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Chen J, Yuan F, Zheng L, Wen L, Gao M, Zhou W, Fan X. Limitations of ALA-PDT as a reliable therapy for AK in clinical practice. Photodiagnosis Photodyn Ther 2023; 44:103797. [PMID: 37775041 DOI: 10.1016/j.pdpdt.2023.103797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Numerous clinical studies have demonstrated the effectiveness of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) in treating actinic keratosis (AK). This therapy has achieved an average lesion clearance rate of approximately 80 % and has also shown to produce satisfactory cosmetic outcomes. However, in our clinical practice, the utilization and adherence to ALA-PDT treatment among AK patients has been lower than anticipated, possibly due to various factors. OBJECTIVE The objectives of this study are twofold: (1) To analyze the actual therapeutic effects of ALA-PDT treatment on AK lesions in clinical practice; and (2) To identify the factors that hinder acceptance of ALA-PDT therapy among AK patients with large area or multiple lesions situated on the head and face. METHOD This study included a group of 20 AK patients, comprising 15 females and 5 males, with an age range of 57-87 years. All patients received a complete course of ALA-PDT therapy, consisting of 3-6 treatments. The study analyzed various factors, including the cure rate, recurrence rate, cosmetic effects, and adverse reactions following treatment. To investigate the factors affecting the acceptance of ALA-PDT treatment among AK patients with large or multiple lesions on the head and face, we also examined a separate group of 43 AK patients. This group included individuals who either had incomplete courses of ALA-PDT treatment or declined the therapy for the first time. The factors potentially influencing patients' acceptance of PDT were analyzed based on the outcomes of these investigations. RESULT Among the 20 patients who completed the full course of ALA-PDT treatment, the cure rate was 95 % (19/20). The recurrence rates at 1 month, 3 months, and 6 months were 0 %, 5 %, and 10 %, respectively. Out of the 19 cured patients, only 2 experienced heavy pigmentation, and no scarring was reported 1-3 months post-treatment. Based on the survey of 43 patients who either had an incomplete course of ALA-PDT treatment or declined the therapy initially, several factors were identified as limiting their choice of PDT therapy. These factors include: (1) Intolerable adverse effects of treatment. (2) Higher treatment cost than expected. (3) Inconvenient transportation. (4) Coexistence of other senile diseases. (5) Unsatisfactory clinical efficacy observed. (6) Inadequate understanding of AK. (7) Lost to follow-up. CONCLUSION The study concludes that ALA-PDT is a beneficial and aesthetically pleasing treatment for AK patients, particularly those with extensive or multiple lesions on the head and face. However, various factors can impede the selection of ALA-PDT therapy, potentially depriving patients of the most suitable option. The study aims to assist dermatologists and AK patients in considering treatment plans and exploring alternative options. Overall, the findings of this study may provide valuable guidance for improving treatment outcomes and patient satisfaction.
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Affiliation(s)
- Jingjing Chen
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei 230022, Anhui, China; Department of Dermatology, Anhui Provincial Corps Hospital of Chinese People's Armed Police Forces, Hefei 230001, Anhui, China
| | - Feng Yuan
- Department of Dermatology, Anhui Provincial Corps Hospital of Chinese People's Armed Police Forces, Hefei 230001, Anhui, China
| | - Liyun Zheng
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei 230022, Anhui, China
| | - Leilei Wen
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei 230022, Anhui, China
| | - Min Gao
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei 230022, Anhui, China
| | - Wenming Zhou
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei 230022, Anhui, China.
| | - Xing Fan
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui, China; Institute of Dermatology, Anhui Medical University, Hefei 230022, Anhui, China.
