1
|
Bromfield JI, Zaugg J, Straw RC, Cathie J, Krueger A, Sinha D, Chandra J, Hugenholtz P, Frazer IH. Characterization of the skin microbiome in normal and cutaneous squamous cell carcinoma affected cats and dogs. mSphere 2024; 9:e0055523. [PMID: 38530017 PMCID: PMC11036808 DOI: 10.1128/msphere.00555-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/03/2024] [Indexed: 03/27/2024] Open
Abstract
Human cutaneous squamous cell carcinomas (SCCs) and actinic keratoses (AK) display microbial dysbiosis with an enrichment of staphylococcal species, which have been implicated in AK and SCC progression. SCCs are common in both felines and canines and are often diagnosed at late stages leading to high disease morbidity and mortality rates. Although recent studies support the involvement of the skin microbiome in AK and SCC progression in humans, there is no knowledge of this in companion animals. Here, we provide microbiome data for SCC in cats and dogs using culture-independent molecular profiling and show a significant decrease in microbial alpha diversity on SCC lesions compared to normal skin (P ≤ 0.05). Similar to human skin cancer, SCC samples had an elevated abundance of staphylococci relative to normal skin-50% (6/12) had >50% staphylococci, as did 16% (4/25) of perilesional samples. Analysis of Staphylococcus at the species level revealed an enrichment of the pathogenic species Staphylococcus felis in cat SCC samples, a higher prevalence of Staphylococcus pseudintermedius in dogs, and a higher abundance of Staphylococcus aureus compared to normal skin in both companion animals. Additionally, a comparison of previously published human SCC and perilesional samples against the present pet samples revealed that Staphylococcus was the most prevalent genera across human and companion animals for both sample types. Similarities between the microbial profile of human and cat/dog SCC lesions should facilitate future skin cancer research. IMPORTANCE The progression of precancerous actinic keratosis lesions (AK) to cutaneous squamous cell carcinoma (SCC) is poorly understood in humans and companion animals, despite causing a significant burden of disease. Recent studies have revealed that the microbiota may play a significant role in disease progression. Staphylococcus aureus has been found in high abundance on AK and SCC lesions, where it secretes DNA-damaging toxins, which could potentiate tumorigenesis. Currently, a suitable animal model to investigate this relationship is lacking. Thus, we examined the microbiome of cutaneous SCC in pets, revealing similarities to humans, with increased staphylococci and reduced commensals on SCC lesions and peri-lesional skin compared to normal skin. Two genera that were in abundance in SCC samples have also been found in human oral SCC lesions. These findings suggest the potential suitability of pets as a model for studying microbiome-related skin cancer progression.
Collapse
Affiliation(s)
- Jacoba I. Bromfield
- Frazer Institute, Faculty of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Julian Zaugg
- Australian Centre for Ecogenomics, University of Queensland, St Lucia, Queensland, Australia
| | - Rodney C. Straw
- Brisbane Veterinary Specialist Centre and the Australian Animal Cancer Foundation, Albany Creek, Queensland, Australia
| | - Julia Cathie
- Brisbane Veterinary Specialist Centre and the Australian Animal Cancer Foundation, Albany Creek, Queensland, Australia
| | - Annika Krueger
- Frazer Institute, Faculty of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Debottam Sinha
- Frazer Institute, Faculty of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Janin Chandra
- Frazer Institute, Faculty of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Philip Hugenholtz
- Australian Centre for Ecogenomics, University of Queensland, St Lucia, Queensland, Australia
| | - Ian H. Frazer
- Frazer Institute, Faculty of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia
| |
Collapse
|
2
|
Nazzaro G, Carugno A, Bortoluzzi P, Buffon S, Astrua C, Zappia E, Trovato E, Caccavale S, Pellegrino V, Paolino G, Balestri R, Lacava R, Ciccarese G, Verdelli A, Barruscotti S, Valenti M, Toni G, Giacalone S, Zavattaro E, Gironi LC, Mercuri SR, Ribero S, Gisondi P, Sena P, Marzano AV. Efficacy and tolerability of tirbanibulin 1% ointment in the treatment of cancerization field: a real-life Italian multicenter observational study of 250 patients. Int J Dermatol 2024. [PMID: 38605473 DOI: 10.1111/ijd.17168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Tirbanibulin 1% ointment is approved for the field treatment of Olsen grade I actinic keratoses (AKs) of the face and scalp. METHODS We performed a multicenter retrospective study involving 15 dermatologic units in Italy to investigate the efficacy and tolerability of tirbanibulin in a real-life setting. 250 patients were enrolled. Tirbanibulin, 1% ointment, was applied daily for five consecutive days. The efficacy of treatment was measured with modifications of the Actinic Keratosis Area and Severity Index (AKASI). A satisfactory response was defined by complete (100% reduction in the number of lesions) or partial clearance (75-99%) of treated AKs. RESULTS Overall, the AKASI score was significantly reduced in the studied population (mean, from 4.1 ± 2.7 to 1.4 ± 1.5; P < 0.001). A satisfactory response was observed in 222 (88.8%) cases. The proportion of satisfactory responses was higher when follow-up was performed after 8 weeks (34/35, 97.1%). The reduction in AKASI was significant in patients with Olsen grade II or III lesions (from 5.3 ± 2.8 to 1.6 ± 1.6; P < 0.001). A satisfactory response was observed in 91/104 (87.5%) cases. AKASI reduction was also significant in patients with trunk or limb AKs (from 7.0 ± 1.3 to 2.0 ± 1.6; P = 0.018) since a satisfactory response was observed in 7/8 (87.5%) cases. Tirbanibulin was well tolerated; all adverse events (AEs) included transient local reactions at the site of treatment. Overall, 231 patients had at least one AE. Only 7 (2.8%) grade 4 AEs were recorded. CONCLUSION Our retrospective study confirmed that tirbanibulin 1% ointment is effective and well tolerated in a real-life setting and is also promising for Olsen grade II and grade III AKs and AKs localized on difficult-to-treat areas.
Collapse
Affiliation(s)
- Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- University of Milan-Bicocca, Milan, Italy
| | - Paolo Bortoluzzi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Buffon
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Chiara Astrua
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Elena Zappia
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
- Magna Graecia University, Catanzaro, Italy
| | - Emanuele Trovato
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Stefano Caccavale
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Pellegrino
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanni Paolino
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Unit of Dermatologic Clinic, Università Vita-Salute, San Raffaele, Milan, Italy
| | - Riccardo Balestri
- Division of Dermatology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento and Rovereto, Italy
| | - Rossella Lacava
- Division of Dermatology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento and Rovereto, Italy
| | - Giulia Ciccarese
- Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, USL Toscana Centre, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Stefania Barruscotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mario Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giulia Toni
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Serena Giacalone
- Institute of Dermatology, ASST Valle Olona, Ospedale Sant'Antonio Abate, Gallarate, Italy
| | - Elisa Zavattaro
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Laura C Gironi
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Santo R Mercuri
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Unit of Dermatologic Clinic, Università Vita-Salute, San Raffaele, Milan, Italy
| | - Simone Ribero
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
3
|
Sjöholm A, Claeson M, Paoli J, Heckemann B. Exploring Patient Pain Experiences during and after Conventional Red Light and Simulated Daylight Photodynamic Therapy for Actinic Keratosis: A Qualitative Interview Study. Acta Derm Venereol 2024; 104:adv19459. [PMID: 38596905 PMCID: PMC11022748 DOI: 10.2340/actadv.v104.19459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Simulated daylight photodynamic therapy is a relatively new and potentially less painful alternative to conventional red light photodynamic therapy for actinic keratosis. Qualitative research exploring patient experiences of pain and skin reactions during these treatments is scarce. To address this, semi-structured interviews were conducted of 10 patients aged 60-81 years with symmetrically distributed actinic keratoses 4 weeks after split-face treatment with conventional red light photodynamic therapy and simulated daylight photodynamic therapy. The participants were recruited from an ongoing clinical randomized trial. Interviews (median length 35 min) were conducted between June 2022 and January 2023, audio-recorded, transcribed verbatim, and analysed qualitatively using content analysis, as described by Graneheim and Lundman. Participants reported that conventional red light photodynamic therapy was very painful during illumination and transiently painful in the post-treatment period, while simulated daylight photodynamic therapy was almost painless during illumination and led to minor post-treatment pain. Also, skin reactions were more intense and longer-lasting with conventional red light photodynamic therapy than with simulated daylight photodynamic therapy. Most participants expressed a treatment preference for simulated daylight photodynamic therapy but had reservations about its unestablished long-term effectiveness. This study underscores the considerable pain associated with conventional red light photodynamic therapy, and the pivotal importance of shared decision-making when selecting the most appropriate treatment.
Collapse
Affiliation(s)
- Alexandra Sjöholm
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden.
| | - Magdalena Claeson
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Birgit Heckemann
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthetics and Intensive Care, Gothenburg, Sweden
| |
Collapse
|
4
|
Ortner VK, Kilov K, Mondragón AC, Fredman G, Omland SH, Manole I, Laugesen CAP, Havsager S, Johansen B, Duvold T, Isberg AP, Andersen AD, Zibert JR, Hædersdal M. Mobile health technologies in an interventional hybrid study on actinic keratosis: Results from an early phase randomized controlled trial investigating the safety and efficacy of a cytosolic phospholipase A2 inhibitor gel in photodamaged skin. Exp Dermatol 2024; 33:e15068. [PMID: 38610094 DOI: 10.1111/exd.15068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
Hybrid trials are a new trend in dermatological research that leverage mobile health technologies to decentralize a subset of clinical trial elements and thereby reduce the number of in-clinic visits. In a Phase I/IIa randomized controlled hybrid trial, the safety and efficacy of an anti-proliferative and anti-inflammatory drug inhibiting cytosolic phospholipase A2 (AVX001) was tested using 1%, 3% or vehicle gel in 60 patients with actinic keratosis (AK) and assessed in-clinic as well as remotely. Over the course of 12 weeks, patients were assessed in-clinic at baseline, end of treatment (EOT) and end of study (EOS), as well as 9 times remotely on a weekly to biweekly basis. Safety outcomes comprising local skin reactions (LSR; 0-5), adverse events (AE) and cosmesis, were graded in-clinic and remotely using patient-obtained smartphone photographs (PSPs) and questionnaires; efficacy was assessed in-clinic based on clinically visible clearance of AK target area of >50%. A total of 55 participants (91.7%) completed the treatment course. The average submission rate of PSPs was high (≥85%), of which 93% were of sufficient quality. No serious AE were reported and only two experienced temporary LSR >2 (scale 0-4) and cosmesis remained stable throughout the study. Based on the mild AE and LSR profile, daily application of AVX001 gel for 1 month appears safe, tolerable, and cosmetically acceptable for use in patients with AK. At EOT, AVX001 achieved a subtle treatment response with clearance of AK target area of >50% in 18% of patients. Remote and in-clinic assessments of LSRs were in high agreement, suggesting that the use of mobile health technologies in early-phase hybrid studies of AK does not compromise patient safety.
