species; with 30 (50%) being gram positive rods, 19 (31.7%) gram positive cocci, and 11 (18.3%) gram negative rods. Thirteen gram positive rods, fifteen gram positive cocci, and eight gram negative rods of bacterial species were found only in podoconiosis individuals among which Cellulomonas spp / Microbacterium spp. (2.8%), Staphylococcus lentus (3.3%), and Burkholderia cepacia (4.0%) dominated. 90% (90%) of the bacterial isolates were sensitive to doxycycline, whereas ampicillin had a high level of intermediate resistance, and penicillin G had the greatest resistant profile. CONCLUSION Our findings show that 94 (37.8%) out of 249 described bacterial isolates were exclusively found in the legs of podoconiosis individuals, and their susceptibility pattern to antibiotics was similar to that of others.
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Affiliation(s)
- Derick Lekealem Nkwetta
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Bangsi Rose Fuen
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Njodzeka Flora Yenban
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Nancielle Mbiatong
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Gordon Takop Nchanji
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - John Bonekeh
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Bertrand Lontum Ndzeshang
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Narcisse Victor Tchamatchoua Gandjui
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
| | - Fanny Fri Fombad
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German Centre for Infection Research (DZIF), Neglected Tropical Disease, partner site, Bonn- Cologne, Bonn, Germany
| | - Mathias Eyong Esum
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
| | - Abdel Jelil Njouendou
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
- Department of Biomedical Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Jerome Fru Cho
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German-West African Centre for Global Health and Pandemic Prevention (G-WAC), Partner Site, Bonn, Bonn, Germany
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon.
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon.
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2
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Schlesinger T, Stockfleth E, Grada A, Berman B. Tirbanibulin for Actinic Keratosis: Insights into the Mechanism of Action. Clin Cosmet Investig Dermatol 2022; 15:2495-2506. [PMID: 36415541 PMCID: PMC9675993 DOI: 10.2147/ccid.s374122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/19/2022] [Indexed: 08/13/2023]
Abstract
Actinic keratosis (AK) is a common pre-neoplastic skin lesion constituted by uncontrolled proliferation of atypical keratinocytes that may evolve to squamous cell carcinoma. With global prevalence increasing, AK is expected to be the most common carcinoma of the skin. Tirbanibulin is a reversible tubulin polymerization inhibitor with potent anti-proliferative and anti-tumoral effects. In-vivo and in-vitro studies have shown that tirbanibulin significantly inhibits cell proliferation, tumor growth and downregulates Src signaling with no overt toxicity. Early phase and Phase III trials have shown high lesion clearance, compliance, and few side effects of once daily tirbanibulin treatment. This review discusses tirbanibulin anti-cancer activity, focusing on tubulin polymerization and Src signaling inhibitory effects, highlighting relevant literature and novel preclinical results from the ATNXUS-KX01-001 study. Furthermore, we address the relevant findings obtained in recent clinical trials to evaluate the safety, efficacy, pharmacokinetics, clearance efficacy, and side effects of the 1% tirbanibulin ointment applied once daily. In summary, we highlight preclinical and clinical evidence on the use of tirbanibulin as an effective and safe treatment option for AK.
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Affiliation(s)
| | - Eggert Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Ayman Grada
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Berman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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3
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Romero MP, Posso V, Ureña V, Inada N, Bagnato V, Cabrera F. Clinical and histopathologycal study of actinic keratosis treatment with photodynamic therapy VS 5-fluorouracil in face cancerization field. Photodiagnosis Photodyn Ther 2022; 39:102967. [PMID: 35716996 DOI: 10.1016/j.pdpdt.2022.102967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
Actinic keratosis (AK) is one of the most frequent pathologies in clinical practice. The prevalence varies according to the area of incidence and age. Approximately 10% of the prevalence of AK occurs at 30 years of age and rises to 80% at 70 years of life. This study conducted a split-face analysis based on Photodynamic Therapy (MALA-PDT) and 5-fluorouracil (5-FU) treatments in patients with AK. Clinical and histopathological studies evaluated each treatment's efficiency and side effects. Six patients were recruited between 50 and 70 years of age for this. MALA-PDT was applied on the right side of the face. A biodistribution time of 2 hours, a dose of light of 36 J / cm2 (20 min irradiation), a spot for photoirradiation with a total area of 100 cm2, and a wavelength of 635 nm were used. (LINCE equipment MMOPTICS-Brazil). By fluorescence diagnosis, clinical and subclinical AK lesions were evidenced in the area called the "cancerization field." Two cycles of MALA-PDT were performed on each patient, and 5-FU was applied twice daily for 15 days. A 2-month follow-up post-MALA-PDT and post-5-FU was carried out. The treatment based on 5-Flu and MALA-PDT clinically shows the same response, but MALA-PDT is less aggressive than 5-FU. The treatment of AK based on MALA-PDT is a practical, cheap, and easy-to-use technique.
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Affiliation(s)
| | - Verónica Posso
- Servicio de Anatomía Patológica. Hospital Carlos Andrade Marín. Quito, Ecuador.
| | - Valeria Ureña
- Postgrado de Dermatología. Facultad de Medicina Eugenio Espejo, Universidad UTE. Quito, Ecuador.
| | - Natalia Inada
- Instituto de Física. Universidade de São Paulo. São Carlos SP-Brasil.
| | - Vanderlei Bagnato
- Instituto de Física. Universidade de São Paulo. São Carlos SP-Brasil.
| | - Franklin Cabrera
- Servicio de Dermatología. Hospital Carlos Andrade Marín. Quito, Ecuador.