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Wang P, Xie F, Zhang L, Zhao S, Zhu L, Shen S, Li D, Chen Z, Xiao R, Lu Y, Lei X, Li Y, Zhang G, Zeng W, Wang X. Plum-blossom needle tapping enhances the efficacy of ALA photodynamic therapy for facial actinic keratosis in Chinese population: a randomized, multicenter, prospective, and observer-blind study. Photodiagnosis Photodyn Ther 2023:103611. [PMID: 37211296 DOI: 10.1016/j.pdpdt.2023.103611] [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: 02/09/2023] [Revised: 04/04/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) is a reliable treatment for actinic keratosis (AK), but its effect needs to be enhanced in thick lesions. Plum-blossom needle is a traditional Chinese cost-effective instrument for enhancing the transdermal delivery of ALA. However, whether it could improve the efficacy of AK treatment has not yet been investigated. OBJECTIVE To compare the efficacy and safety of plum-blossom needle-assisted PDT in facial AK in the Chinese population. METHODS In this multicenter, prospective study, a total of 142 patients with AKs (grades I-III) were randomized into the plum-blossom needle-assisted PDT group (P-PDT) and control PDT group (C-PDT). In the P-PDT group, each AK lesion was tapped vertically by a plum-blossom needle before the application of 10% ALA cream. In the C-PDT group, each lesion was only wiped with regular saline before ALA cream incubation. Then, 3 hours later, all the lesions were irradiated with light-emitting diode (LED) at a wavelength of 630 nm. PDT was performed once every 2 weeks until all lesion patients achieved complete remission or completed six sessions. The efficacy (lesion response) and safety (pain scale and adverse events) in both groups were evaluated before each treatment and at every follow-up visit at 3-month intervals until 12 months. RESULTS In the P-PDT and C-PDT groups, the clearance rates for all AK lesions after the first treatment were 57.9% and 48.0%, respectively (P < 0.05). For grade I AK lesions, the clearance rates were 56.5% and 50.4%, respectively (P = 0.34). For grade II AK lesions, the clearance rates were 58.0% and 48.9%, respectively (P = 0.1). For grade III AK lesions, the clearance rates were 59.0% and 44.2%, respectively (P < 0.05). Moreover, grade III AK lesions in the P-PDT group required fewer treatment sessions (P < 0.05). There was no significant difference in the pain score between the two groups (P = 0.752). CONCLUSION Plum-blossom needle tapping may enhance the efficacy of ALA-PDT by facilitating ALA delivery in the treatment of AK.
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Affiliation(s)
- Peiru Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Fang Xie
- Department of Dermatology, The First Medical Center of Chinese PLA General Hospital, Beijing100853, China
| | - Linglin Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Shuang Zhao
- Xiangya Hospital Central South University, Changsha City, China
| | - Lude Zhu
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shuzhan Shen
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | | | - Zhou Chen
- Peking University People's Hospital, Beijing, China
| | - Rong Xiao
- Xiangya Hospital Central South University, Changsha City, China
| | - Yan Lu
- First Affiliated Hospital of Nanjing Medical University, Department of Dermatology, Nanjing, China
| | - Xia Lei
- Department of Dermatology, Daping Hospital, The Army Medical University, Department of Dermatology, Chongqing, China
| | - Yan Li
- Henan Provincial People's Hospital, Department of Dermatology, Zhengzhou, China
| | - Guolong Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, P. R. China
| | - Weihui Zeng
- Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an city, Shaanxi Province, China.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, P. R. China.
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Luan C, Jin S, Hu Y, Zhou X, Liu L, Li R, Ju M, Huang D, Chen K. Whole-genome identification and construction of the lncRNA-mRNA co-expression network in patients with actinic keratosis. Transl Cancer Res 2022; 11:4070-4078. [PMID: 36523309 PMCID: PMC9745357 DOI: 10.21037/tcr-22-842] [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: 03/28/2022] [Accepted: 08/17/2022] [Indexed: 08/30/2023]
Abstract
BACKGROUND Actinic keratosis (AK) is a common premalignant lesion induced by chronic exposure to ultraviolet radiation and may develop into invasive cutaneous squamous carcinoma (cSCC). The identification of specific biomarkers in AK are still unclear. Long non-coding RNAs (lncRNAs), as transcripts of more than 200 nucleotides, significantly involving in multiple biologic processes, especially in the development of tumors. METHODS In our study, we obtained data from RNA-sequencing analysis using two AK lesion tissues and three normal cutaneous tissues to comparatively analyze the differentially expressed (DE) lncRNAs and messenger RNAs (mRNAs). Firstly, we used microarray analyses to identify DE lncRNAs and DE mRNAs. Secondly, we performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to analyze the primary function and find out significant pathways of these DE mRNA and lncRNAs. Finally, we used the top ten DE lncRNAs to construct a lncRNA-mRNA co-expression network. RESULTS Our results showed that there were a total of 2,097 DE lncRNAs and 2,043 DE mRNAs identified. GO and KEGG analysis and the lncRNA-mRNA co-expression network (using the top 10 DE lncRNAs comprises 130 specific co-expressed mRNAs to construct) indicated that lncRNA uc011fnr.2 may negatively regulate SCIMP and Toll-like receptor 4 (TLR4) and play an important role in Janus kinase-signal transducer and activator of transcription 3 (JAK-STAT3) signaling pathway of AK. CONCLUSIONS lncRNA uc011fnr.2 may play an important role in JAK-STAT3 signaling pathway of AK by modulating SCIMP, TLR4 and IL-6. Further research is required to validate the value of lncRNA uc011fnr.2 in the progression of AK.