Collapse
Affiliation(s)
- Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | | | - Gabriella Fredman
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Silje Haukali Omland
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ionela Manole
- Studies&Me A/S, Copenhagen, Denmark
- 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | - Berit Johansen
- Coegin Pharma AB, Lund, Sweden
- Department of Biology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | | | | - John R Zibert
- Studies&Me A/S, Copenhagen, Denmark
- Coegin Pharma AB, Lund, Sweden
| | - Merete Hædersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Zuberi H, Amin SA. Ingenol mebutate-associated immune thrombocytopenic purpura. JAAD Case Rep 2024; 46:30-32. [PMID: 38510842 PMCID: PMC10950484 DOI: 10.1016/j.jdcr.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Affiliation(s)
- Hafsa Zuberi
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | | |
Collapse
|
6
|
GADDEY PK, SUNDARARAJAN R. Development of a Stability Indicating UPLC Method for the Determination of Tirbanibulin in Bulk and Its Pharmaceutical Dosage Form. Turk J Pharm Sci 2024; 21:25-35. [PMID: 38528791 PMCID: PMC10982887 DOI: 10.4274/tjps.galenos.2023.18124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
Objectives The primary goal of this study was to create and validate a simple, precise, sensitive, and accurate ultra-performance liquid chromatography (UPLC) method for estimating tirbanibulin in pure and dosage form. Materials and Methods A UPLC technique was developed using a Waters Acquity UPLC Phenyl (100 x 2.1 mm, 1.7 µm) column. The developed technique was validated in accordance with the International Conference on Harmonization (ICH) guidelines. Results Tirbanibulin was separated chromatographically with high resolution using the mobile phase acetonitrile: buffer (30:70 v/v) at 0.5 mL/min, 5 µL injection volume, and 220 nm wavelength. The validated technique was found to be linear in the 1-15 µg/mL range. The detection and quantification limits for tirbanibulin were 0.03 and 0.1 µg/mL, respectively. The percentage relative standard deviation was less than 2%, demonstrating the precision of the developed technique. Furthermore, the recovery rate was nearly 100%, confirming the accuracy of the method. Minor modifications to the chromatographic conditions demonstrated the robustness of the method. Conclusion The developed analytical method was precise, simple, reproducible, and sensitive. Consequently, it can be used to determine tirbanibulin.
Collapse
Affiliation(s)
| | - Raja SUNDARARAJAN
- GITAM (Deemed to be University), School of Pharmacy, Visakhapatnam, India
| |
Collapse
|
7
|
Wang Z, Wang X, Shi Y, Wu S, Ding Y, Yao G, Chen J. Advancements in elucidating the pathogenesis of actinic keratosis: present state and future prospects. Front Med (Lausanne) 2024; 11:1330491. [PMID: 38566927 PMCID: PMC10985158 DOI: 10.3389/fmed.2024.1330491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Solar keratosis, also known as actinic keratosis (AK), is becoming increasingly prevalent. It is a benign tumor that develops in the epidermis. Individuals with AK typically exhibit irregular, red, scaly bumps or patches as a result of prolonged exposure to UV rays. These growths primarily appear on sun-exposed areas of the skin such as the face, scalp, and hands. Presently, dermatologists are actively studying AK due to its rising incidence rate in the United States. However, the underlying causes of AK remain poorly understood. Previous research has indicated that the onset of AK involves various mechanisms including UV ray-induced inflammation, oxidative stress, complex mutagenesis, resulting immunosuppression, inhibited apoptosis, dysregulated cell cycle, altered cell proliferation, tissue remodeling, and human papillomavirus (HPV) infection. AK can develop in three ways: spontaneous regression, persistence, or progression into invasive cutaneous squamous cell carcinoma (cSCC). Multiple risk factors and diverse signaling pathways collectively contribute to its complex pathogenesis. To mitigate the risk of cancerous changes associated with long-term UV radiation exposure, prompt identification, management, and prevention of AK are crucial. The objective of this review is to elucidate the primary mechanisms underlying AK malignancy and identify potential treatment targets for dermatologists in clinical settings.
Collapse
Affiliation(s)
- Zhongzhi Wang
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Xiaolie Wang
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yuanyang Shi
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Siyu Wu
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Yu Ding
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
| | - Guotai Yao
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianghan Chen
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University, Shanghai, China
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai, China
| |
Collapse
|
8
|
Aleisa A, Cordova M, Payulert C, Aldawood H, Lee EH, Nehal KS, Rossi AM. Combined reflectance confocal microscopy and optical coherence tomography in the evaluation of cutaneous squamous cell carcinoma. J Am Acad Dermatol 2024:S0190-9622(24)00314-1. [PMID: 38342245 DOI: 10.1016/j.jaad.2024.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/13/2024]
Affiliation(s)
- Abdullah Aleisa
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, King Saud University, Riyadh, Saudi Arabia.
| | - Miguel Cordova
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Payulert
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haifa Aldawood
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
9
|
Maxwell Regester R, Cannella AC, Hirz J, Sayles B, Schlange S, Rau A, Sayles HR, Griess AJ. Combination therapy with imiquimod and 5-fluorouracil cream for the treatment of actinic keratoses, a prospective open-label nonrandomized uncontrolled pilot trial. J Am Acad Dermatol 2024:S0190-9622(24)00214-7. [PMID: 38316257 DOI: 10.1016/j.jaad.2024.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Affiliation(s)
| | | | | | - Brian Sayles
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Amy Rau
- Dermatology Specialists of Omaha, Omaha, Nebraska
| | | | - Anthony J Griess
- University of Nebraska Medical Center, Omaha, Nebraska; Dermatology Specialists of Omaha, Omaha, Nebraska
| |
Collapse
|
10
|
DuBois J, Jones TM, Lee MS, Falqués M, Kiyasova V, Jiménez G, Otero R, Jansat JM, Aubets J, Forconi RJ. Pharmacokinetics, Safety, and Tolerability of a Single 5-Day Treatment of Tirbanibulin Ointment 1% in 100 cm 2 : A Phase 1 Maximal-Use Trial in Patients with Actinic Keratosis. Clin Pharmacol Drug Dev 2024; 13:208-218. [PMID: 38185925 DOI: 10.1002/cpdd.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024]
Abstract
Tirbanibulin ointment 1% is approved in the United States and Europe for the treatment of actinic keratosis with demonstrated efficacy, safety, and tolerability when applied over a field up to 25 cm2 . This Phase 1 maximal-use trial determines the plasma pharmacokinetics, safety, and tolerability of tirbanibulin ointment 1% applied to 100 cm2 of the face or balding scalp in adults with actinic keratosis. Twenty-eight patients self-applied tirbanibulin once daily for a single 5-day treatment course. On Day 5, the mean maximum plasma concentration was 1.06 ng/mL and area under the plasma concentration-time curve during a dosing interval was 16.2 ng • h/mL. Systemic exposure was approximately 4-fold higher than in a previous pharmacokinetic study with a 25 cm2 field, consistent with the increase in the treated area. Tirbanibulin applied to a 100-cm2 treatment field showed favorable safety and tolerability. The most common treatment-emergent adverse events were application site reactions (in 35.7% of patients). All treatment-emergent adverse events and most of the tolerability signs were mild/moderate and resolved or returned to baseline by Day 29. In summary, under maximal-use conditions, tirbanibulin ointment 1% was safe and well tolerated supporting its potential use over a field up to 100 cm2 .
Collapse
Affiliation(s)
| | | | - Mark S Lee
- Progressive Clinical Research, San Antonio, TX, USA
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Shen AS, Heusinkveld LE, Updyke A, Nowacki AS, Warren CB, Maytin EV. Painless photodynamic therapy for facial actinic keratoses: A retrospective cohort study of the post-treatment inflammatory response. Photodiagnosis Photodyn Ther 2024; 45:103838. [PMID: 37844787 PMCID: PMC10922787 DOI: 10.1016/j.pdpdt.2023.103838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Photodynamic therapy (PDT) is a safe, non-mutagenic, and non-scarring treatment for actinic keratoses (AK). BACKGROUND 'Painless' photodynamic therapy (p-PDT) is a regimen for AK that employs simultaneous aminolevulinate incubation and blue light illumination. The efficacy of p-PDT resembles that of traditional PDT, but detailed mechanisms of action for p-PDT are not well understood. METHODS To characterize the inflammatory effects of the p-PDT procedure 48 h following treatment and determine the association of inflammation with precancer burden, we performed a retrospective cohort study of 104 patients with AK of face or scalp treated with p-PDT between 2017 and 2019. Patients self-reported their side effects 48 h following p-PDT and took photographs of their face and scalp. Photographs were edited to define seven anatomic regions, and erythema was scored by four investigators. RESULTS Ninety-eight patients provided photographs suitable for erythema evaluation. Most patients experienced 2 or more side effects and some pain 48 h post-procedure. Females experienced more pain (p = 0.01) and side effects (p = 0.002) compared to males. AK burden was positively associated with post p-PDT erythema response (p < 0.0001) at all sites, but particularly in the temples (p = 0.002) and supralabial area (p = 0.009). DISCUSSION This study confirms a strong clinical inflammatory response after p-PDT. Severity of inflammation is positively associated with AK tumor burden, suggesting that post-treatment inflammation may be a pre-requisite for p-PDT efficacy. Interestingly, the results also identify certain gender-related differences in the severity of side effects experienced by patients post-PDT.
Collapse
Affiliation(s)
- Alan S Shen
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lauren E Heusinkveld
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Abigail Updyke
- Department of Biomedical Engineering, Cleveland Clinic, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Amy S Nowacki
- Department of Quantitative Health Sciences; Cleveland Clinic, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Christine B Warren
- Department of Dermatology, Cleveland Clinic, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Edward V Maytin
- Department of Dermatology, Cleveland Clinic, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA; Department of Biomedical Engineering, Cleveland Clinic, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA; Department of Quantitative Health Sciences; Cleveland Clinic, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Desk A60, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
12
|
Garcia RM, Mobilia M, Newcomer JB, Wilson CL. Focal Neurotoxicity Associated With Topical 5-Fluorouracil. Cureus 2024; 16:e54365. [PMID: 38500891 PMCID: PMC10948119 DOI: 10.7759/cureus.54365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
Topical 5-Fluorouracil (5-FU) is an antineoplastic chemotherapy drug used to treat precancerous and cancerous skin growths, such as actinic keratoses (AKs), squamous cell carcinoma in situ, and superficial basal cell carcinoma. The topical agent may rarely cause neurotoxic adverse effects. Multiple cases of systemic 5-FU and capecitabine chemotherapy-induced neuropathies have been reported. However, until now, the topical administration of the drug has not been reported to cause neurotoxicity. We present a case of an 83-year-old male who was prescribed topical 5-FU 5% cream to treat AKs on the left anterior scalp and returned weeks later with the development of focal neurotoxicity in the treatment area. He presented with focal paralysis of the left medial frontalis muscle, with initial loss of sensation followed by intermittent pain and paresthesias, persisting four months after the cessation of therapy. He was referred to a neurologist and received a diagnosis of supraorbital neuralgia. The temporal relationship of symptom onset and the localization of symptoms to the treated area strongly suggests that the medication contributed to the observed neurologic effects. These effects are more likely to be observed in patients with a genetic deficiency of dihydropyrimidine dehydrogenase (DPD), which is responsible for the majority of 5-FU degradation (80%), therefore potentially leading to toxic levels of unmetabolized 5-FU. Providers should be aware of the potentially neurotoxic effects of topical 5-FU in order to properly counsel patients and to consider this as a possible etiology of neurologic deficits in patients using this drug.