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4
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Feng G, Wei L, Che H, Shen Y, Mi K, Bian H, Yang H, Wu J, Mu L. Cathelicidin-NV from Nanorana ventripunctata effectively protects HaCaT cells, ameliorating ultraviolet B-induced skin photoaging. Peptides 2022; 150:170712. [PMID: 34929265 DOI: 10.1016/j.peptides.2021.170712] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/17/2022]
Abstract
Cathelicidins are diverse effector molecules in the vertebrate immune system and are related to immune regulation, inflammatory response, wound healing, and blood vessel formation. However, little is known about their free radical scavenging ability, especially in vivo. In this study, a cathelicidin molecule (cathelicidin-NV, ARGKKECKDDRCRLLMKRGSFSYV) previously identified from the spot-bellied plateau frog (Nanorana ventripunctata) (Anura, Dicroglossidae, Dicroglossinae) by us was shown to alleviate ultraviolet B (UVB)-induced skin photoaging in mice. Cathelicidin-NV effectively suppressed cytotoxicity, DNA fragmentation, apoptosis and reduced the protein expression levels of JNK, c-Jun, and MMP-1, which are involved in the regulation of collagen degradation in HaCaT cells induced by UVB irradiation. Furthermore, cathelicidin-NV also scavenged UVB-induced intracellular reactive oxygen species (ROS). Taken together, cathelicidin-NV directly scavenged excessive intracellular ROS to protect HaCaT cells, and subsequently alleviated UVB-induced skin photoaging. This study extends reports on the antioxidant function of the cathelicidin family. In addition, the properties of cathelicidin-NV make it an excellent candidate for the prevention and treatment of UV-induced skin photoaging.
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Affiliation(s)
- Guizhu Feng
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Lin Wei
- Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, Jiangsu, China
| | - Helong Che
- Department of General Surgery, The 908th Hospital of Chinese PLA Joint Logistic Support Force, Nanchang, Jiangxi, China
| | - Yan Shen
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Kai Mi
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Hui Bian
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - Hailong Yang
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China.
| | - Jing Wu
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China.
| | - Lixian Mu
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China.
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5
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Ruini C, Schuh S, Gust C, Hartmann D, French LE, Sattler EC, Welzel J. In-Vivo LC-OCT Evaluation of the Downward Proliferation Pattern of Keratinocytes in Actinic Keratosis in Comparison with Histology: First Impressions from a Pilot Study. Cancers (Basel) 2021; 13:2856. [PMID: 34201052 PMCID: PMC8228287 DOI: 10.3390/cancers13122856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
It is known that actinic keratoses (AKs) can progress to invasive squamous cell carcinoma (SCC). The histological PRO grading of AKs is based on the growth pattern of basal keratinocytes and relates to their progression risk. AKs can be non-invasively characterized by line-field confocal optical coherence tomography (LC-OCT). The aim of the study was to define criteria for an LC-OCT grading of AKs based on the PRO classification and to correlate it with its histological counterpart. To evaluate the interobserver agreement for the LC-OCT PRO classification, fifty AKs were imaged by LC-OCT and biopsied for histopathology. PRO histological grading was assessed by an expert consensus, while two evaluator groups separately performed LC-OCT grading on vertical sections. The agreement between LC-OCT and histological PRO grading was 75% for all lesions (weighted kappa 0.66, 95% CI 0.48-0.83, p ≤ 0.001) and 85.4% when comparing the subgroups PRO I vs. PRO II/III (weighted kappa 0.64, 95% CI 0.40-0.88, p ≤ 0.001). The interobserver agreement for LC-OCT was 90% (Cohen's kappa 0.84, 95% CI 0.71-0.91, p ≤ 0.001). In this pilot study, we demonstrated that LC-OCT is potentially able to classify AKs based on the basal growth pattern of keratinocytes, in-vivo reproducing the PRO classification, with strong interobserver agreement and a good correlation with histopathology.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86156 Augsburg, Germany;
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
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Souissi A, Ben Slimane M, Alaoui F, Bacha T, Zeglaoui F, Mokni M. Flag sign: the trichoscopic feature of white hair phenomenon in alopecia areata. J Eur Acad Dermatol Venereol 2020; 35:e126-e128. [PMID: 32762090 DOI: 10.1111/jdv.16853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/03/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- A Souissi
- Dermatology Department, Rabta hospital, Tunis, Tunisia
| | - M Ben Slimane
- Dermatology Department, Rabta hospital, Tunis, Tunisia
| | - F Alaoui
- Dermatology Department, Rabta hospital, Tunis, Tunisia
| | - T Bacha
- Dermatology Department, Charles Nicolle hospital, Tunis, Tunisia
| | - F Zeglaoui
- Dermatology Department, Charles Nicolle hospital, Tunis, Tunisia
| | - M Mokni
- Dermatology Department, Rabta hospital, Tunis, Tunisia
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Kopera D. Earliest stage treatment of actinic keratosis with imiquimod 3.75% cream: Two case reports-Perspective for non melanoma skin cancer prevention. Dermatol Ther 2020; 33:e13517. [PMID: 32378272 PMCID: PMC7507202 DOI: 10.1111/dth.13517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/26/2020] [Accepted: 04/30/2020] [Indexed: 11/26/2022]
Abstract
Imiquimod 3.75% cream is licensed for the treatment of actinic keratosis (AK). Two case reports on the treatment of facial UV-exposed skin shall open the discussion if subclinical AKs can be detected by the use of imiquimod cream in UV-exposed areas even if no lesions can be found clinically. A 87-year old female showing small scaly AK lesions on her right cheek was treated with imiquimod 3.75% cream. A 59-year old female without obvious clinical signs of UV-damage on the face experimentally applied imiquimod 3.75% cream twice daily on the entire face for 2 weeks. In the 87-year old, inflammatory reaction developed from day 3 onward and showed field cancerization, the lesions healed without scarring. In the 59-year old at the end of the treatment phase, distinct signs of inflammation appeared, then taking 2 weeks for healing without sequalae. These results open the discussion if the use of imiquimod 3.75% cream could be recommended preventively in UV-exposed skin areas to obviate a later development of AKs/squamous cell carcinoma/nonmelanoma skin cancer.
