Daylight photodynamic therapy is an option for the treatment of actinic keratosis in patients with xeroderma pigmentosum in Africa

BACKGROUND

Xeroderma pigmentosum (XP) is a very rare and severe genetic disorder with a DNA repair defect of ultraviolet (UV)-induced damage. Photodynamic therapy (PDT) has been successfully used in XP patients to treat actinic keratosis (AK) and daylight PDT (DL-PDT) has demonstrated similar efficacy to conventional PDT (C-PDT) for AK.

OBJECTIVES

To assess DL-PDT for the treatment of AK in patients with XP.

METHODS

Patients with XP were evaluated by a group of Spanish and African dermatologists. Clinical characteristics of the patients were assessed and divided in mild, severe or moderate affectation of AK in the face. A topical photosensitizer was extended on the patients' faces and after two hours of indoor light exposure, fluorescence was assessed and the cream was removed. Patients were examined two and seven days later to assess the reaction to PDT and followed up three months later.

RESULTS

A total of 13 patients were treated on the whole face. Three were classified as severe AK, six as moderate AK and four as mild AK. Fluorescence assessment showed a soft yellow-green colour and a pink-color delineating the AK. Two days after treatment patients presented a scaly reaction. After one week the reaction healed, there was improvement and after three months no adverse events were noticed.

CONCLUSIONS

PDT is an option for treatment of AK in patients with XP.

Surgical treatment of lagophthalmos in facial palsy: ear cartilage graft for elongating the levator palpebrae muscle

Ocular exposure, conjunctival irritation and corneal keratitis are disturbing consequences of facial paralysis with lagophthalmos. Many techniques have been described for correcting this condition. A new method for decreasing the palpebral fissure is presented. An ear cartilage graft is interposed between the tarsal plate and the levator palpebrae superioris muscle. 12 patients with paralysis of the orbicularis oculi muscle, as assessed by electromyography, were treated with this technique. The palpebral fissure was decreased by 2-3 mm in all cases. 11 patients showed significant improvement of their eye symptoms. One patient, in whom the palpebral fissure could not be closed sufficiently to protect the eye, required additional lengthening by 4 mm of the cartilage graft and a lateral tarsorrhaphy.