Collapse
Affiliation(s)
- Ryan M Garcia
- Dermatology, University of Kentucky College of Medicine, Lexington, USA
| | - Maura Mobilia
- Dermatology, University of Kentucky College of Medicine, Lexington, USA
| | - Jack B Newcomer
- Dermatology, University of Kentucky College of Medicine, Lexington, USA
| | | |
Collapse
|
13
|
Li Pomi F, Vaccaro M, Pallio G, Rottura M, Irrera N, Borgia F. Tirbanibulin 1% Ointment for Actinic Keratosis: Results from a Real-Life Study. Medicina (Kaunas) 2024; 60:225. [PMID: 38399512 PMCID: PMC10890708 DOI: 10.3390/medicina60020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Tirbanibulin 1% ointment is a novel synthetic anti-proliferative agent that inhibits tubulin polymerization. It is approved for treating actinic keratosis (AK) on the face and scalp in adults. It has demonstrated good efficacy, an adequate safety profile and excellent patient adherence in the phase 3 clinical trials, however data about its real-life efficacy and safety are lacking. Here we report the experience of the dermatology unit of the University Hospital of Messina. Materials and Methods: We performed a spontaneous open-label, prospective non-randomized study to assess the effectiveness and safety of tirbanibulin 1% ointment for the treatment of 228 AKs in 38 consecutive patients-28 males (73%) and 10 females (26%)-aged between 52 and 92 years (mean age: 72 ± 8.92 years). Results: Total clearance was recorded in 51% of lesions, while partial clearance was recorded in 73% of lesions. An excellent tolerability profile and high compliance rate were observed, with no treatment discontinuation due to the onset of adverse events. Conclusion: Our real-life experience confirms the effectiveness and safety of tirbanibulin ointment for the treatment of AKs.
Collapse
Affiliation(s)
- Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
| | - Giovanni Pallio
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy;
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Messina, 98125 Messina, Italy; (M.R.); (N.I.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Messina, 98125 Messina, Italy; (M.R.); (N.I.)
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy; (F.L.P.); (M.V.)
| |
Collapse
|
14
|
Soare C, Cozma EC, Celarel AM, Rosca AM, Lupu M, Voiculescu VM. Digitally Enhanced Methods for the Diagnosis and Monitoring of Treatment Responses in Actinic Keratoses: A New Avenue in Personalized Skin Care. Cancers (Basel) 2024; 16:484. [PMID: 38339236 PMCID: PMC10854727 DOI: 10.3390/cancers16030484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Non-melanocytic skin cancers represent an important public health problem due to the increasing incidence and the important local destructive potential. Thus, the early diagnosis and treatment of precancerous lesions (actinic keratoses) is a priority for the dermatologist. In recent years, non-invasive skin imaging methods have seen an important development, moving from simple observational methods used in clinical research, to true diagnostic and treatment methods that make the dermatologist's life easier. Given the frequency of these precancerous lesions, their location on photo-exposed areas, as well as the long treatment periods, with variable, imprecise end-points, the need to use non-invasive imaging devices is increasingly evident to complete the clinical observations in the diagnosis and treatment of these lesions, with the aim of increasing accuracy and decreasing the adverse effects due to long treatment duration. This is the first review that brings together all skin imaging methods (dermoscopy, reflectance confocal microscopy, ultrasonography, dermoscopy-guided high frequency ultrasonography, and optical coherence tomography) used in the evaluation of actinic keratoses and their response to different treatment regimens.
Collapse
Affiliation(s)
- Cristina Soare
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Elena Codruta Cozma
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Celarel
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Rosca
- Department of Dermatology, University Military Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania;
| | - Mihai Lupu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Vlad Mihai Voiculescu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| |
Collapse
|
15
|
Luo OD, Bose R, Bawazir MA, Thuraisingam T, Ghazawi FM. A Review of the Dermatologic Clinical Applications of Topical Photodynamic Therapy. J Cutan Med Surg 2024; 28:NP1. [PMID: 38243786 DOI: 10.1177/12034754231216969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Topical photodynamic therapy is a widely approved therapy for actinic keratoses and low-risk nonmelanoma skin cancers with a rapidly growing range of emerging indications for other cutaneous diseases. This review summarizes the best-available evidence to provide a clinical update for dermatologists on the approved and emerging indications of photodynamic therapy. The body of evidence suggests that photodynamic therapy is superior or noninferior to other available treatment modalities for actinic keratoses, low-risk basal cell carcinomas, Bowen's disease, skin field cancerization, chemoprevention of keratinocyte carcinomas in organ transplant recipients, photoaging, acne vulgaris, and cutaneous infections including verrucae, onychomycosis, and cutaneous leishmaniasis. There is emerging evidence that photodynamic therapy plays a role in the management of actinic cheilitis, early-stage mycosis fungoides, extramammary Paget disease, lichen sclerosis, and folliculitis decalvans but there are no comparative studies with other active treatment modalities. Common barriers to topical photodynamic therapy include procedural pain, costs, and the time required for treatment delivery. There is significant heterogeneity in the photodynamic therapy protocols reported in the literature, including different photosensitizers, light sources, number of treatments, time between treatments, and use of procedural analgesia. Topical photodynamic therapy should be considered in the management of a spectrum of inflammatory, neoplastic, and infectious dermatoses. However, more comparative research is required to determine its role in the treatment algorithm for these dermatologic conditions and more methodological research is required to optimize photodynamic therapy protocols to improve the tolerability of the procedure for patients.
Collapse
Affiliation(s)
- Owen Dan Luo
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Reetesh Bose
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed A Bawazir
- Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Thusanth Thuraisingam
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Feras M Ghazawi
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Dermatology, Department of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
16
|
Zou DD, Sun YZ, Li XJ, Wu WJ, Xu D, He YT, Qi J, Tu Y, Tang Y, Tu YH, Wang XL, Li X, Lu FY, Huang L, Long H, He L, Li X. Single-cell sequencing highlights heterogeneity and malignant progression in actinic keratosis and cutaneous squamous cell carcinoma. eLife 2023; 12:e85270. [PMID: 38099574 PMCID: PMC10783873 DOI: 10.7554/elife.85270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most frequent of the keratinocyte-derived malignancies with actinic keratosis (AK) as a precancerous lesion. To comprehensively delineate the underlying mechanisms for the whole progression from normal skin to AK to invasive cSCC, we performed single-cell RNA sequencing (scRNA-seq) to acquire the transcriptomes of 138,982 cells from 13 samples of six patients including AK, squamous cell carcinoma in situ (SCCIS), cSCC, and their matched normal tissues, covering comprehensive clinical courses of cSCC. We identified diverse cell types, including important subtypes with different gene expression profiles and functions in major keratinocytes. In SCCIS, we discovered the malignant subtypes of basal cells with differential proliferative and migration potential. Differentially expressed genes (DEGs) analysis screened out multiple key driver genes including transcription factors along AK to cSCC progression. Immunohistochemistry (IHC)/immunofluorescence (IF) experiments and single-cell ATAC sequencing (scATAC-seq) data verified the expression changes of these genes. The functional experiments confirmed the important roles of these genes in regulating cell proliferation, apoptosis, migration, and invasion in cSCC tumor. Furthermore, we comprehensively described the tumor microenvironment (TME) landscape and potential keratinocyte-TME crosstalk in cSCC providing theoretical basis for immunotherapy. Together, our findings provide a valuable resource for deciphering the progression from AK to cSCC and identifying potential targets for anticancer treatment of cSCC.
Collapse
Affiliation(s)
- Dan-Dan Zou
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
- Department of Dermatology, The Affiliated Hospital of Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, KunmingYunnanChina
| | - Ya-Zhou Sun
- Clinical Big Data Research Center, The Seventh Affiliated Hospital of Sun Yat-sen UniversityShenzhen, GuangdongChina
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
| | - Xin-Jie Li
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
| | - Wen-Juan Wu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Dan Xu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Yu-Tong He
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
| | - Jue Qi
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Ying Tu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Yang Tang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Yun-Hua Tu
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Xiao-Li Wang
- Department of Dermatology, Changzheng Hospital, Naval Medical UniversityShanghaiChina
| | - Xing Li
- Department of Dermatology, People's Hospital of Chuxiong Yi Autonomous Prefecture, ChuxiongYunnanChina
| | - Feng-Yan Lu
- Department of Dermatology, Qujing Affiliated Hospital of Kunming Medical University, The First People’s Hospital of QujingYunnanChina
| | - Ling Huang
- Department of Dermatology, First Affiliated Hospital of Dali University, DaliYunnanChina
| | - Heng Long
- Wenshan Zhuang and Miao Autonomous Prefecture Dermatology Clinic, Wenshan Zhuang and Miao Autonomous Prefecture Specialist Hospital of Dermatology, WenshanYunnanChina
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical UniversityYunnanChina
| | - Xin Li
- School of Medical, Shenzhen Campus of Sun Yat-sen UniversityShenzhen, GuangdongChina
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen UniversityGuangdongChina
| |
Collapse
|
17
|
Campione E, Rivieccio A, Gaeta Shumak R, Costanza G, Cosio T, Lambiase S, Garofalo V, Artosi F, Lozzi F, Freni C, Romeo A, Dika E, Falconi M, Bianchi L. Preliminary Evidence of Efficacy, Safety, and Treatment Satisfaction with Tirbanibulin 1% Ointment: A Clinical Perspective on Actinic Keratoses. Pharmaceuticals (Basel) 2023; 16:1686. [PMID: 38139813 PMCID: PMC10748142 DOI: 10.3390/ph16121686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Actinic keratosis is a common precancerous skin lesion that can progress into invasive squamous cell carcinomas. Many topical treatments for actinic keratoses often have poor tolerability and prolonged duration. Tirbanibulin is a novel synthetic drug with potent antitumor and antiproliferative activities. METHODS We conducted a single-center, prospective and observational study using tirbanibulin ointment on a 25 cm2 area for 5 consecutive days on 30 participants with AKs on the face or scalp. They were followed for at least 57 days to assess the safety profile and efficacy of the drug as well as treatment satisfaction. We evaluated six signs of local skin reaction (LSR): erythema, scaling, crusting, swelling, blisters/pustules, and erosions/ulcerations, grading the severity as mild, moderate, or severe. The effectiveness was evaluated both clinically and dermoscopically. The treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). RESULTS On day 57, 70% of the patients showed a complete clinical and dermoscopic response. The highest scores obtained from the TSQM 1.4 were more evident in the convenience and side effects domains. Most LSRs, including erythema (83.3%), scaling (30%), and swelling (3.3%), occurred on day 8 but resolved spontaneously. CONCLUSION Tirbanibulin is a viable therapeutic option with a short regimen treatment and good tolerability, which favors therapy adherence.
Collapse
Affiliation(s)
- Elena Campione
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Antonia Rivieccio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Ruslana Gaeta Shumak
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Gaetana Costanza
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Terenzio Cosio
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
- Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Sara Lambiase
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Virginia Garofalo
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Fabio Artosi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Flavia Lozzi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| | - Claudia Freni
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (C.F.); (A.R.); (M.F.)
| | - Alice Romeo
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (C.F.); (A.R.); (M.F.)
| | - Emi Dika
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, DIMEC, University of Bologna, 40126 Bologna, Italy;
| | - Mattia Falconi
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (C.F.); (A.R.); (M.F.)