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Affiliation(s)
- Daisy Kopera
- Department of Dermatology, Medical University Graz, Graz, Austria
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8
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Lupu M, Caruntu A, Boda D, Caruntu C. In Vivo Reflectance Confocal Microscopy-Diagnostic Criteria for Actinic Cheilitis and Squamous Cell Carcinoma of the Lip. J Clin Med 2020; 9:jcm9061987. [PMID: 32630380 PMCID: PMC7356181 DOI: 10.3390/jcm9061987] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022] Open
Abstract
Actinic cheilitis (AC) is one of the most frequent pathologies to affect the lips. Studies show that the most commonplace oral malignancy, squamous cell carcinoma (SCC), often emerges from AC lesions. Invasive diagnostic techniques performed on the lips carry a high risk of complications, but reflectance confocal microscopy (RCM), a non-invasive skin imaging technique, may change the current diagnostic pathway. This retrospective study was aimed at consolidating the RCM diagnostic criteria for AC and lip SCC. The study was conducted in two tertiary care centers in Bucharest, Romania. We included adults with histopathologically confirmed AC and SCC who also underwent RCM examination. Of the twelve lesions included in the study, four were AC and eight were SCC. An atypical honeycomb pattern and the presence of target cells in the epidermis were RCM features associated with AC. SCC was typified by the presence of complete disruption of the epidermal architecture and dermal inflammatory infiltrates. The mean blood vessel diameter in SCC was 18.55 µm larger than that in AC (p = 0.006) and there was no significant difference (p = 0.64) in blood vessel density, as measured by RCM, between SCC and AC. These data confirm that RCM can be useful for the in vivo distinction between AC and lip SCC.
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Affiliation(s)
- Mihai Lupu
- Dermatology Research Laboratory, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.L.); (D.B.)
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania
- Faculty of Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
- Correspondence: ; Tel.: +40-72-2345-344
| | - Daniel Boda
- Dermatology Research Laboratory, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.L.); (D.B.)
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania;
| | - Constantin Caruntu
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania;
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Cohen PR. The Nail Flag Sign: Case Report in a Man with Diverticulitis and Review of Dermatology Flag Sign of the Hair, Skin, and Nails. Cureus 2018; 10:e2929. [PMID: 30197851 PMCID: PMC6126787 DOI: 10.7759/cureus.2929] [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] [Indexed: 11/10/2022] Open
Abstract
A sign is a physical feature or microscopic change which can be observed when the patient or their tissue specimen is evaluated. An astute clinician or pathologist may be able to diagnose a patient’s condition by recognizing this unique morphologic feature or pathological change. In dermatology, the flag sign—alternating transverse bands of the skin or its adnexal structures that are analogous to the alternating colors of the stripes of a flag—has been associated with distinctive disorders of the hair, skin, or nails. The hair flag sign is characterized by alternating horizontal bands of hypopigmentation of the hair (in children with kwashiorkor type of protein-calorie malnutrition) or hyperpigmentation of the hair (in a male child who has intravenously received several cycles of high-dose methotrexate). In skin, the flag sign can be observed microscopically in actinic keratosis, and demonstrates by alternating parakeratosis and orthokeratosis of the stratum corneum—corresponding to the type of hyperkeratosis occurring above the interadnexal epidermis or the ostea of the acrosyringia and acrotrichia. The nail flag sign—noted in some individuals who have diabetes mellitus, diverticulitis, leprosy, or vitiligo—presents with alternating white and pink-red horizontal bands beginning at the proximal nail fold and extending distally to the free edge of the nail plate. A man with chronic diverticulitis and the nail flag sign is reported; he also has a history of congenital leukonychia, actinic keratoses, basal cell carcinoma and psoriasis. In addition, the features of hair, skin, and nail flag signs are reviewed. The detection of the dermatology flag sign can prompt a pathologist to consider the diagnosis of actinic keratosis. Alternating horizontal bands of hair color can indicate protein-calorie malnutrition or an effect of chemotherapy in a child. Certain autoimmune, inflammatory, or infectious conditions in individuals present with white and pink-red horizontal bands on their nails.
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Affiliation(s)
- Philip R Cohen
- Dermatologist, San Diego Family Dermatology, San Diego, USA
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Schmitz L, Gambichler T, Gupta G, Stücker M, Stockfleth E, Szeimies R, Dirschka T. Actinic keratoses show variable histological basal growth patterns - a proposed classification adjustment. J Eur Acad Dermatol Venereol 2017; 32:745-751. [DOI: 10.1111/jdv.14512] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - G. Gupta
- Department of Dermatology; Monklands Hospital; Lanarkshire UK
- University of Glasgow; Glasgow UK
| | - M. Stücker
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - R.M. Szeimies
- Department of Dermatology and Allergology; Vest Hospital; Academic Teaching Hospital University of Bochum; Recklinghausen Germany
| | - T. Dirschka
- CentroDerm Clinic; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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11
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Gupta V, Khandpur S, Arava S, Ramam M. Alternating histopathologic pattern in blaschkoid dermatoses with epidermal changes: A retrospective series of 61 cases. J Am Acad Dermatol 2017; 78:812-813. [PMID: 29017841 DOI: 10.1016/j.jaad.2017.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/04/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sujay Khandpur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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12
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Dirschka T, Pellacani G, Micali G, Malvehy J, Stratigos AJ, Casari A, Schmitz L, Gupta G. A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index. J Eur Acad Dermatol Venereol 2017; 31:1295-1302. [PMID: 28401585 DOI: 10.1111/jdv.14267] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/16/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients. OBJECTIVES To develop and perform an initial pilot validation of a new easy-to-use quantitative tool for assessing AK severity on the head. METHODS The actinic keratosis area and severity index (AKASI) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index (PASI). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment (PGA) and AKASI. To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AKs was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness. RESULTS There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean (SD) AKASI increased from 2.88 (1.18) for 'light' to 5.33 (1.48) for 'moderate', 8.28 (1.89) for 'severe', and 8.73 (3.03) for 'very severe' PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories. CONCLUSIONS Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice.