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Affiliation(s)
- Chao Luan
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Shuang Jin
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Yu Hu
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Xuyue Zhou
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Lingxi Liu
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Rong Li
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Mei Ju
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Dan Huang
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Kun Chen
- Institute of Dermatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
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Sgouros D, Milia-Argyti A, Arvanitis DK, Polychronaki E, Kousta F, Panagiotopoulos A, Theotokoglou S, Syrmali A, Theodoropoulos K, Stratigos A, Rigopoulos D, Katoulis A. Actinic Keratoses (AK): An Exploratory Questionnaire-Based Study of Patients’ Illness Perceptions. Curr Oncol 2022; 29:5150-5163. [PMID: 35877268 PMCID: PMC9323725 DOI: 10.3390/curroncol29070408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary We recorded 208 patients receiving treatment for AK and conducted a cross-sectional questionnaire-based study, which aimed to investigate patients’ perceptions of their illness. Our main objective was the detection not only of the illness perception of AK patients, but also of its influence on their perception of treatment and the correlation with patients’ demographic characteristics and history, as well as the readiness to use sunscreen. The rising incidence of AK and its socioeconomic burden place the illness perception of AK patients among the most important barriers to overcome for the effective management of the disease. To the best of our knowledge, this is one of the first studies to attempt to unveil the illness perceptions of AK patients and their correlation with patients’ demographics and sunscreen use and the influence on AK treatment. We strongly support reinforcing the awareness of AK and the role of dermatologists is crucial for this direction. Abstract Background: Decreased illness perception among actinic keratoses (AK) patients is a major barrier to the effective management of AK. Objective: We aimed to investigate patients’ illness and treatment perceptions, their correlation to demographics and AK/skin cancer history, and secondarily the influence of these perspectives on treatment and sunscreen use. Materials and Methods: Participants completed questionnaires based on the Brief Illness Perception Questionnaire and statistical analysis was performed. Results: In total, 208 AK patients were enrolled. A large proportion were poorly aware of the disease (41.4%), with less than half (43%) being familiar with AK. Patients were aware of the chronic nature of the disease and its correlation to sunlight regardless of demographic characteristics. The level of education played a role in disease awareness (p = 0.006), and treatment plan perception (p = 0.002). The increase in sunscreen protection after AK diagnosis was higher in women (p = 0.009) and younger patients (p = 0.044). Patients’ concerns regarding treatment were mainly related to the duration (30%) and effectivity (25%). Dermatologists’ statements highlighting that AK are precancerous lesions (86.2%) influenced patients’ willingness for treatment. Conclusion: Improved awareness of AK is necessary to increase treatment seeking and compliance, regarding both treatment and sunscreen use. Dermatologists’ statements may have critical influence on patients’ decisions to receive treatment for AK.
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Affiliation(s)
- Dimitrios Sgouros
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (S.T.); (A.S.); (K.T.); (A.K.)
- Correspondence: or ; Tel.: +30-69-74816025 or +30-21-0583-2396; Fax: +30-21-0583-2396
| | - Adamantia Milia-Argyti
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (A.M.-A.); (E.P.); (F.K.); (A.P.); (A.S.); (D.R.)
| | - Dimitrios K. Arvanitis
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (S.T.); (A.S.); (K.T.); (A.K.)
| | - Eleni Polychronaki
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (A.M.-A.); (E.P.); (F.K.); (A.P.); (A.S.); (D.R.)
| | - Fiori Kousta
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (A.M.-A.); (E.P.); (F.K.); (A.P.); (A.S.); (D.R.)
| | - Antonios Panagiotopoulos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (A.M.-A.); (E.P.); (F.K.); (A.P.); (A.S.); (D.R.)
| | - Sofia Theotokoglou
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (S.T.); (A.S.); (K.T.); (A.K.)
| | - Anna Syrmali
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (S.T.); (A.S.); (K.T.); (A.K.)
| | - Konstantinos Theodoropoulos
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (S.T.); (A.S.); (K.T.); (A.K.)