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (A.R.); (R.G.S.); (T.C.); (F.A.); (F.L.); (L.B.)
| |
Collapse
|
18
|
Li J, Zhang Y, Zhang G, Zhang L, Zhou Z, Wang P, Wang X. Modified painless photodynamic therapy for facial multiple actinic keratosis in China: A prospective split-face control study. Lasers Surg Med 2023; 55:871-879. [PMID: 37814511 DOI: 10.1002/lsm.23728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/08/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Aminolevulinic acid photodynamic therapy (ALA-PDT) is an effective treatment for multiple actinic keratosis (AK). However, PDT-induced pain often discontinues the therapy to reduce its efficacy, limiting its application. If modified painless PDT schedule with shorter photosensitizer dressing and higher dose illumination could achieve good efficacy in AK, it is still unknown. OBJECTIVES To explore the efficacy and pain tolerance of the modified painless PDT (M-PDT) in facial multiple AK. METHODS A split-face controlled clinical study including 14 patients with facial multiple AK was conducted. The patients received conventional PDT (C-PDT) on the left and M-PDT in the contralateral area. The left area (C-PDT) was illuminated by a red light-emitting diode light (144 J/cm2 ) after applying the 10% ALA cream for 3 h; the other had illumination for a total light dose of 288 J/cm2 after applying the 10% ALA cream for 0.5 h. The primary endpoint was the lesion clearance rate at 1-month postthree sessions of PDT. Secondary endpoints included pain scores, the incidence of adverse events during treatment, and cosmetic outcomes. RESULTS At 1 month following three treatments, the total lesion clearance rate was comparable between M-PDT and C-PDT (91.6% vs. 89.0%). While the lesion clearance rate of M-PDT was higher than that of C-PDT in the Grade III lesions (86.5% vs. 72.0%, respectively) (p < 0.05). M-PDT achieved a 100% lesion clearance rate for Grade I lesions earlier than C-PDT, with M-PDT treated twice and C-PDT treated thrice. Moreover, the pain score during illumination was significantly lower for M-PDT than for C-PDT (p < 0.01). Regarding photoaging, the Global Subjective Skin Aging Assessment score showed that the total and atrophy scores of C-PDT and M-PDT were significantly improved, and M-PDT also reduced discoloration. There was no significant difference in adverse reactions between C-PDT and M-PDT. CONCLUSIONS M-PDT is comparable to C-PDT's efficacy for treating facial multiple AK, resulting in much lower pain scores.
Collapse
Affiliation(s)
- Jiandan Li
- School of Medicine, Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, PR China
| | - Yunfeng Zhang
- School of Medicine, Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, PR China
| | - Guolong Zhang
- School of Medicine, Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, PR China
| | - Linglin Zhang
- School of Medicine, Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, PR China
| | - Zhongxia Zhou
- School of Medicine, Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, PR China
| | - Peiru Wang
- School of Medicine, Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, PR China
| | - Xiuli Wang
- School of Medicine, Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, Shanghai, PR China
| |
Collapse
|
19
|
Soto‐Moreno A, Montero‐Vilchez T, Diaz‐Calvillo P, Molina‐Leyva A, Arias‐Santiago S. The impact of photodynamic therapy on skin homeostasis in patients with actinic keratosis: A prospective observational study. Skin Res Technol 2023; 29:e13493. [PMID: 38017667 PMCID: PMC10684974 DOI: 10.1111/srt.13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AKs), but there is little information on how PDT affects skin barrier function. The objectives of this study are: To compare skin barrier function between skin with AKs and healthy skin and to evaluate the impact of PDT on skin homeostasis in patients with AKs. METHODS A prospective observational study was conducted in patients with AKs to evaluate epidermal barrier function and skin homeostasis before and 1 ek after receiving PDT. RESULTS A total of 21 subjects were included in the study, male/female ratio was 17:4, mean age was 75.86 years. The number of AKS observed before starting treatment was reduced with respect to those diagnosed 1 month after starting PDT (14.83 vs. 1.91, p < 0.0001). Application of PDT for treating AKs modifies epidermal barrier function. Immediately after the first session temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH) and total antioxidant capacity (TAC) increased while pH decreased on lesional skin. After 1-month follow-up, the only remained change was the increased in SCH. Higher increases in temperature were observed when using occlusive PDT compared to mixed modality. 5-ALA and M-ALA seem to have a similar impact on skin barrier. CONCLUSIONS PDT can improve skin barrier function in patients with AKs. Skin homeostasis parameters can be used to assess efficacy and optimize dosing.
Collapse
Affiliation(s)
- Alberto Soto‐Moreno
- Dermatology DepartmentHospital Universitario Virgen de las NievesGranadaSpain
| | - Trinidad Montero‐Vilchez
- Dermatology DepartmentHospital Universitario Virgen de las NievesGranadaSpain
- TECe19‐Dermatología Clínica y TraslacionalInstituto de Investigación Biosanitaria ibs. GRANADAGranadaSpain
| | - Pablo Diaz‐Calvillo
- Dermatology DepartmentHospital Universitario Virgen de las NievesGranadaSpain
| | - Alejandro Molina‐Leyva
- Dermatology DepartmentHospital Universitario Virgen de las NievesGranadaSpain
- TECe19‐Dermatología Clínica y TraslacionalInstituto de Investigación Biosanitaria ibs. GRANADAGranadaSpain
| | - Salvador Arias‐Santiago
- Dermatology DepartmentHospital Universitario Virgen de las NievesGranadaSpain
- TECe19‐Dermatología Clínica y TraslacionalInstituto de Investigación Biosanitaria ibs. GRANADAGranadaSpain
| |
Collapse
|
20
|
Orte Cano C, Suppa M, del Marmol V. Where Artificial Intelligence Can Take Us in the Management and Understanding of Cancerization Fields. Cancers (Basel) 2023; 15:5264. [PMID: 37958437 PMCID: PMC10649750 DOI: 10.3390/cancers15215264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/15/2023] Open
Abstract
Squamous cell carcinoma and its precursor lesion actinic keratosis are often found together in areas of skin chronically exposed to sun, otherwise called cancerisation fields. The clinical assessment of cancerisation fields and the correct diagnosis of lesions within these fields is usually challenging for dermatologists. The recent adoption of skin cancer diagnostic imaging techniques, particularly LC-OCT, helps clinicians in guiding treatment decisions of cancerization fields in a non-invasive way. The combination of artificial intelligence and non-invasive skin imaging opens up many possibilities as AI can perform tasks impossible for humans in a reasonable amount of time. In this text we review past examples of the application of AI to dermatological images for actinic keratosis/squamous cell carcinoma diagnosis, and we discuss about the prospects of the application of AI for the characterization and management of cancerization fields.
Collapse
Affiliation(s)
- Carmen Orte Cano
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Groupe d’Imagerie Cutanée Non Invasive (GICNI), Société Française de Dermatologie (SFD), 75008 Paris, France
| | - Véronique del Marmol
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
| |
Collapse
|
21
|
Hackney J, Swerlick RA, Muir J. The limits of claims databases: A response to "A comparison of invasive squamous cell carcinoma greater than 1 year after treatment with 5-fluorouracil, imiquimod, or photodynamic therapy with aminolevulinic acid". J Am Acad Dermatol 2023; 89:e219-e220. [PMID: 36775103 DOI: 10.1016/j.jaad.2022.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 02/12/2023]
Affiliation(s)
- Joshua Hackney
- School of Medicine, Griffith University, Queensland, Australia.
| | - Robert A Swerlick
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - James Muir
- The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
22
|
McCampbell L, Zaino M, Prajapati S, Kontzias C, Feldman SR. Relationship Between Number of Actinic Keratosis and Size of Field of Photodamage. J Cutan Med Surg 2023; 27:664-665. [PMID: 37823359 DOI: 10.1177/12034754231204860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Lillian McCampbell
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mallory Zaino
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Stuti Prajapati
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christina Kontzias
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
23
|
Mansilla-Polo M, Abril-Pérez C, Martín-Torregrosa D, López-Davia J, de Unamuno-Bustos B, Torres-Navarro I, Escutia-Muñoz B, Botella-Estrada R. Effectiveness, safety and satisfaction of 1% tirbanibulin ointment in the treatment of actinic keratoses: A prospective study in real clinical practice. Australas J Dermatol 2023; 64:560-564. [PMID: 37675890 DOI: 10.1111/ajd.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Miguel Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Carlos Abril-Pérez
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Daniel Martín-Torregrosa
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Javier López-Davia
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Blanca de Unamuno-Bustos
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Ignacio Torres-Navarro
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Begoña Escutia-Muñoz
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Rafael Botella-Estrada
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
- University of Valencia, Valencia, Spain
| |
Collapse
|
24
|
Fronville M, Creusot M, Mordon SR. Is a 4 J/cm 2 PpIX-Weighted Simulated Daylight (SDL-PDT) Dose Still Efficient for Photodynamic Therapy of Actinic Keratosis? Pharmaceuticals (Basel) 2023; 16:1454. [PMID: 37895925 PMCID: PMC10610017 DOI: 10.3390/ph16101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/19/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Several solutions are now proposed to provide indoor illumination with so-called artificial white light or simulated daylight (SDL-PDT), resulting in an effective treatment for actinic keratosis (AK). However, the optimal PpIX-weighted light dose is still debated. Integrating the effective irradiance over the irradiation time yields the effective light dose, which is also known as the protoporphyrin IX-weighted light dose and is a key parameter for the efficacy of the treatment. Objectives: The paper aims to report the clinical outcomes of SDL-PDT when using the PpIX-weighted light dose of 4 J/cm2, in patients treated for AK lesions of the scalp or the face at our medical dermatology center (ClinicalTrials.gov NCT052036). Methods: A total of 30 patients (16 males, 14 females), with a mean age of 71.0 ± 10.2, with phototype 1 (16 patients) and phototype 2 (14 patients) with grade I-II AK were treated with a drug light interval (DLI) of 10 min and a light exposure of 35 min (Dermaris, Surgiris, Croix, France), corresponding to a PpIX-weighted light dose of 4 J/cm2. The primary endpoint was the cure rate of patients at six months post-treatment. Secondary endpoints included scores of pain, erythema, crusts, and discomfort during or/and post the treatment. Results: In total, 762 AK were treated. Six months following treatment, the cure rate of the patients was 77%. The median pain score was less than 1 out of 10 for most of the patients. Erythema was observed in all patients and lasted 3 days (±1.5 day). Crusts were seen in 28 patients. Discomfort was reported as mild or less in more than 97% of patients. Conclusions: The shortening of the PpIX-weighted light dose to 4 J/cm2, corresponding to an illumination duration of 35 min with the Dermaris, does not modify the efficacy of the SDL-PDT. This observation is in agreement with recent published data demonstrating that the light dose can be reduced. Furthermore, this clinical study confirmed that SDL-PDT is an effective and nearly painless treatment with minimal side effects for patients with AK lesions of the scalp.