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Affiliation(s)
- T Dirschka
- Centroderm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - A J Stratigos
- First Department of Dermatology, Andreas Sygros Hospital, University of Athens Medical School, Athens, Greece
| | - A Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Schmitz
- Centroderm Clinic, Wuppertal, Germany.,Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - G Gupta
- Department of Dermatology, Monklands Hospital, Lanarkshire, UK.,University of Glasgow, Glasgow, UK
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Abstract
La queratosis actínica (QA) es motivo de consulta frecuente tanto en atención primaria como en atención especializada. Supone el tercer o cuarto motivo más frecuente de consulta en dermatología, llegando a representar hasta un 5-6% de los pacientes atendidos. Además, se ha observado que esta prevalencia ha ido en aumento en los últimos 10 años, en comparación con otras dermatosis, y se prevé que seguirá aumentado por la mayor esperanza de vida y por los cambios de hábitos de exposición solar acontecidos desde mediados del siglo pasado. El objetivo de este artículo es actualizar los conceptos de QA y de campo de cancerización, y exponer las herramientas terapéuticas disponibles actualmente.
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Genders RE, Beck S, Bouwes Bavinck JN, van den Munckhof HAM, Kouwenhoven STP, de Koning MNC, de Gruijl FR, Jenkins D, Willemze R, Quint KD. p16 immunostaining in keratinocytic neoplasia in organ transplant recipients: Bowen's disease shows a characteristic pattern. J Cutan Pathol 2016; 44:28-33. [PMID: 27717097 DOI: 10.1111/cup.12840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/30/2016] [Accepted: 09/30/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND For selecting therapy, it is important to distinguish different types of keratinocytic neoplasia. It is sometimes difficult to make histopathologic diagnosis, especially in organ transplant recipients (OTR) who develop numerous lesions. METHODS To investigate p16 immunostaining in different types of keratinocytic neoplasia in OTR, we studied 59 actinic keratoses (AK), 51 Bowen' s disease (BD), 63 squamous cell carcinomas (SCC), 16 benign keratotic lesions (BKL) from 31 OTR patients and 25 controls (eczema and psoriasis). Tissue sections were stained for H&E and p16. We scored intensity, proportion and distribution of p16 positive lesional cells. RESULTS In 19% of AK, 92% of BD, 35% of SCC and 12% of BKL more than 15% of lesional cells were p16-positive. In 16% of AK, 80% of BD, 18% of SCC and 13% of BKL strong p16 staining was observed. BKL, AK and SCC showed focal and patchy staining, BD showed diffuse pattern with strong staining of all atypical cells. Sparing of the basal layer was predominantly seen in BD. No control specimen showed p16-overexpression. CONCLUSIONS p16 immunostaining shows a characteristic pattern in BD, but not in AK, SCC and BKL. It appears useful in recognizing BD, but not in differentiating between other keratinocytic neoplasia.
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Affiliation(s)
- Roel E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | - Samuel Beck
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | | | | | - Stijn T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Frank R de Gruijl
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Jenkins
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
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Clinical and histopathological analysis of 152 pigmented skin lesion excisions apart from melanocytic nevus due to cosmetic reasons. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1093-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Aktinische Keratose, Morbus Bowen, Keratoakanthom und Plattenepithelkarzinom der Haut. DER PATHOLOGE 2015; 36:16-29. [DOI: 10.1007/s00292-014-2063-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Malvehy J. A new vision of actinic keratosis beyond visible clinical lesions. J Eur Acad Dermatol Venereol 2014; 29 Suppl 1:3-8. [DOI: 10.1111/jdv.12833] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/06/2014] [Indexed: 12/01/2022]
Affiliation(s)
- J. Malvehy
- Melanoma Skin Unit; University Hospital Clinic of Barcelona; Barcelona Spain
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18
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Alomar A. Actinic Keratosis: New Concepts and Therapeutic Approaches for an Ancestral Condition. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Mainly elderly people with pale skin are affected by actinic keratoses (AK). Due to the demographic change, the prevalence of AK increased over the last years. An established risk factor is chronic UV-exposure (outdoor workers) inducing mutations of the tumor suppressor gene TP53 and the oncogene H-Ras. This leads to an intraepidermal proliferation of atypical keratinocytes. The term “field cancerization” characterises the presentation of multiple AK in UV-exposed areas. AK are also termed squamous cell carcinoma (SCC) in situ. The risk for AK turning into a SCC is 6-10%. In order to avoid invasive growth, an early treatment is recommended. During the last years multiple therapeutic options have been established. Depending on the clinical extent, lesion- or field-directed therapies with excellent clinical response and cosmetic results are available.
