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Salman S, Sarsik SM, El-Qushayri AE, Sakr S, Ghozy S, Salem ML. Safety and efficacy of the combination of cryotherapy and photodynamic modalities with imiquimod in patients with actinic keratosis: a systematic review and meta-analysis. Ital J Dermatol Venerol 2023; 158:15-20. [PMID: 36799007 DOI: 10.23736/s2784-8671.22.07461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Actinic keratosis (AK) is an intraepithelial tumor that, in most cases, arises in chronically sun-exposed areas. The combination of cryotherapy and photodynamic modalities with imiquimod has been proven to be a potential therapeutic option for AKs. However, there is no comprehensive systematic study that discussed this concept in literature taking into consideration both efficacy and safety. EVIDENCE ACQUISITION We performed a comprehensive search of the literature for studies assessing the efficacy and toxicity of the combinatorial tripartite regimen, consisting of cryotherapy and photodynamic modalities with imiquimod in AK. Metanalysis was performed using comprehensive meta-analysis version 3.0. EVIDENCE SYNTHESIS After the screening of 1031 studies, five studies were included. Two trials compared the effect of imiquimod/cryotherapy versus cryotherapy alone or versus cryotherapy/vehicle. Our meta-analysis indicated that imiquimod/cryotherapy effectively induces complete clinical clearance in patients with AKs (OR: 6.26; 95%CI: 1.56-24.1; P=0.01). Moreover, another two studies, which were not meta-analyzed, indicated a substantial clinical clearance in the number of AK lesions in the imiquimod plus photodynamic therapy arm as compared to 5% imiquimod or PDT alone. No serious systemic adverse events were reported in all the treatment arms. CONCLUSIONS Combined PDT or cryotherapy with imiquimod is more effective in the complete recovery of AK than treatment with imiquimod alone.
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Affiliation(s)
- Samar Salman
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sameh M Sarsik
- Department of Dermatology and Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | | | - Samar Sakr
- Department of Biochemistry, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic Hospital, Rochester, MN, USA
| | - Mohamed L Salem
- Unit of Immunology and Biotechnology, Department of Zoology, Faculty of Science, Tanta University, Tanta, Egypt
- Center of Excellence in Cancer Research (CECR), Tanta University, Tanta, Egypt
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Efficacy and safety of a thermal fractional skin rejuvenation system (Tixel) for the treatment of facial and/or scalp actinic keratoses. Lasers Med Sci 2022; 37:2899-2905. [PMID: 35412157 DOI: 10.1007/s10103-022-03558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
Actinic keratoses are common cutaneous lesions with a potential to progress to invasive squamous cell carcinoma. Therefore, treatment is crucial. The Tixel® is a noninvasive thermomechanical device designed to transfer heat to the upper dermis in a controlled manner according to a predetermined setting. This study aimed to evaluate the safety and efficacy of a thermomechanical fractional skin resurfacing technology for the treatment of facial and scalp actinic keratoses. A prospective, open-label, before-after study was conducted in a tertiary medical centre from May 2020 to April 2021. Patients presenting with facial/scalp actinic keratoses of mild-to-moderate thickness underwent 2 or 3 Tixel treatments (depending on clinical improvement), 3-4 weeks apart. The reduction in lesion count and overall improvement in appearance were assessed by clinical examination and digital photography. Findings were compared between baseline and follow-up at 3 months after the last treatment session. Patient satisfaction was evaluated by questionnaire, and adverse effects were documented. A total of 20 patients participated in the study. All completed 2-3 treatments and follow-up visits. Assessment of digital photographs was performed by 2 assessors blinded to the timepoint at which each photo was taken (before or after treatment). The average number of lesions at baseline was 9.8 (± 4.8) and the mean reduction in lesion count was 7.9 (± 4.4) (80.6%). Complete clearance was observed in 31.6% of patients. No adverse effects were noted during treatment and follow-up. Most patients reported being "very satisfied" or "satisfied" with the treatment results (85%) and experience (95%). Treating facial and scalp actinic keratoses with the Tixel device was found to be effective and safe.