Collapse
Affiliation(s)
- Mathilde Fronville
- Centre Dermatologique du Roy, Plancenoit, 1380 Lasne, Belgium; (M.F.); (M.C.)
| | - Muriel Creusot
- Centre Dermatologique du Roy, Plancenoit, 1380 Lasne, Belgium; (M.F.); (M.C.)
| | | |
Collapse
|
25
|
Derekas P, Spyridonos P, Likas A, Zampeta A, Gaitanis G, Bassukas I. The Promise of Semantic Segmentation in Detecting Actinic Keratosis Using Clinical Photography in the Wild. Cancers (Basel) 2023; 15:4861. [PMID: 37835555 PMCID: PMC10571759 DOI: 10.3390/cancers15194861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
AK is a common precancerous skin condition that requires effective detection and treatment monitoring. To improve the monitoring of the AK burden in clinical settings with enhanced automation and precision, the present study evaluates the application of semantic segmentation based on the U-Net architecture (i.e., AKU-Net). AKU-Net employs transfer learning to compensate for the relatively small dataset of annotated images and integrates a recurrent process based on convLSTM to exploit contextual information and address the challenges related to the low contrast and ambiguous boundaries of AK-affected skin regions. We used an annotated dataset of 569 clinical photographs from 115 patients with actinic keratosis to train and evaluate the model. From each photograph, patches of 512 × 512 pixels were extracted using translation lesion boxes that encompassed lesions in different positions and captured different contexts of perilesional skin. In total, 16,488 translation-augmented crops were used for training the model, and 403 lesion center crops were used for testing. To demonstrate the improvements in AK detection, AKU-Net was compared with plain U-Net and U-Net++ architectures. The experimental results highlighted the effectiveness of AKU-Net, improving upon both automation and precision over existing approaches, paving the way for more effective and reliable evaluation of actinic keratosis in clinical settings.
Collapse
Affiliation(s)
- Panagiotis Derekas
- Department of Computer Science & Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece; (P.D.); (A.L.)
| | - Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Aristidis Likas
- Department of Computer Science & Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece; (P.D.); (A.L.)
| | - Athanasia Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (G.G.); (I.B.)
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (G.G.); (I.B.)
| | - Ioannis Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (G.G.); (I.B.)
| |
Collapse
|
26
|
Bakirtzi K, Papadimitriou I, Vakirlis E, Lallas A, Sotiriou E. Photodynamic Therapy for Field Cancerization in the Skin: Where Do We Stand? Dermatol Pract Concept 2023; 13:dpc.1304a291. [PMID: 37992384 PMCID: PMC10656191 DOI: 10.5826/dpc.1304a291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Photodynamic therapy (PDT) with a photosensitizer is available for the treatment of multiple actinic keratoses (AKs) in a restricted skin area or, as it is established, for the field-cancerized skin. OBJECTIVES Our review aims to present the up-to-date literature on skin field cancerization using PDT employing different topical photosensitizers, modified light delivery protocols and combination treatments to obtain excellent efficacy and safety in everyday clinical practice. METHODS We sought PubMed, MEDLINE, Scopus, OVID, Embase, Science Direct, Cochrane Library, Research Gate and Google Scholar for [(aminolevulinic acid OR aminolevulinate) AND photodynamic therapy] with (field-directed OR field cancerization, (actinic keratosis), and (efficacy OR effectiveness OR pain OR tolerability) for studies published until February 2023. RESULTS Advantages of PDT compared to the other field treatments, including imiquimod, 5-fluorouracil, ingenol mebutate gel and diclofenac, reported better cosmetic outcomes and greater patient satisfaction. On the other hand, some drawbacks of field PDT include pain and treatment duration. Alternate illumination methods have also been investigated, including daylight as a light source. Pretreating the affected area may enhance photosensitizer absorption leading to better therapeutic results, while combinational treatments have also been tested. Patients prefer daylight PDT to traditional light sources since it is more well-tolerated and equally effective. Even as a preventive treatment, field PDT yields promising outcomes, especially for high-risk individuals, including organ transplant recipients. CONCLUSIONS This review provides a thorough display of the field of PDT on cancerized skin, which will facilitate physicians in applying PDT more efficiently and intuitively.
Collapse
Affiliation(s)
- Katerina Bakirtzi
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilias Papadimitriou
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Sotiriou
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
27
|
Kincaid CM, Horton L, Mesinkovska NA, Lee P. Trends in Medicare claims and costs for field therapies by dermatologists. J Am Acad Dermatol 2023; 89:810-811. [PMID: 37269924 DOI: 10.1016/j.jaad.2023.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Colin M Kincaid
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Luke Horton
- Department of Dermatology, University of California, Irvine, Irvine, California
| | | | - Patrick Lee
- Department of Dermatology, University of California, Irvine, Irvine, California
| |
Collapse
|
28
|
Almheiri SK, Almrzooqi EAM. Erosive Pustular Dermatosis of the Scalp in a Patient With Vitiligo Successfully Treated With Topical Antibiotics. Cureus 2023; 15:e45913. [PMID: 37885526 PMCID: PMC10599214 DOI: 10.7759/cureus.45913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Erosive pustular dermatosis of the scalp is a rare inflammatory skin disorder that most commonly affects the elderly with androgenic alopecia. It is characterized by painless crusted erosions that usually appear following a traumatic event. It has been associated with several autoimmune diseases and commonly responds to high-potency topical steroids.This report presents a rare case of erosive pustular dermatosis of the scalp in an 84-year-old man who presented to our clinic.
Collapse
|
29
|
Trovato E, Fiorani D, Cartocci A, Cinotti E, Rubegni P. IGF1 synthesis after CO 2 fractional laser resurfacing (FLR): New insights in the treatment of scalp actinic keratoses. Lasers Surg Med 2023; 55:642-652. [PMID: 37222180 DOI: 10.1002/lsm.23680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/06/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Actinic keratosis have a high risk of progression to a squamous cell carcinoma. Insulin-like growth factor 1 and its receptor play a relevant role in restoring repair of ultraviolet-induced cell damage. This pathway is reduced in patients older than 65 years. Ablative fractional laser resurfacing could normalize insulin-like growth factor 1 (IGF-1) secretion in elderly by recruiting new fibroblasts. The aim of the study is to evaluate restoration of IGF1 values by PCR in senescent fibroblasts after ablative fractional laser resurfacing. METHODS We enrolled 30 male patients with multiple actinic keratosis on the scalp, equally divided into two mirror areas of up to 50 cm2 , treating only the right one. We performed one skin biopsy for each area 30 days after treatment. Real-time PCR in fibroblasts was performed to assess the change in IGF1. At baseline and after 6 months, in vivo reflectance confocal microscopy examination was performed in all patients. RESULTS IGF1 values were increased in the treated side by about 60%. The right areas had fairly complete resolution of actinic keratosis at the last follow-up visit after 6 months with no appearance of new lesions. The mean number of actinic keratosis in the right area was reduced by more than 75% at four- and six-follow-up visits compared to the left area. The improvement in the right area was also evidenced by lower values of the mean AKASI (actinic keratosis area and severity index) score. Reflectance confocal microscopy showed a reduction of keratinocytic disarray and scales after treatment. DISCUSSION Taken together, all the clinical, laboratory, and in vivo results of our study allowed us to confirm that ablative fractional laser resurfacing is a valuable tool for the treatment of actinic keratosis and cancerization field, both for the management of clinically evident lesions and for preventing the occurrence of squamous cell carcinoma.
Collapse
Affiliation(s)
- Emanuele Trovato
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Diletta Fiorani
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | | | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| |
Collapse
|
30
|
Ogura Y, Shimano M, Bise R, Yamashita T, Katagiri C, Sato I. Analysis of optical absorption of photoaged human skin using a high-frequency illumination microscopy analysis system. Exp Dermatol 2023; 32:1402-1411. [PMID: 37264684 DOI: 10.1111/exd.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/04/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
Skin is composed of different layers, including the stratum corneum, epidermal living layer and papillary and reticular dermis. Each has specific optical properties due to differences in their biological components. Alterations in the skin's cutaneous biological components resulting from photoaging caused by chronic exposure to UV light affect the deterioration of appearance associated with the skin's optical properties. Various methods for analysing cutaneous optical properties have been previously proposed, including mathematical models and computer simulations. However, these were insufficient to elucidate changes in each skin layer and comprehensively understand the skin's integrated optical properties. We focused on UV-induced yellowing of the facial skin. We evaluated site-specific optical absorption of human skin tissue sections to investigate the yellowish discoloration, which is suggested to be related to the photodamage process. The method includes our original technique of separating the transmitted and scattered light using high-frequency illumination microscopy, leading to microscopic analysis of the tissue's optical absorption in the regions of interest. In analysing the sun-exposed facial skin tissue sections, we successfully showed that dermal regions of aged skin have increased absorption at 450 nm, where yellowish colours are complemented. Furthermore, we confirmed that elastic fibres with observable histological disorder resulting from photodamage are a prominent source of high optical absorption. We detected changes in the skin's optical absorption associated with dermal degeneration resulting from photodamage using a novel optical microscopy technique. The results provide a base for the evaluation of optical property changes for both yellowing discoloration and other tissue disorders.
Collapse
Affiliation(s)
- Yuki Ogura
- Shiseido Global Innovation Center, Yokohama, Japan
| | | | - Ryoma Bise
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | | | | | - Imari Sato
- National Institute of Informatics, Tokyo, Japan
| |
Collapse
|
31
|
Mahen KK, Markley L, Bogart J, Klatka H, Krishna V, Maytin EV, Stark GR, McDonald C. Topical N-phosphonacetyl-l-aspartate is a dual action candidate for treating non-melanoma skin cancer. Exp Dermatol 2023; 32:1485-1497. [PMID: 37309615 PMCID: PMC10527533 DOI: 10.1111/exd.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Each year, 3.3 million Americans are diagnosed with non-melanoma skin cancers (NMSC) and an additional 40 million individuals undergo treatment of precancerous actinic keratosis lesions. The most effective treatments of NMSC (surgical excision and Mohs surgery) are invasive, expensive and require specialised training. More readily accessible topical therapies currently are 5-fluorouracil (a chemotherapeutic agent) and imiquimod (an immune modulator), but these can have significant side effects which limit their efficacy. Therefore, more effective and accessible treatments are needed for non-melanoma cancers and precancers. Our previous work demonstrated that the small molecule N-phosphonacetyl-L-aspartate (PALA) both inhibits pyrimidine nucleotide synthesis and activates pattern recognition receptor nucleotide-binding oligomerization domain 2. We propose that topical application of PALA would be an effective NMSC therapy, by combining the chemotherapeutic and immune modulatory features of 5-fluorouracil and imiquimod. Daily topical application of PALA to mouse skin was well tolerated and resulted in less irritation, fewer histopathological changes, and less inflammation than caused by either 5-fluorouracil or imiquimod. In an ultraviolet light-induced NMSC mouse model, topical PALA treatment substantially reduced the numbers, areas and grades of tumours, compared to vehicle controls. This anti-neoplastic activity was associated with increased expression of the antimicrobial peptide cathelicidin and increased recruitment of CD8+ T cells and F4/80+ macrophages to the tumours, demonstrating both immunomodulatory and anti-proliferative effects. These findings indicate that topical PALA is an excellent candidate as an effective alternative to current standard-of-care NMSC therapies.