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20
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Strunk T., Braathen LR, Szeimies RM. Actinic keratoses - a systemic review. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-5-42-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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21
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Alomar A. Actinic keratosis: new concepts and therapeutic approaches for an ancestral condition. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:809-12. [PMID: 25060321 DOI: 10.1016/j.ad.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/03/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- A Alomar
- Departamento de Dermatología, Institut Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, España.
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22
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Visualization and treatment of subclinical actinic keratoses with topical imiquimod 5% cream: an observational study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:135916. [PMID: 24900953 PMCID: PMC4037597 DOI: 10.1155/2014/135916] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/19/2014] [Accepted: 03/31/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Imiquimod 5% is licensed for the treatment of external genital warts, superficial basal cell carcinoma, and actinic keratosis (AK) and is being used experimentally in various other dermato-oncological conditions. OBJECTIVE This observational study shall show that nonmelanoma skin cancer can be detected at its earliest subclinical stage by its reaction with imiquimod and can be cleared by finishing the course of treatment. MATERIAL AND METHODS In this single arm trial 15 patients with chronically sun-exposed skin who had no clinical evidence of AK were treated with 5% imiquimod cream on the face or scalp for 4 weeks three times per week. RESULTS During treatment, all patients developed multiple areas with mild to moderate inflammatory skin reactions, such as erythema, induration, and scaling. Biopsies obtained from 12 patients prior to treatment revealed no malignancies. However, in cases with more pronounced inflammation during treatment, targeted biopsies indicated very early malignant alterations. CONCLUSION Topical imiquimod treatment of chronically sun-exposed skin without overt clinical signs of AK is able to detect subclinical actinic keratoses (SAK) and to completely clear the lesions, even before they can be clinically diagnosed as AK. In such patients, imiquimod might be able to prevent the evolution of SCC.
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24
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Schmitt JV, Miot HA. Actinic keratosis: a clinical and epidemiological revision. An Bras Dermatol 2013; 87:425-34. [PMID: 22714759 DOI: 10.1590/s0365-05962012000300012] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/25/2011] [Indexed: 11/21/2022] Open
Abstract
Actinic keratoses are benign intraepithelial skin neoplasms constituted by atypical proliferation of keratinocytes that may evolve to squamous cell carcinoma. They develop in photoexposed skin areas; they are induced mainly by ultraviolet radiation and are considered cutaneous markers of chronic exposure to sunlight. They develop mainly in adults and older, fair skinned individuals, and are the fourth most common cause of dermatologic consultation in Brazil. Damage to the apoptosis pathway in photoexposed epithelium favors cellular proliferation and the permanence of the lesions. In this revision, the authors assemble the main epidemiological data regarding this disease and suggest that strategies to identify risky phenotypes, early diagnosis, adequate treatment, clinical follow-up, stimulus to skin self examination, photoeducation and photoprotection should be promoted with the aim of avoiding the progression to malignancy and also the prevention and the diagnose of concomitant neoplasms also induced by ultraviolet radiation.
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25
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Clinical, dermoscopic and immunohistochemical assessment of actinic keratoses and evaluation of the effectiveness of diclofenac therapy with immunohistochemical analysis. Arch Dermatol Res 2013; 305:389-95. [PMID: 23397597 DOI: 10.1007/s00403-013-1322-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
Abstract
Actinic keratoses (AKs) is a keratinocytic neoplasm that typically develops on the face of elderly patients. Little is known regarding the clinical, dermatoscopic and immunohistochemical assessments of AK using topical diclofenac therapy. We sought to determine these assessments and evaluate the efficacy of topical diclofenac gel in AK. In this prospective, open-label study, 44 patients with 66 AKs were treated for 12 weeks with topically applied diclofenac (3% gel in 2.5% hyaluronic acid). Immunohistopathologic analyses were performed before and after diclofenac treatment using epidermal stem cell markers such as Cytokeratin 15 (CK15), Cytokeratin 19 (CK19) and p63, in addition to proliferation markers (Bcl-2, Ki-67). Diclofenac gel was found to be effective in AK, including the hyperkeratotic type. Surprisingly, complete remission was observed at a significantly higher rate in Grade 3 lesions (p = 0.017). However, imunohistochemical and histopathologic examinations revealed that 12-week treatment periods may not be sufficient to fully cure AK. The immunohistochemical analyses revealed no change in the expression levels of CK15, CK19 and Bcl-2 following diclofenac therapy. However, the expression of Ki-67 (p = 0.042) and p63 (p = 0.030) exhibited a significant decrease after therapy. Dermatoscopy is an effective method for diagnosis of AK, and topical diclofenac sodium gel was found as an effective additional treatment modality. Since positive histopathological findings were detected in some patients even with significant remission, a 12-week treatment period should be extended even in patients presenting with positive clinical response. Importantly, anti-proliferative effects of diclofenac were demonstrated by decreased Ki-67 and p63 expression levels.
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26
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Abstract
Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these “signs” and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. “Signs” commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper.