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Dianzani C, Conforti C, Giuffrida R, Corneli P, di Meo N, Farinazzo E, Moret A, Magaton Rizzi G, Zalaudek I. Current therapies for actinic keratosis. Int J Dermatol 2020; 59:677-684. [PMID: 32012240 DOI: 10.1111/ijd.14767] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 12/31/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022]
Abstract
Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp, neck, hands, and forearms. AKs must be considered an early squamous cell carcinoma (SCC) for their probable progression into invasive SCC. For this reason, all AK should be treated, and clinical follow-up is recommended. The aims of treatment are: (i) to clinically eradicate evident and subclinical lesions, (ii) to prevent their evolution into SCC, and (iii) to reduce the number of relapses. Among available treatments, it is possible to distinguish lesion-directed therapies and field-directed therapies. Lesion-directed treatments include: (i) cryotherapy; (ii) laser therapy; (iii) surgery; and (iv) curettage. Whereas, field-directed treatments are: (i) 5-fluorouracil (5-FU); (ii) diclofenac 3% gel; (iii) chemical peeling; (iv) imiquimod; and (v) photodynamic therapy (PDT). Prevention plays an important role in the treatment of AKs, and it is based on the continuous use of sunscreen and protective clothing. This review shows different types of available treatments and describes the characteristics and benefits of each medication, underlining the best choice.
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Affiliation(s)
- Caterina Dianzani
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Claudio Conforti
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Paola Corneli
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Nicola di Meo
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Eleonora Farinazzo
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Anna Moret
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | - Iris Zalaudek
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
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Benati E, Longhitano S, Pampena R, Mirra M, Raucci M, Pellacani G, Longo C. Digital follow‐up by means of dermatoscopy and reflectance confocal microscopy of actinic keratosis treated with Imiquimod 3.75% cream. J Eur Acad Dermatol Venereol 2020; 34:1471-1477. [DOI: 10.1111/jdv.16143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022]
Affiliation(s)
- E. Benati
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - S. Longhitano
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - R. Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - M. Mirra
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - M. Raucci
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
| | - G. Pellacani
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - C. Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia Reggio Emilia Italy
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
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Befon A, Tzanetakou V, Panagiotopoulos A, Chasapi V, Antoniou C, Stratigos AJ. Imiquimod 3.75% for field-directed therapy of actinic keratosis: results of a prospective case-series study in Greece. Int J Dermatol 2019; 58:1040-1044. [PMID: 30779341 PMCID: PMC6850341 DOI: 10.1111/ijd.14397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/15/2018] [Accepted: 01/17/2019] [Indexed: 01/07/2023]
Abstract
Background Imiquimod 3.75% is a field‐directed treatment for actinic keratosis that can detect and treat clinical and subclinical lesions across an entire sun‐exposed field. The detection of subclinical lesions is evidenced by an increase in lesions to the maximum lesion count during treatment (Lmax). We report clinical outcomes for the first 15 patients treated with imiquimod 3.75% in daily clinical practice in Greece. Methods Fifteen patients with actinic keratosis lesions were treated with imiquimod 3.75% in an outpatient setting in two 2‐week treatment cycles separated by a 2‐week treatment‐free interval. Actinic keratosis lesions were counted before treatment, at the end of the first treatment cycle (Week 2; Lmax), and 2 weeks after the second treatment cycle (Week 8). Local skin reactions (LSR) were also evaluated at Weeks 2 and 8. Results The median baseline actinic keratosis lesion count was 25, which increased to a median Lmax of 29 at Week 2 and decreased to a median of 5 at Week 8. The median percentage and absolute reduction in actinic keratosis lesions from Lmax to Week 8 were 87% and 23%, respectively. Most of the LSR were mild‐to‐moderate in intensity at Week 2 and had resolved by Week 8. Conclusion Imiquimod 3.75% effectively detected and cleared both the clinical and subclinical actinic keratosis lesions across the entire sun‐exposed field in this cohort of Greek patients. Treatment was well tolerated.