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (A.M.-A.); (E.P.); (F.K.); (A.P.); (A.S.); (D.R.)
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece; (A.M.-A.); (E.P.); (F.K.); (A.P.); (A.S.); (D.R.)
| | - Alexander Katoulis
- 2nd Department of Dermatology-Venereology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (D.K.A.); (S.T.); (A.S.); (K.T.); (A.K.)
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Xu D, Sun JF, Qi RQ, Zhang W, Dong LD, Liu TY, Zheng S, Niu RX, Zhang J, Cui TT, He L, Chen HD. A multicenter retrospective analysis of the clinical and pathological characteristics of 1188 cases of actinic keratosis in different ultraviolet radiation intensity areas of China. J Cosmet Dermatol 2021; 21:2879-2888. [PMID: 34719097 DOI: 10.1111/jocd.14479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a precancerous disease, caused by ultraviolet radiation (UV). OBJECTIVE To analyze the clinical and pathological characteristics of AK in four areas with different ultraviolet radiation intensities. METHODS 1188 diagnosed AK patients, from January 2000 to July 2015, in dermatology department of four hospitals were collected. The UV intensity of hospital located cities from high to low is Kunming, Yinchuan, Shenyang and Nanjing. The information comes from medical records, and the pathological types and Keratinocyte Intraepithelial Neoplasia (KIN) grades were checked by two experienced pathologists. All information was conducted a retrospective multicenter research. RESULTS The patients were mainly middle-aged and elderly female, which was in direct contrast to the majority of men in European. The age of onset in Kunming group was lower than that in Yinchuan Group (p = 0.013) and Nanjing Group (p < 0.01). The course of disease in Kunming group was significantly shorter than that in Nanjing Group (p < 0.001). The lesions were almost located in the exposed area. The proportion of unexposed areas in Shenyang group was significantly higher than that in other groups (p < 0.001). There were statistical differences in pathological morphological classification among the four groups. These differences were not affected by age and gender. The number of KIN III grade patients in Shenyang group was significantly higher than that in other three groups (p < 0.05). CONCLUSION The Asian patients were mainly female. The clinical characteristics of AK are closely related to UV intensity, and environmental pollution, lifestyle, religious beliefs and other factors are also related.
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Affiliation(s)
- Dan Xu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian-Fang Sun
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Rui-Qun Qi
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Ling-Di Dong
- Department of Dermatology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Tong-Yun Liu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Song Zheng
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
| | - Rui-Xian Niu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Juan Zhang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ting-Ting Cui
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hong-Duo Chen
- Department of Dermatology, Key Laboratory of Immunodermatology of NHC and Ministry of Education, The First Hospital of China Medical University, Shenyang, China
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Lee D, Kim B, Yang S, Kim M, Yoon T, Youn S. Histopathological predictor of the progression from actinic keratosis to squamous cell carcinoma: quantitative computer‐aided image analysis. J Eur Acad Dermatol Venereol 2020; 35:116-122. [DOI: 10.1111/jdv.16680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/11/2020] [Indexed: 12/28/2022]
Affiliation(s)
- D.Y. Lee
- Department of Dermatology Seoul National University Bundang Hospital Seoul National University College of Medicine Seongnam Korea
| | - B.R. Kim
- Department of Dermatology Seoul National University Bundang Hospital Seoul National University College of Medicine Seongnam Korea
| | - S. Yang
- Department of Dermatology Seoul National University Bundang Hospital Seoul National University College of Medicine Seongnam Korea
| | - M. Kim
- Department of Dermatology Seoul National University Bundang Hospital Seoul National University College of Medicine Seongnam Korea
| | - T.Y. Yoon
- Department of Dermatology College of Medicine and Medical Research Institute Chungbuk National University Cheongju Korea
| | - S.W. Youn
- Department of Dermatology Seoul National University Bundang Hospital Seoul National University College of Medicine Seongnam Korea
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Wang L, Chen A, Zhang Y, Wang X, Zhang Y, Shen Q, Xue Y. AK-DL: A Shallow Neural Network Model for Diagnosing Actinic Keratosis with Better Performance Than Deep Neural Networks. Diagnostics (Basel) 2020; 10:diagnostics10040217. [PMID: 32294962 PMCID: PMC7235884 DOI: 10.3390/diagnostics10040217] [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: 03/16/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/29/2022] Open
Abstract
Actinic keratosis (AK) is one of the most common precancerous skin lesions, which is easily confused with benign keratosis (BK). At present, the diagnosis of AK mainly depends on histopathological examination, and ignorance can easily occur in the early stage, thus missing the opportunity for treatment. In this study, we designed a shallow convolutional neural network (CNN) named actinic keratosis deep learning (AK-DL) and further developed an intelligent diagnostic system for AK based on the iOS platform. After data preprocessing, the AK-DL model was trained and tested with AK and BK images from dataset HAM10000. We further compared it with mainstream deep CNN models, such as AlexNet, GoogLeNet, and ResNet, as well as traditional medical image processing algorithms. Our results showed that the performance of AK-DL was better than the mainstream deep CNN models and traditional medical image processing algorithms based on the AK dataset. The recognition accuracy of AK-DL was 0.925, the area under the receiver operating characteristic curve (AUC) was 0.887, and the training time was only 123.0 s. An iOS app of intelligent diagnostic system was developed based on the AK-DL model for accurate and automatic diagnosis of AK. Our results indicate that it is better to employ a shallow CNN in the recognition of AK.