Collapse
Affiliation(s)
- Kala K. Mahen
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Lilian Markley
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Jolie Bogart
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Hope Klatka
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Vijay Krishna
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Edward V. Maytin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
- Department of Dermatology, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - George R. Stark
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| | - Christine McDonald
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
| |
Collapse
|
32
|
Lindholm V, Salmivuori M, Hahtola S, Kerttu Mäkelä, Pitkänen S, Isoherranen K. Ablative Fractional Laser Enhances Artificial or Natural Daylight Photodynamic Therapy of Actinic Field Cancerization: A Randomized and Investigator-initiated Half-side Comparative Study. Acta Derm Venereol 2023; 103:adv6579. [PMID: 37584092 PMCID: PMC10442926 DOI: 10.2340/actadv.v103.6579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/31/2023] [Indexed: 08/17/2023] Open
Abstract
Artificial daylight photodynamic therapy is a near-painless treatment for actinic keratoses, which can be performed indoors using a controlled light dose. Daylight photodynamic therapy is approved only for treatment of grade I-II actinic keratoses. The aim of this study was to evaluate whether fractional laser pre-treatment improves the outcomes of daylight photodynamic therapy for actinic keratoses of all grades. In addition, the study compared the outcomes of artificial and natural daylight photodynamic therapy. This randomized single-blinded split-side comparative study included 60 patients with ≥ 2 actinic keratoses of the head. Fractional laser pre-treatment was assigned randomly for actinic keratoses on 1 side of the head and, subsequently, the entire treatment area was treated with artificial or natural daylight photodynamic therapy. Fractional laser-mediated daylight photodynamic therapy achieved significantly higher complete clearance (50.0% vs 30.3%, p = 0.04), partial clearance (78.6% vs 50.0%, p < 0.01) and lesion-specific clearance (86.2% vs 70.2%, p < 0.01) than daylight photodynamic therapy alone at the 6-month follow-up. No significant differences were found in the outcomes of artificial vs natural daylight photodynamic therapy or grade I lesions vs grade II-III lesions. Thus, fractional laser pre-treatment appears to significantly increase the efficacy of artificial and natural daylight photodynamic therapy, and to be suitable for treatment of actinic keratoses of all grades.
Collapse
Affiliation(s)
- Vivian Lindholm
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland.
| | - Mari Salmivuori
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Sonja Hahtola
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Kerttu Mäkelä
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Sari Pitkänen
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Kirsi Isoherranen
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| |
Collapse
|
33
|
Tan IJ, Pathak GN, Silver FH. Topical Treatments for Basal Cell Carcinoma and Actinic Keratosis in the United States. Cancers (Basel) 2023; 15:3927. [PMID: 37568743 PMCID: PMC10416997 DOI: 10.3390/cancers15153927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Skin cancer is an overarching label used to classify a variety of cutaneous malignancies. Surgical excision procedures are the commonly used treatments for these lesions; however, the choice to perform operative intervention may be influenced by other factors. Established research and literature suggest that topical treatments limit the need for surgical intervention and its commonly associated adverse effects, including infection and scarring. In addition, the growing indications for the usage of topical therapies in BCC treatment, as well as their increased availability and therapeutic options, allow for their greater applicability in the dermatology clinic. Certain topical therapies have been highlighted in research, especially those targeting basal cell carcinoma (BCC) and actinic keratosis (AK). There is also a clear correlation between cost and treatment outcomes, considering BCC's ever-growing prevalence and the proportion of excised lesions being reported as malignant. This review will discuss BCC and AK lesion criteria that result in the most successful outcomes using topical treatments, then highlight the various topical treatment options, and finally address their clinical significance moving forward.
Collapse
Affiliation(s)
| | | | - Frederick H. Silver
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08854, USA
| |
Collapse
|
34
|
Ruiz AJ, Allen R, Giallorenzi MK, Samkoe KS, Shane Chapman M, Pogue BW. Smartphone-based dual radiometric fluorescence and white-light imager for quantification of protoporphyrin IX in skin. J Biomed Opt 2023; 28:086003. [PMID: 37638107 PMCID: PMC10460113 DOI: 10.1117/1.jbo.28.8.086003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/06/2023] [Indexed: 08/29/2023]
Abstract
Significance The quantification of protoporphyrin IX (PpIX) in skin can be used to study photodynamic therapy (PDT) treatments, understand porphyrin mechanisms, and enhance preoperative mapping of non-melanoma skin cancers. Aim We aim to develop a smartphone-based imager for performing simultaneous radiometric fluorescence (FL) and white light (WL) imaging to study the baseline levels, accumulation, and photobleaching of PpIX in skin. Approach A smartphone-based dual FL and WL imager (sDUO) is introduced alongside new radiometric calibration methods for providing SI-units of measurements in both pre-clinical and clinical settings. These radiometric measurements and corresponding PpIX concentration estimations are applied to clinical measurements to understand mechanistic differences between PDT treatments, accumulation differences between normal tissue and actinic keratosis lesions, and the correlation of photosensitizer concentrations to treatment outcomes. Results The sDUO alongside the developed methods provided radiometric FL measurements (nW / cm 2 ) with a demonstrated sub nanomolar PpIX sensitivity in 1% intralipid phantoms. Patients undergoing PDT treatment of actinic keratosis (AK) lesions were imaged, capturing the increase and subsequent decrease in FL associated with the incubation and irradiation timepoints of lamp-based PDT. Furthermore, the clinical measurements showed mechanistic differences in new daylight-based treatment modalities alongside the selective accumulation of PpIX within AK lesions. The use of the radiometric calibration enabled the reporting of detected PpIX FL in units of nW / cm 2 with the use of liquid phantom measurements allowing for the estimation of in-vivo molar concentrations of skin PpIX. Conclusions The phantom, pre-clinical, and clinical measurements demonstrated the capability of the sDUO to provide quantitative measurements of PpIX FL. The results demonstrate the use of the sDUO for the quantification of PpIX accumulation and photobleaching in a clinical setting, with implications for improving the diagnosis and treatment of various skin conditions.
Collapse
Affiliation(s)
- Alberto J. Ruiz
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- QUEL Imaging, LLC, White River Junction, Vermont, United States
| | - Richard Allen
- QUEL Imaging, LLC, White River Junction, Vermont, United States
| | - Mia K. Giallorenzi
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Kimberley S. Samkoe
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - M. Shane Chapman
- Dartmouth Health, Department of Dermatology, Lebanon, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
| |
Collapse
|
35
|
Minoretti P, Emanuele E, García Martín Á, Liaño Riera M, Gómez Serrano M, Santiago Sáez A. Exploring the Protective Efficacy of Topical Products for Actinic Keratosis Against Ultraviolet-Induced DNA and Protein Damage: An Experimental, Double-Blind Irradiation Study. Cureus 2023; 15:e44065. [PMID: 37746407 PMCID: PMC10517867 DOI: 10.7759/cureus.44065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Numerous studies have delved into the clinical efficacy of different topical treatments for actinic keratosis (AK). However, our understanding remains limited regarding their capacity to prevent DNA and protein damage caused by ultraviolet radiation (UVR). Objectives The aim of this study was to analyze and compare the preventive capabilities of various AK-targeted products in countering DNA and protein alterations in human biopsies following exposure to experimental UVR. Methods Twelve healthy Caucasian volunteers (six men and six women) aged 18 years and above, with Fitzpatrick skin types II-III, participated in an experimental irradiation study. Six topical products, containing various ingredients (DNA repair enzymes, antioxidants, keratolytic agents, cyclooxygenase inhibitors, and/or sunscreens) were tested. The experimental sites were exposed to UVR at six times the minimal erythema dose for eight consecutive days. Each test product was applied 30 to 45 minutes before irradiation at a standard thickness of 2 mg/cm2. A control site was treated with the vehicle alone, serving as a negative control. The study focused on cyclobutane pyrimidine dimers (CPDs) and protein carbonylation (PC) as molecular markers of UVR-induced DNA and protein damage, respectively. Results The efficacy of different AK-targeted topical products showed substantial variation when applied to normal skin before experimental exposure to UVR. While sunscreens, predictably, played a crucial role, additional ingredients (i.e., DNA repair enzymes and antioxidants) also acted as vital protective agents for both the cellular genome and proteome, shielding them against UVR-induced damage. Conclusion In topical products specifically designed for AK, the strategic integration of DNA repair enzymes and antioxidants, in addition to sunscreens, establishes a critical defense mechanism against the detrimental effects of UVR on cellular DNA and proteins.
Collapse
Affiliation(s)
| | | | - Ángel García Martín
- Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid, ESP
| | - Miryam Liaño Riera
- Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid, ESP
| | - Manuel Gómez Serrano
- Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid, ESP
| | - Andrés Santiago Sáez
- Legal Medicine, Hospital Clinico San Carlos, Madrid, ESP
- Legal Medicine, Psychiatry, and Pathology, Complutense University of Madrid, Madrid, ESP
| |
Collapse
|
36
|
Kirchberger MC, Gfesser M, Erdmann M, Schliep S, Berking C, Heppt MV. Tirbanibulin 1% Ointment Significantly Reduces the Actinic Keratosis Area and Severity Index in Patients with Actinic Keratosis: Results from a Real-World Study. J Clin Med 2023; 12:4837. [PMID: 37510952 PMCID: PMC10381110 DOI: 10.3390/jcm12144837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Actinic keratosis (AK) is a cutaneous lesion resulting from the proliferation of atypical epidermal keratinocytes caused by long-term exposure to ultraviolet radiation. AK may progress to cutaneous squamous cell carcinoma (cSCC) and therefore is often treated with topical agents such as 5-fluorouracil, diclofenac, imiquimod, and photodynamic therapy. Tirbanibulin has been approved based on two phase III trials in the USA. However, real-world evidence for tirbanibulin is absent. METHODS This was a single-centre study of adult patients with clinically typical, visible AK on the face or scalp treated with tirbanibulin 1% ointment. Treatment was administered as per label once daily for 5 consecutive days on the same lesions or field. Treatment outcomes were assessed 4 weeks after treatment, with additional optional assessments conducted at later time points. Efficacy was measured using the actinic keratosis area and severity index (AKASI) and digital dermoscopy. RESULTS A total of 33 patients were treated of whom 30 were analysed. The median AKASI score was 5.6 (1.4-11) pre-treatment and 1.2 (0-7.4) post-treatment (p < 0.0001). Complete clearance as defined by AKASI scores less than 1 was achieved in 47% (n = 14) and 57% (n = 13) at the first and second follow-up, respectively. All local reactions resolved spontaneously and without sequelae. The most common local reactions were erythema (80%, n = 26) and flaking or scaling (43%, n = 13). CONCLUSIONS Tirbanibulin 1% ointment significantly and rapidly reduced the AKASI score in a real-world setting. The complete clearance rates were in line with those observed in the two pivotal trials.
Collapse
Affiliation(s)
- Michael Constantin Kirchberger
- Hautarztzentrum Ingolstadt, Schlüterstr. 3a, 85057 Ingolstadt, Germany
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Michael Gfesser
- Hautarztzentrum Ingolstadt, Schlüterstr. 3a, 85057 Ingolstadt, Germany
| | - Michael Erdmann
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Stefan Schliep
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus Vincent Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| |
Collapse
|
37
|
Garcia-Mouronte E, Berna-Rico E, de Nicolas-Ruanes B, Azcarraga-Llobet C, Alonso-Martinez de Salinas L, Bea-Ardebol S. Imiquimod as Local Immunotherapy in the Management of Premalignant Cutaneous Conditions and Skin Cancer. Int J Mol Sci 2023; 24:10835. [PMID: 37446011 DOI: 10.3390/ijms241310835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Cutaneous cancers are, by far, the most common malignant neoplasms of the human being. Due to the great array of clinical conditions, their worldwide increasing incidence and the steady ageing of the population, non-invasive treatments modalities that show a good clinical response, a proper benefit-risk ratio and cosmetic results are becoming increasingly important in the clinical setting. Imiquimod is a topically applied immunomodulator which is often used in the management of several premalignant and malignant cutaneous disorders. This article is a review of the current literature on its mechanism of action, pharmacokinetics, and therapeutical effects.