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Affiliation(s)
- Bhushan Madke
- Department of Skin and VD, Topiwala National Medical College and BYL Charitable Hospital, Mumbai, India
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27
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Bonerandi JJ, Beauvillain C, Caquant L, Chassagne JF, Chaussade V, Clavère P, Desouches C, Garnier F, Grolleau JL, Grossin M, Jourdain A, Lemonnier JY, Maillard H, Ortonne N, Rio E, Simon E, Sei JF, Grob JJ, Martin L. Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions. J Eur Acad Dermatol Venereol 2012; 25 Suppl 5:1-51. [PMID: 22070399 DOI: 10.1111/j.1468-3083.2011.04296.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J J Bonerandi
- Department of Dermatology, La Timone University Hospital, Marseille, France
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Poggiani SDSC, Hatayde MR, Laufer-Amorim R, Werner J. Expression of Cyclooxygenase-2 and Ki-67 in Actinic Keratosis and Cutaneous Squamous Cell Carcinoma in Dogs. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojvm.2012.22007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Van der Geer S, Krekels GAM. Treatment of actinic keratoses on the dorsum of the hands: ALA-PDT versus diclofenac 3% gel followed by ALA-PDT. A placebo-controlled, double-blind, pilot study. J DERMATOL TREAT 2010; 20:259-65. [PMID: 19370466 DOI: 10.1080/09546630902882048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Actinic keratoses (AK) are sun-induced epithelial skin lesions, which are at risk to progress to squamous cell carcinoma. One of the treatments of AK is photodynamic therapy (PDT), which often has to be repeated. Another treatment for these lesions is diclofenac 3% gel. Although both treatments have shown to be effective, they have never been studied together. OBJECTIVE To investigate whether a pre-treatment of AK on the dorsum of the hands with diclofenac 3% gel improves the efficacy of PDT. METHODS In this placebo-controlled, randomized, double-blind, pilot study with 10 patients, both hands were pre-treated--one with diclofenac gel and the other with placebo gel--and then the hands were treated with ALA-PDT. Total lesion number scores, total thickness scores and global improvement scores were used to assess efficacy. Pain scores were recorded during PDT. RESULTS In both groups, the number of lesions significantly decreased. At 12 months' follow-up, significantly fewer AK were seen in the diclofenac group. Total lesion thickness scores decreased significantly in both groups. Pain during PDT was greater in the diclofenac group. CONCLUSIONS Both treatments are effective in treating AK. A pre-treatment with diclofenac gel seems to result in fewer AK at 12 months' follow-up, compared to placebo. Side effects were worse when using the active drug.
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30
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Carcinome épidermoïde cutané (carcinome spinocellulaire) : Recommandations de pratique clinique pour la prise en charge diagnostique et thérapeutique Argumentaire - Mai 2009. Ann Dermatol Venereol 2009. [DOI: 10.1016/s0151-9638(09)75172-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Nespeca G, Grest P, Rosenkrantz WS, Ackermann M, Favrot C. Detection of novel papillomaviruslike sequences in paraffin-embedded specimens of invasive and in situ squamous cell carcinomas from cats. Am J Vet Res 2008; 67:2036-41. [PMID: 17144807 DOI: 10.2460/ajvr.67.12.2036] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To detect and partially characterize papillomavirus (PV) DNA in squamous cell carcinoma (SCC) tumor specimens from cats. SAMPLE POPULATION 54 formalin-fixed paraffinembedded skin biopsy specimens were examined. Specimens originated from Bowenoid in situ SCC (BISC; n = 21), invasive SCC (22), and skin affected by miscellaneous nonneoplastic conditions (11). PROCEDURES Samples from each tissue block underwent DNA extraction after deparaffinization, and PCR assays were performed. Two sets of primers derived from PV E1 were used. The first set of primers was designed for the narrow-range PCR assay and was able to generate amplification products of feline PV (FePV), canine oral PV, or closely related PVs. The second set of primers was selected for the broad-range PCR assay because of its ability to amplify DNA from 64 human PVs. Sequence analysis of each amplified DNA was performed. RESULTS 1 of the 21 specimens of BISC was positive for PV DNA on the basis of narrow-range PCR assay results, whereas all the other specimens (BISC, invasive SCC, and controls) had negative results for PV DNA. In contrast, 5 of 21 BISC specimens and 4 of 22 invasive SCC specimens were positive for PV DNA on the basis of broad-range PCR assay results. Sequence analysis revealed that only 1 specimen was infected by a virus closely related to classic FePV. In the 8 other specimens positive for PV DNA, DNA of unknown PVs was uncovered. CONCLUSIONS AND CLINICAL RELEVANCE Bowenoid in situ SCC and invasive SCC of cats may be associated with PVs of genetic diversity.
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Affiliation(s)
- Gilles Nespeca
- Clinic for Small Animal Internal Medicine, Dermatology Unit, Vetsuisse Faculty, University of Zürich, Winterthurerstrasse 260, CH 8057 Zurich, Switzerland
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33
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Mueller CSL, Reichrath J. Histology of melanoma and nonmelanoma skin cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2008; 624:215-26. [PMID: 18348459 DOI: 10.1007/978-0-387-77574-6_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Cornelia S L Mueller
- The Saarland University Hospital, Dermatology Clinic, Kirrbergerstr., 66421 Homburg/Saar, Germany.