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Affiliation(s)
- Liyang Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Plant Protein and Grain Processing, National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (L.W.); (X.W.); (Q.S.)
| | - Angxuan Chen
- College of Information and Electrical Engineering, China Agricultural University, Beijing 100083, China; (A.C.); (Y.Z.); (Y.Z.)
| | - Yan Zhang
- College of Information and Electrical Engineering, China Agricultural University, Beijing 100083, China; (A.C.); (Y.Z.); (Y.Z.)
| | - Xiaoya Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Plant Protein and Grain Processing, National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (L.W.); (X.W.); (Q.S.)
| | - Yu Zhang
- College of Information and Electrical Engineering, China Agricultural University, Beijing 100083, China; (A.C.); (Y.Z.); (Y.Z.)
| | - Qun Shen
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Plant Protein and Grain Processing, National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (L.W.); (X.W.); (Q.S.)
| | - Yong Xue
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Plant Protein and Grain Processing, National Engineering and Technology Research Center for Fruits and Vegetables, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (L.W.); (X.W.); (Q.S.)
- Correspondence:
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Reinehr CPH, Bakos RM. Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects. An Bras Dermatol 2019; 94:637-657. [PMID: 31789244 PMCID: PMC6939186 DOI: 10.1016/j.abd.2019.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023] Open
Abstract
Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.
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Affiliation(s)
| | - Renato Marchiori Bakos
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Kim JS, Woo YR, Kim M, Park HJ. Effect of ingenol mebutate on actinic keratosis in a Korean population: A prospective clinical, dermoscopic and histopathological study from a single center. J Dermatol 2018; 45:1324-1330. [PMID: 30260493 DOI: 10.1111/1346-8138.14632] [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: 05/02/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Abstract
Actinic keratosis (AK) is an in situ squamous cell carcinoma which is mostly found on sun-damaged skin, and it is prevalent among Caucasians. However, there is a lack of research on evaluating the treatment efficacy of ingenol mebutate (IM) on AK in Asians. This study was intended to analyze the treatment outcomes of IM on AK in Korean patients with regards to clinical, dermoscopic and histopathological aspects. A prospective study on 46 Korean patients who were diagnosed with AK and treated with IM was conducted. Clinically, 80% (24/30) of the patients showed an improvement at 8 weeks. Twenty out of the 30 (66.7%) patients were found to have achieved histopathological clearance. All local skin responses had disappeared at T4 in all patients. Patients with Fitzpatrick skin type III were proven to exhibit better treatment outcomes, both clinically (P = 0.001) and histopathologically (P = 0.001), than those with Fitzpatrick skin type IV. The clinical and histopathological clearance rate of AK with IM in Korean patients was 80% and 66.7%, respectively. The patients with Fitzpatrick skin type IV showed a tendency to have residual AK, histopathologically after treatment with IM. In conclusion, IM could be an effective and safe treatment option on AK in Korean patients. In addition, it would be helpful to carry out a cautious check-up when treating AK with IM in patients with a darker skin color.