Collapse
Affiliation(s)
| | - Emilio Berna-Rico
- Dermatology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | | | | | | | - Sonia Bea-Ardebol
- Dermatology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| |
Collapse
|
38
|
Li S, Li C, Liu Q, Pei Y, Wang L, Shen Z. An Actinic Keratosis Auxiliary Diagnosis Method Based on an Enhanced MobileNet Model. Bioengineering (Basel) 2023; 10:732. [PMID: 37370662 DOI: 10.3390/bioengineering10060732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Actinic keratosis (AK) is a common precancerous skin lesion with significant harm, and it is often confused with non-actinic keratoses (NAK). At present, the diagnosis of AK mainly depends on clinical experience and histopathology. Due to the high difficulty of diagnosis and easy confusion with other diseases, this article aims to develop a convolutional neural network that can efficiently, accurately, and automatically diagnose AK. This article improves the MobileNet model and uses the AK and NAK images in the HAM10000 dataset for training and testing after data preprocessing, and we performed external independent testing using a separate dataset to validate our preprocessing approach and to demonstrate the performance and generalization capability of our model. It further compares common deep learning models in the field of skin diseases (including the original MobileNet, ResNet, GoogleNet, EfficientNet, and Xception). The results show that the improved MobileNet has achieved 0.9265 in accuracy and 0.97 in Area Under the ROC Curve (AUC), which is the best among the comparison models. At the same time, it has the shortest training time, and the total time of five-fold cross-validation on local devices only takes 821.7 s. Local experiments show that the method proposed in this article has high accuracy and stability in diagnosing AK. Our method will help doctors diagnose AK more efficiently and accurately, allowing patients to receive timely diagnosis and treatment.
Collapse
Affiliation(s)
- Shiyang Li
- School of Information Science and Engineering, Yunnan University, Kunming 650091, China
| | - Chengquan Li
- School of Clinical Medicine, Tsinghua University, Beijing 100084, China
| | - Qicai Liu
- Center for Reproductive Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350004, China
- Vanke School of Public Health, Tsinghua University, Beijing 100084, China
| | - Yilin Pei
- School of Clinical Medicine, Tsinghua University, Beijing 100084, China
| | - Liyang Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100084, China
| | - Zhu Shen
- Department of Dermatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| |
Collapse
|
39
|
Kehrmann J, Koch F, Zumdick S, Höwner A, Best L, Masshöfer L, Scharfenberg S, Zeschnigk M, Becker JC, Schadendorf D, Buer J, Roesch A. Reduced Staphylococcus Abundance Characterizes the Lesional Microbiome of Actinic Keratosis Patients after Field-Directed Therapies. Microbiol Spectr 2023; 11:e0440122. [PMID: 37212689 PMCID: PMC10269920 DOI: 10.1128/spectrum.04401-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/23/2023] [Indexed: 05/23/2023] Open
Abstract
Skin microbiome dysbiosis with a Staphylococcus overabundance is a feature of actinic keratosis (AK) and squamous skin carcinoma (SCC) patients. The impact of lesion-directed treatments for AK lesions such as diclofenac (DIC) and cold atmospheric plasma (CAP) on the lesional microbiome is not established. We studied 321 skin microbiome samples of 59 AK patients treated with DIC 3% gel versus CAP. Microbial DNA from skin swabs taken before start of treatment (week 0), at the end of the treatment period (week 24), and 3 months after end of treatment (week 36) was analyzed after sequencing the V3/V4 region of the 16S rRNA gene. The relative abundance of S. aureus was scrutinized by a tuf gene specific TaqMan PCR assay. The total bacterial load and both, relative and absolute abundance of Staphylococcus genus was reduced upon both therapies at week 24 and 36 compared to week 0. Notably, the lesional microbiome of patients responding to CAP therapy at week 24 was characterized by an increased relative abundance of Corynebacterium genus compared to nonresponders. A higher relative abundance of Staphylococcus aureus at week 36 was a feature of patients classified as nonresponders for both treatments 12 weeks after therapy completion. The reduction of the Staphylococcus abundance after treatment of AK lesions and alterations linked to treatment response encourage further studies for investigation of the role of the skin microbiome for both, the carcinogenesis of epithelial skin cancer and its function as predictive therapeutic biomarker in AK. IMPORTANCE The relevance of the skin microbiome for development of actinic keratosis (AK), its progression into squamous skin cancer, and for field-directed treatment response is unknown. An overabundance of staphylococci characterizes the skin microbiome of AK lesions. In this study, analyses of the lesional microbiome from 321 samples of 59 AK patients treated with diclophenac gel versus cold atmospheric plasma (CAP) revealed a reduced total bacterial load and reduced relative and absolute Staphylococcus genus abundance upon both treatments. A higher relative Corynebacterium abundance was a feature of patients classified as responders at the end of CAP-treatment period (week 24) compared with nonresponders and the Staphylococcus aureus abundance of patients classified as responders 3 months after treatment completion was significantly lower than in nonresponders. The alterations of the skin microbiome upon AK treatment encourage further investigations for establishing its role for carcinogenesis and its function as predictive biomarker in AK.
Collapse
Affiliation(s)
- Jan Kehrmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fiona Koch
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Partner site Essen/Düsseldorf, Essen, Germany
| | - Skrollan Zumdick
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna Höwner
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Partner site Essen/Düsseldorf, Essen, Germany
| | - Lara Best
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lars Masshöfer
- Institute for Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sarah Scharfenberg
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Partner site Essen/Düsseldorf, Essen, Germany
| | - Michael Zeschnigk
- Institute for Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jürgen C. Becker
- Departments of Translational Skin Cancer Research and Dermatology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Partner site Essen/Düsseldorf, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen and German Cancer Partner site Essen/Düsseldorf, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf and German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
40
|
Chiantore MV, Iuliano M, Mongiovì RM, Luzi F, Mangino G, Grimaldi L, Accardi L, Fiorucci G, Romeo G, Di Bonito P. MicroRNAs Differentially Expressed in Actinic Keratosis and Healthy Skin Scrapings. Biomedicines 2023; 11:1719. [PMID: 37371814 DOI: 10.3390/biomedicines11061719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Actinic keratosis (AK) is a carcinoma in situ precursor of cutaneous squamous cell carcinoma (cSCC), the second most common cancer affecting the Caucasian population. AK is frequently present in the sun-exposed skin of the elderly population, UV radiation being the main cause of this cancer, and other risk factors contributing to AK incidence. The dysregulation of microRNAs (miRNAs) observed in different cancers leads to an improper expression of miRNA targets involved in several cellular pathways. The TaqMan Array Human MicroRNA Card assay for miRNA expression profiling was performed in pooled AK compared to healthy skin scraping samples from the same patients. Forty-three miRNAs were modulated in the AK samples. The expression of miR-19b (p < 0.05), -31, -34a (p < 0.001), -126, -146a (p < 0.01), -193b, and -222 (p < 0.05) was validated by RT-qPCR. The MirPath tool was used for MiRNA target prediction and enriched pathways. The top DIANA-mirPath pathways regulated by the targets of the 43 miRNAs are TGF-beta signaling, Proteoglycans in cancer, Pathways in cancer, and Adherens junction (7.30 × 10-10 < p < 1.84 × 10-8). Selected genes regulating the KEGG pathways, i.e., TP53, MDM2, CDKN1A, CDK6, and CCND1, were analyzed. MiRNAs modulated in AK regulate different pathways involved in tumorigenesis, indicating miRNA regulation as a critical step in keratinocyte cancer.
Collapse
Affiliation(s)
| | - Marco Iuliano
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, 04100 Latina, Italy
| | - Roberta Maria Mongiovì
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, 04100 Latina, Italy
| | - Fabiola Luzi
- Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute IRCCS, 00144 Rome, Italy
| | - Giorgio Mangino
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, 04100 Latina, Italy
| | - Lorenzo Grimaldi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, 04100 Latina, Italy
| | - Luisa Accardi
- EVOR Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Gianna Fiorucci
- EVOR Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
- Institute of Molecular Biology and Pathology, CNR, 00185 Rome, Italy
| | - Giovanna Romeo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, 04100 Latina, Italy
| | - Paola Di Bonito
- EVOR Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| |
Collapse
|
41
|
Koch EAT, Steeb T, Bender-Säbelkampf S, Busch D, Feustel J, Kaufmann MD, Maronna A, Meder C, Ronicke M, Toussaint F, Wellein H, Berking C, Heppt MV. Poor Adherence to Self-Applied Topical Drug Treatment Is a Common Source of Low Lesion Clearance in Patients with Actinic Keratosis-A Cross-Sectional Study. J Clin Med 2023; 12:jcm12113813. [PMID: 37298008 DOI: 10.3390/jcm12113813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Many treatments for actinic keratosis (AK) have been proven efficient in clinical trials. However, patients with AK may still experience unsatisfactory therapeutic outcomes in clinical practice. OBJECTIVES To investigate patient adherence to self-applied topical interventions for AK and to explore factors associated with adherence in a real-world setting. METHODS A cross-sectional study was conducted. Patients presenting with AK were asked to complete a self-administered questionnaire about their last topical AK treatment. RESULTS A total of 113 patients participated with a median age of 78.5 years (range 58-94). Fifty-four patients (47.8%) received topical diclofenac, ten (8.8%) imiquimod, nine (8%) 5-fluorouracil, nine (8%) 5-fluorouracil plus salicylic acid, and eight (7.1%) photodynamic therapy. The non-adherence rate was 46.9% (n = 53), and only 30.9% (n = 35) used the topical treatments according to the summary of product characteristics (SmPC). These subgroups were compared. Patients of the non-compliant group were significantly less informed about the application time of the specific topical intervention (p = 0.002) and adjusted the timeframe (p < 0.001) and application frequency of the therapy (p = 0.02) independently of their physician. Conversely, patients reporting a sufficient pre-treatment consultation (p = 0.019) generally complied with the SmPC compliance application. CONCLUSIONS A thorough pre-treatment consultation can help to increase treatment adherence and ensure lesion clearance.