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34
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Person B, Addiss D, Bartholomew LK, Meijer C, Pou V, Gonzálvez G, Van Den Borne B. “Can It Be That God Does Not Remember Me”:A Qualitative Study on the Psychological Distress, Suffering, and Coping of Dominican Women With Chronic Filarial Lymphedema and Elephantiasis of the Leg. Health Care Women Int 2008; 29:349-65. [DOI: 10.1080/07399330701876406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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35
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Immunohistochemical Staining of Palisading Basal Cells in Bowen's Disease and Basal Involvement in Actinic Keratosis: Contrasting Staining Patterns Suggest Different Cells of Origin. Am J Dermatopathol 2008; 30:123-6. [DOI: 10.1097/dad.0b013e3181658062] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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36
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Ramos-Ceballos FI, Ounpraseuth ST, Horn TD. Diagnostic concordance among dermatopathologists using a three-tiered keratinocytic intraepithelial neoplasia grading scheme. J Cutan Pathol 2008; 35:386-91. [DOI: 10.1111/j.1600-0560.2007.00827.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Dianzani C, Pierangeli A, Chiricozzi A, Avola A, Degener A. Cutaneous Human Papillomaviruses as Recurrence Factor in Actinic Keratoses. Int J Immunopathol Pharmacol 2008; 21:145-52. [DOI: 10.1177/039463200802100116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Actinic keratoses (AK) are common, premalignant lesions cause mainly by UV DNA damage. Progression into squamous cell carcinoma may be influenced by other several factors such as chronic chemical exposure or viral infection. A carcinogenic role of Human Papillomaviruses (HPV) in early steps of skin tumour development was recently hypothesized; moreover the presence of HPV DNA seems to be higher in cancer precursor lesions. The aim of this work is to identify the presence of HPV DNA in biopsies from Actinic Keratoses (AK) and from normal skin samples collected from dermatological healthy subjects in Italy, in order to evaluate the severity and the clinical evolution of the HPV positive lesions. The DNA test revealed 37% HPV positivity in AK patients versus 0% in the control group; many different genotypes and variants were identified by direct sequencing of PCR product. The HPV positive AK were usually clinically indistinguishable from the HPV negative. All AK lesions were removed by laser treatment, but AK lesions recurred in all HPV positive patients after a period of 45–60 days whereas the same disappeared in the HPV negative ones. These data permit to hypothesize that the presence of HPV DNA could be an aggravating factor for AK lesion severity and recurrence.
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Affiliation(s)
| | - A. Pierangeli
- Department of Experimental Medicine, Section of Virology, “Sapienza” University, Rome, Italy
| | | | | | - A.M. Degener
- Department of Experimental Medicine, Section of Virology, “Sapienza” University, Rome, Italy
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38
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Patel MJ, Stockfleth E. Does progression from actinic keratosis and Bowen's disease end with treatment: diclofenac 3% gel, an old drug in a new environment? Br J Dermatol 2007; 156 Suppl 3:53-6. [PMID: 17488408 DOI: 10.1111/j.1365-2133.2007.07859.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Progression from actinic keratosis (AK) and Bowen's disease (BD) to invasive disease involves a complex cascade of events. The preparation of diclofenac 3% gel (Solaraze; Shire Pharmaceuticals) has been shown to be efficacious and well tolerated in AK. The inhibition of the COX enzymes results in a decrease in downstream by-products of arachidonic acid metabolism. These metabolites have been shown to play a pivotal role in promoting epithelial tumour growth. Given its mechanism of action, we hypothosize that diclofenac 3% gel may have potential to halt the progression of actinic keratoses (AKs) in the setting of field cancerisation and BD. We report a series of five patients with BD, all treated with diclofenac 3% gel with clinical and histological clearance.
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Affiliation(s)
- M J Patel
- Department of Dermatology, Skin Cancer Center Charité, University Hospital of Berlin, Berlin, Germany
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39
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Ostertag JU, Quaedvlieg PJF, van der Geer S, Nelemans P, Christianen MEMC, Neumann MHAM, Krekels GAM. A clinical comparison and long-term follow-up of topical 5-fluorouracil versus laser resurfacing in the treatment of widespread actinic keratoses. Lasers Surg Med 2007; 38:731-9. [PMID: 16912977 DOI: 10.1002/lsm.20379] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Many treatment modalities exist for actinic keratoses (AK). Topical 5-fluorouracil (5-FU) has been one of the standard treatments. Laser resurfacing is a more recent treatment option. In the literature prospective randomized studies comparing these treatments are lacking. STUDY DESIGN/PATIENTS AND METHODS Prospective randomized study to compare topical 5-FU with Er:YAG laser resurfacing. Fifty-five patients with multiple AK on the scalp and or the face were included. Clinical and histopathological evaluation took place at 3, 6, and 12 months after treatment. RESULTS At 3, 6, and 12 months after treatment, there were significantly less recurrences in the laser group compared to the group of patients treated with 5-FU. Side effects did occur more frequently in the laser group, especially erythema and hypopigmentation. CONCLUSIONS Compared to treatment with topical 5-FU, Er:YAG laser resurfacing is more effective regarding recurrence rates. Although significantly more side effects occur, laser resurfacing is a useful therapeutic option especially in patients with widespread AK.
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Affiliation(s)
- Judith U Ostertag
- Department of Dermatology, University Hospital Maastricht, Maastricht, The Netherlands
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Cerio R, Zaro SM. Actinic keratoses: a cosmetic nuisance or a mortal risk? J Cosmet Dermatol 2006; 3:185-6. [PMID: 17166104 DOI: 10.1111/j.1473-2130.2004.00144.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Affiliation(s)
- A B Ackerman
- Ackerman Academy of Dermatopathology, New York, NY 10021, USA.
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42
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Shekar SN, Luciano M, Duffy DL, Martin NG. Genetic and environmental influences on skin pattern deterioration. J Invest Dermatol 2006; 125:1119-29. [PMID: 16354181 DOI: 10.1111/j.0022-202x.2005.23961.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sun exposure has been known to cause histological changes in the dermal layer of the skin. Using deterioration in the fine reticular patterning of the epidermal stratum corneum (skin pattern, as measured on the Beagley-Gibson scale) as a proxy measure of histological changes in the dermal layer, previous studies have typically assumed that degradation of skin pattern is largely caused by sun exposure. A twin study comprising 332 monozygotic twin pairs and 488 dizygotic twin pairs at ages 12, 14, and 16 was used to investigate the etiology of variation in skin pattern, particularly in relation to measured sun exposure and skin color. Our results indicate that although self-reported sun exposure is a significant contributor to variation in skin pattern, its effect is small, explaining only 3.4% of variation in skin pattern at age 14. Additive genetic effects explain 86% of variation in skin pattern at age 12 but these effects reduce with age so that 75% of variation is due to additive genetic effects at age 14 and 72% at age 16. This trend of diminishing genetic influences continues into adulthood, with 62% of variation due to non-additive genetic factors in a smaller adult sample (aged 32-86). Skin color explains 10.4% of variation in skin pattern at age 12, which is due to additive genetic influences common to both. Melanin content appears to provide a protective effect against skin pattern deterioration, perhaps because of the structural differences in melanosomes between different skin types or the free radical scavenging properties of melanin.