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Affiliation(s)
- Angeliki Befon
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens and State Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Vassiliki Tzanetakou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens and State Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Antonios Panagiotopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens and State Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Vasiliki Chasapi
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens and State Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Christina Antoniou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens and State Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
| | - Alexander J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens and State Department of Dermatology-Venereology, Andreas Sygros Hospital, Athens, Greece
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Imiquimoid 5%: In Pursuit of New Treatment Regimens for Actinic Keratosis. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Búsqueda de nuevas pautas terapéuticas de imiquimod 5% para el tratamiento de las queratosis actínicas. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:200. [DOI: 10.1016/j.ad.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022] Open
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Serra-Guillén C, Nagore E, Llombart B, Sanmartín O, Requena C, Calomarde L, Guillén C. A 12-Day Course of Imiquimod 5% for the Treatment of Actinic Keratosis: Effectiveness and Local Reactions. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Serra-Guillén C, Nagore E, Llombart B, Sanmartín O, Requena C, Calomarde L, Guillén C. A 12-Day Course of Imiquimod 5% for the Treatment of Actinic Keratosis: Effectiveness and Local Reactions. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:248-253. [PMID: 29246367 DOI: 10.1016/j.ad.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/08/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Imiquimod is an excellent option for patients with actinic keratosis, although its use may be limited by the long course of treatment required (4 weeks) and the likelihood of local skin reactions. The objectives of the present study were to demonstrate the effectiveness of a 12-day course of imiquimod 5% for the treatment of actinic keratosis and to examine the association between treatment effectiveness and severity of local reactions. PATIENTS AND METHODS We included patients with at least 8 actinic keratoses treated with imiquimod 5% cream for 12 consecutive days. Local reactions were classified as mild, moderate, or severe. The statistical analysis of the association between local reactions and clinical response was based on the Pearson χ2 test and the Spearman rank correlation test. RESULTS Sixty-five patients completed the study. Complete response was recorded in 52.3% and partial response in 75.4%. We found a statistically significant association between severity of the local reaction and response to treatment in both the Pearson χ2 test and the Spearman rank correlation test. CONCLUSIONS A 12-day course of imiquimod 5% proved effective for the treatment of actinic keratosis. Severity of local reactions during treatment was correlated with clinical response.
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Affiliation(s)
- C Serra-Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Piel y Órganos de los Sentidos, Facultad de Medicina, Universidad CEU Cardenal Herrera, Valencia, España.
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Dermatología, Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Dermatología, Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - L Calomarde
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Piel y Órganos de los Sentidos, Facultad de Medicina, Universidad CEU Cardenal Herrera, Valencia, España
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Dirschka T, Gupta G, Micali G, Stockfleth E, Basset-Séguin N, Del Marmol V, Dummer R, Jemec GBE, Malvehy J, Peris K, Puig S, Stratigos AJ, Zalaudek I, Pellacani G. Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology. J DERMATOL TREAT 2016; 28:431-442. [DOI: 10.1080/09546634.2016.1254328] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Dirschka
- Centroderm Clinic, Wuppertal, and Faculty of Health, University of Witten-Herdecke, Witten, Germany
| | - Girish Gupta
- Department of Dermatology, Monklands Hospital, Lanarkshire, and University of Glasgow, Glasgow, UK
| | | | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Véronique Del Marmol
- Department of Dermatology, Hôpital Erasme – Université Libre de Bruxelles, Bruxelles, Belgium
| | - Reinhard Dummer
- Department of Dermatology Skin Cancer Unit, University Hospital Zürich, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Ketty Peris
- Department of Dermatology, Catholic University of Rome, Largo A. Gemelli 8, Rome, Italy
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - Alexander J. Stratigos
- First Department of Dermatology-Venereology, University of Athens Medical School, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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