Collapse
Affiliation(s)
- Elias A T Koch
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Sophia Bender-Säbelkampf
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Dorothee Busch
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Janina Feustel
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Matthias D Kaufmann
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Andreas Maronna
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Christine Meder
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Moritz Ronicke
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Frédéric Toussaint
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Hedwig Wellein
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nürnberg (CCC ER-EMN), 91054 Erlangen, Germany
| |
Collapse
|
42
|
Ikediobi O, Sui JY, Kellogg C, Mares AR, Takashima S, Bertini JD, Daniels B, Hinds B, Sun BK. A pilot study using immunohistochemical staining to characterize dihydropyrimidine dehydrogenase expression in keratinocyte neoplasms. JAAD Int 2023; 11:90-91. [PMID: 36941911 PMCID: PMC10023894 DOI: 10.1016/j.jdin.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Bryan K. Sun
- Correspondence to: Bryan K. Sun, MD, PhD, Department of Dermatology, University of California San Diego, 9500 Gilman Dr, MC 0869, La Jolla, CA 92093-0869
| |
Collapse
|
43
|
Toffoli L, Dianzani C, Bonin S, Guarneri C, Guarneri F, Giuffrida R, Zalaudek I, Conforti C. Actinic Keratoses: A Prospective Pilot Study on a Novel Formulation of 4% 5-Fluorouracil Cream and a Review of Other Current Topical Treatment Options. Cancers (Basel) 2023; 15:cancers15112956. [PMID: 37296918 DOI: 10.3390/cancers15112956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Actinic keratosis (AK) is one of the most common skin diseases, with a low risk of progression into invasive squamous cell carcinoma. We aim to assess efficacy and safety of a novel formulation of 5-Fluorouracil (5-FU) 4% with once daily application for the treatment of multiple AKs. METHODS A pilot study was performed on 30 patients with a clinical and dermoscopic diagnosis of multiple AKs, enrolled between September 2021 and May 2022 at the Dermatology Departments of two Italian hospitals. Patients were treated with 5-FU 4% cream once daily for 30 consecutive days. The Actinic Keratosis Area and Severity Index (AKASI) was calculated before starting therapy, and at each follow-up, to assess objective clinical response. RESULTS The cohort analyzed included 14 (47%) males and 16 (53%) females (mean age: 71 ± 12 years). A significant decrease in AKASI score at both 6 and 12 weeks (p < 0.0001) was observed. Only three patients (10%) discontinued therapy, and 13 patients (43%) did not report any adverse reactions; no unexpected adverse events were observed. CONCLUSIONS In the setting of topical chemotherapy and immunotherapy, the new formulation of 5-FU 4% proved to be a highly effective treatment for AKs and field cancerization.
Collapse
Affiliation(s)
- Ludovica Toffoli
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
| | - Caterina Dianzani
- Department of Plastic Surgery Unit, Section of Dermatology, University Campus Biomedico of Rome, 00128 Rome, Italy
| | - Serena Bonin
- Department of Medical Science, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, 98124 Messina, Italy
| | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, 98124 Messina, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, 98124 Messina, Italy
| | - Iris Zalaudek
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy
| |
Collapse
|
44
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
45
|
Yi Q, Liu J. Safety of photodynamic therapy combined with surgical excision in patients with actinic keratosis and risk factors for secondary cutaneous squamous cell carcinoma. Am J Transl Res 2023; 15:3548-3555. [PMID: 37303615 PMCID: PMC10251020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/11/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the efficacy of photodynamic therapy combined with surgical excision on the prognosis of patients with actinic keratosis (AK) and to analyze the risk factors for secondary cutaneous squamous cell carcinoma (cSCC). METHODS Clinical data of 114 patients with AK treated at the West China Hospital from March 2014 to November 2018 were enrolled to this retrospective analysis. Among them 55 patients who underwent surgical resection alone were the control group (CG) and the other 59 who received photodynamic therapy combined with surgical resection were in the research group (RG). The treatment efficacy, lesion area, quality of life, incidence of adverse effects, and incidence of secondary sSCC in 3 years were compared, and the risk factors for sSCC were analyzed by multivariate logistics analysis. RESULTS The treatment efficacy of the RG was dramatically higher than that of the CG (P<0.05), and there was no obvious difference in the incidence of adverse reactions between the two groups (P>0.05). The lesion area and dermatology life quality index of the RG were dramatically lower than those of the CG after treatment (P<0.05), and the 3-year incidence of secondary cSCC in the RG was not statistically different from that of the OG (P>0.05). A greater number of lesion sites, a family history of tumor, and a history of skin disease were independent risk factors for secondary cSCC. CONCLUSION Photodynamic therapy combined with surgical excision has better therapeutic efficacy in AK with a high safety.
Collapse
Affiliation(s)
- Qin Yi
- Department of Dermatology and Venereology, West China Hospital, Sichuan University Guoxue Alley No. 37, Wuhou District, Chengdu 610041, Sichuan, China
| | - Jiayan Liu
- Department of Dermatology and Venereology, West China Hospital, Sichuan University Guoxue Alley No. 37, Wuhou District, Chengdu 610041, Sichuan, China
| |
Collapse
|
46
|
Edah E, Patel D, Singh J, Tiesenga F. Verruca Vulgaris-Associated Cutaneous Horn: A Case Report. Cureus 2023; 15:e38962. [PMID: 37313094 PMCID: PMC10259315 DOI: 10.7759/cureus.38962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
A cutaneous horn is a yellow or white-colored conical projection made up of complex keratin that arises from the surface of the skin. It is usually diagnosed clinically but requires histologic examination to rule out malignancy or determine the underlying lesion. Verruca vulgaris, a human papillomavirus-associated lesion, is a very common benign underlying lesion. We present a case of an 80-year-old female who presented with a cutaneous horn on a unique location, the proximal interphalangeal joint (PIP) of her left fourth digit. Post-excision biopsy revealed a diagnosis of a verruca vulgaris-associated cutaneous horn.
Collapse
Affiliation(s)
- Elizabeth Edah
- Department of Surgery, All Saints University, Roseau, DMA
| | - Dhruviben Patel
- Department of Surgery, St. George's University, True Blue, GRD
| | - Jetvir Singh
- Department of Surgery, Windsor University School of Medicine, Cayon, KNA
| | - Frederick Tiesenga
- Department of General Surgery, West Suburban Medical Center, Chicago, USA
| |
Collapse
|
47
|
Cowen EA, Sun MD, Gu L, Acevedo C, Rotemberg V, Halpern AC. Store-and-forward mobile application as an accessible method of study participant assessment. J Eur Acad Dermatol Venereol 2023; 37:e482-e485. [PMID: 36264231 PMCID: PMC10023268 DOI: 10.1111/jdv.18671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Emily A Cowen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary Daotung Sun
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lilly Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Veronica Rotemberg
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
48
|
Dubois-Pot-Schneider H, Khairallah G, Brzenczek C, Plénat F, Marchal F, Amouroux M. Transcriptomic Study on Human Skin Samples: Identification of Two Subclasses of Actinic Keratoses. Int J Mol Sci 2023; 24:ijms24065937. [PMID: 36983009 PMCID: PMC10058209 DOI: 10.3390/ijms24065937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Actinic keratoses (AKs) are sun-damaged skin areas that affect 20% of the European adult population and more than 50% of people aged 70 years and over. There are currently no clinical or histological features allowing us to identify to which clinical class (i.e., regression or progression) an AK belongs. A transcriptomic approach seems to be a robust tool for AK characterization, but there is a need for additional studies, including more patients and elucidating the molecular signature of an AK. In this context, the present study, including the largest number of patients to date, is the first aiming at identifying biological features to objectively distinguish different AK signatures. We highlight two distinct molecular profiles: AKs featuring a molecular profile similar to squamous cell carcinomas (SCCs), which are called "lesional AKs" (AK_Ls), and AKs featuring a molecular profile similar to normal skin tissue, which are called "non-lesional AKs" (AK_NLs). The molecular profiles of both AK subclasses were studied, and 316 differentially expressed genes (DEGs) were identified between the two classes. The 103 upregulated genes in AK_L were related to the inflammatory response. Interestingly, downregulated genes were associated with keratinization. Finally, based on a connectivity map approach, our data highlight that the VEGF pathway could be a promising therapeutic target for high-risk lesions.
Collapse
Affiliation(s)
| | - Grégoire Khairallah
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
- Department of Plastic, Aesthetic and Reconstructive Surgery, Metz-Thionville Regional Hospital, 57530 Ars-Laquenexy, France
| | | | | | - Frédéric Marchal
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
- Département de Chirurgie, Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | | |
Collapse
|
49
|
Pellacani G, Peris K, Ciardo S, Pezzini C, Tambone S, Farnetani F, Longo C, Chello C, Gonzalez S. The combination of oral and topical photoprotection with a standardized Polypodium leucotomos extract is beneficial against actinic keratosis. Photodermatol Photoimmunol Photomed 2023. [PMID: 36892441 DOI: 10.1111/phpp.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
This study describes a prospective, multicentre, randomized controlled, open-label study with three arms aimed at studying the differences between: [Cnt], self-administered sun protection; [T], topical treatment; and [TO], topical + oral treatment; for the management of AK in a cohort of subjects of advanced age displaying severe actinic damage (SAD). Treatments administered to groups [T] and [TO] had a common component, which is a botanical extract, Fernblock, with demonstrated photoprotective activity. 131 subjects were distributed randomly in the three groups, and followed up clinically at three separate time points, beginning of the study (t=0) and after 6 months and 12 months. Analysis of clinical data and examination using reflectance confocal microscopy (RCM) revealed that group [T] and [TO] displayed decreased clinical AK and field cancerization parameters, including the number of new lesions, and reduced the need for additional interventions in these patients. RCM revealed a normalization of the keratinocyte layer. Improvements in AK and field cancerization parameters were greatest in group [TO], suggesting that topical and oral photoprotection improves the clinical and anatomical outcome compared to control conditions. The combination of topical and oral immune photoprotection provides an advantage compared to topical photoprotection alone.
Collapse
Affiliation(s)
| | - Ketty Peris
- Dermatology Clinic, Catholic University Rome, Italy
| | - Silvana Ciardo
- Dermatology Clinic University of Modena and Reggio Emilia, Italy
| | - Claudia Pezzini
- Dermatology Clinic University of Modena and Reggio Emilia, Italy
| | - Sara Tambone
- Dermatology Clinic, Catholic University Rome, Italy
| | | | | | | | - Salvador Gonzalez
- Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain
| |
Collapse
|
50
|
Arcuri D, Ramchatesingh B, Lagacé F, Iannattone L, Netchiporouk E, Lefrançois P, Litvinov IV. Pharmacological Agents Used in the Prevention and Treatment of Actinic Keratosis: A Review. Int J Mol Sci 2023; 24:ijms24054989. [PMID: 36902419 PMCID: PMC10003023 DOI: 10.3390/ijms24054989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Actinic keratosis (AK) is among the most commonly diagnosed skin diseases with potentially life-threatening repercussions if left untreated. Usage of pharmacologic agents represents one of many therapeutic strategies that can be used to help manage these lesions. Ongoing research into these compounds continues to change our clinical understanding as to which agents most benefit particular patient populations. Indeed, factors such as past personal medical history, lesion location and tolerability of therapy only represent a few considerations that clinicians must account for when prescribing appropriate treatment. This review focuses on specific drugs used in either the prevention or treatment of AKs. Nicotinamide, acitretin and topical 5-fluorouracil (5-FU) continue to be used with fidelity in the chemoprevention of actinic keratosis, although some uncertainty persists in regard to which agents should be used in immunocompetent vs. immunodeficient/immunosuppressed patients. Topical 5-FU, including combination formulations with either calcipotriol or salicylic acid, as well as imiquimod, diclofenac and photodynamic light therapy are all accepted treatment strategies employed to target and eliminate AKs. Five percent of 5-FU is regarded as the most effective therapy in the condition, although the literature has conflictingly shown that lower concentrations of the drug might also be as effective. Topical diclofenac (3%) appears to be less efficacious than 5% 5-FU, 3.75-5% imiquimod and photodynamic light therapy despite its favorable side effect profile. Finally, traditional photodynamic light therapy, while painful, appears to be of higher efficacy in comparison to its more tolerable counterpart, daylight phototherapy.
Collapse
Affiliation(s)
- Domenico Arcuri
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | | | - François Lagacé
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | - Lisa Iannattone
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | | | | | - Ivan V. Litvinov
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
- Division of Dermatology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- Correspondence:
| |
Collapse
|