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Affiliation(s)
- Sri Niranjan Shekar
- Genetic Epidemiology Unit, Queensland Institute of Medical Research, Brisbane, Qld, Australia.
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Zaugg N, Nespeca G, Hauser B, Ackermann M, Favrot C. Detection of novel papillomaviruses in canine mucosal, cutaneous and in situ squamous cell carcinomas. Vet Dermatol 2005; 16:290-8. [PMID: 16238808 DOI: 10.1111/j.1365-3164.2005.00467.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Papillomavirus (PV) DNA is frequently uncovered in samples of human skin squamous cell carcinomas (SCC). However, the role of these viruses in the development of such cancers in canine species remains controversial. While approximately 100 human PVs are known, only one single canine oral PV (COPV) has been identified and studied extensively. Therefore, we applied a narrow-range polymerase chain reaction (PCR) suitable for the detection of classical canine and feline PVs, as well as a broad-range PCR, which has been used for the detection of various novel PVs in humans, in order to analyse 42 paraffin-embedded samples, representing three different forms of canine SCCs. Ten samples of skin tissues with various non-neoplastic conditions served as controls. While none of the negative controls reacted positively, PV DNA was discovered in 21% of the tested SCC samples. Interestingly, the classical COPV was amplified from only one sample, while the other positive cases were associated with a variety of thus far unknown PVs. This study suggests that a fraction of canine SCC is infected with PVs and that a genetic variety of canine PVs exists. Therefore, these results will facilitate the future study of the role of PVs in the development of canine skin cancers.
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Affiliation(s)
- N Zaugg
- Clinic for Small Animal Internal Medicine, Dermatology Unit, Vetsuisse Faculty, University of Zürich, Switzerland
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Davis DA, Donahue JP, Bost JE, Horn TD. The diagnostic concordance of actinic keratosis and squamous cell carcinoma. J Cutan Pathol 2005; 32:546-51. [PMID: 16115053 DOI: 10.1111/j.0303-6987.2005.00381.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Diagnostic concordance of intraepithelial malignancy is generally only fair. Because the diagnosis of actinic keratosis (AK) and squamous cell carcinoma (SCC) is not uniform and because such terms are not consonant with the nomenclature of other human epithelial malignancies, nomenclature revisions have been attempted. One hundred dermatopathologists were solicited to review 15 tissue sections representing a spectrum of varying thickness epidermal malignancy and to choose either AK or SCC as the diagnosis. Among the 77 participating dermatopathologists, intraclass correlation was high for what was perceived as AK, SCC, and their differentiation. Development of a two-tiered diagnostic system that retains our present diagnostic capabilities, but better fits the pathobiology of superficial epidermal malignancy is suggested. Davis DA, Donahue JP, Bost JE, Horn TD. The diagnostic concordance of actinic keratosis and squamous cell carcinoma.
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Affiliation(s)
- Daniel A Davis
- Department of Dermatology, University of Arkansas for Medical Sciences, Central Arkansas Healthcare System, Little Rock, AR 72205-7199, USA.
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Abstract
Non-melanoma skin cancer is an increasingly common problem with a diversity of aetiologies as well as treatments. This article describes the clinical sub-groups and discusses potential management strategies as determined by best clinical practice and patients' individual needs.
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Affiliation(s)
- F A Campbell
- Department of Dermatology, Monklands Hospital, Monkscourt Avenue, Airdrie ML6 0JS, Lanarkshire, UK
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Abstract
This article reviews qualitative and quantitative studies that evaluate health-related quality of life (HRQoL) in lymphoedema. Qualitative studies reveal a number of factors that can affect HRQoL. These include a lack of understanding of lymphoedema by health professionals and poor information provided to patients. Emotional responses include shock, fear, annoyance, frustration and negative body image. Treatment can be costly in terms of time and disruption to lifestyle. Quantitative studies show that patients with lymphoedema experience greater levels of functional impairment, poorer psychological adjustment, anxiety and depression than the general population. Increased limb volume is poorly related to the impact of lymphoedema on the patient. Factors leading to deficits in quality of life include the frequency of acute inflammatory episodes, the presence of pain, skin quality, lymphoedema in the dominant hand and reduced limb mobility. There is some evidence that the adoption of patient-centred guidelines can improve quality of life in patients with breast-cancer-related lymphoedema. HRQoL is an important outcome in the management of patients with lymphoedema. Further studies must examine how lymphoedema impacts on patients other than those with breast-cancer-related lymphoedema and the consequences to patients of different approaches to care.
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Affiliation(s)
- Philip A Morgan
- Centre for Research and Implementation of Clinical Practice (CRICP), Thames Valley University, London, UK.
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Eedy DJ, English JSC. Updates from the British Association of Dermatologists 83rd Annual Meeting, 1-4 July 2003, Brighton, U.K. Br J Dermatol 2004; 150:11-32. [PMID: 14746613 DOI: 10.1111/j.1365-2133.2004.05774.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- D J Eedy
- Craigavon Area Hospital Group Trust, 68 Lurgan Road, Portadown BT63 5QQ, U.K.
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