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Affiliation(s)
- Jong Sic Kim
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Ri Woo
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Miri Kim
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Backes C, Religi A, Moccozet L, Vuilleumier L, Vernez D, Bulliard JL. Facial exposure to ultraviolet radiation: Predicted sun protection effectiveness of various hat styles. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 34:330-337. [PMID: 29682802 DOI: 10.1111/phpp.12388] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Solar ultraviolet radiation (UVR) doses received by individuals are highly influenced by behavioural and environmental factors. This study aimed at quantifying hats' sun protection effectiveness in various exposure conditions, by predicting UVR exposure doses and their anatomical distributions. METHODS A well-defined 3-dimensional head morphology and 4 hat styles (a cap, a helmet, a middle- and a wide-brimmed hat) were added to a previously published model. Midday (12:00-14:00) and daily (08:00-17:00) seasonal UVR doses were estimated at various facial skin zones, with and without hat wear, accounting for each UVR component. Protection effectiveness was calculated by the relative reduction in predicted UVR dose, expressed as a predictive protection factor (PPF). RESULTS The unprotected entire face received 2.5 times higher UVR doses during a summer midday compared to a winter midday (3.3 vs 1.3 standard erythema dose [SED]) with highest doses received at the nose (6.1 SED). During a cloudless summer day, the lowest mean UVR dose is received by the entire face protected by a wide-brimmed hat (1.7 SED). No hat reached 100% protection at any facial skin zone (PPFmax : 76%). Hats' sun protection effectiveness varied highly with environmental conditions and was mainly limited by the high contribution of diffuse UVR, irrespective of hat style. Larger brim sizes afforded greater facial protection than smaller brim sizes except around midday when the sun position is high. CONCLUSION Consideration of diffuse and reflected UVR in sun educational messages could improve sun protection effectiveness.
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Affiliation(s)
- Claudine Backes
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, Switzerland.,Centre Hospitalier Universitaire Vaudois, University Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
| | - Arianna Religi
- Computer Science Centre, Information Science Institute, University of Geneva, Geneva, Switzerland
| | - Laurent Moccozet
- Computer Science Centre, Information Science Institute, University of Geneva, Geneva, Switzerland
| | - Laurent Vuilleumier
- Federal Office of Meteorology and Climatology (MeteoSwiss), Payerne, Switzerland
| | - David Vernez
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Centre Hospitalier Universitaire Vaudois, University Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
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COMPARATIVE STUDIES OF EFFICACY OF PHOTODYNAMIC THERAPY AND CRYOTHERAPY FOR TREATMENT OF ACTINIC KERATOSIS. BIOMEDICAL PHOTONICS 2016. [DOI: 10.24931/2413-9432-2016-5-3-19-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The results of a study on the effectiveness of photodynamic therapy with a photosensitizer fotoditazin and cryotherapy for actinic keratosis are represented in the article. The study included 80 patients with 215 lesions, among them erythematous form of actinic keratosis was diagnosed in 151 (70.2%) cases, hyperkeratotic form – in 46 (21.4%) cases, a pigmented form – in 12 (5.6%) and an atypical variant of the disease – in 6 (2.8%) cases. According to histological type the distribution of tumor was as follows: 19 (54.3%) cases were diagnosed as hypertrophic type, 6 (17.1%) – atrophic, 8 (22.9%) – bowenoid and 2 (5.7% ) – pigmented type. Patients from the study group received one session of photodynamic therapy using laser unit "LAMI" (662 nm) after 2 hours of application of fotoditazin 0.5% gel at dose of 0,2-0,3 ml per 1 cm2 of actinic keratosis focus with the following parameters: the energy density of the laser radiation – 200 J/cm2, power density – 0.14–0.48 W/cm2. In the control group patients underwent cryotherapy with liquid nitrogen with an exposure of 30-60 sec. The comparative analysis of the immediate results showed a tendency for the efficacy of photodynamic therapy to increase (the rate of complete regression was 92.5%) compared with cryotherapy (85.0%) (p>0,05). There were also a tendency for long-term results after photodynamic therapy to improve: three-year recurrence-free survival was 94.6% and 88.2%, respectively. For the photodynamic therapy there were significantly fewer adverse reactions, the epithelization time in lesions was significantly shorter. Compared with cryotherapy the photodynamic therapy provided significantly better cosmetic results (p <0.01), and can be used for out-patient treatment of patients with actinic keratosis.><0.01) and can be used for out-patient treatment of patients with actinic keratosis.
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Wakkee M, Nijsten T. Actinic keratosis in China: big numbers and small percentages. Br J Dermatol 2016; 174:954. [DOI: 10.1111/bjd.14590] [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]
Affiliation(s)
- M. Wakkee
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam the Netherlands
| | - T. Nijsten
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam the Netherlands
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