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Falkenberg C, Schmitz L, Dicke K, Dervenis V, Szeimies RM, Dirschka T. Pretreatment with ablative fractional carbon dioxide laser improves treatment efficacy in a synergistic PDT protocol for actinic keratoses on the head. Photodiagnosis Photodyn Ther 2021; 34:102249. [PMID: 33711530 DOI: 10.1016/j.pdpdt.2021.102249] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/12/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment. METHODS 28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm2, power 30 W, beam size 4-18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS). RESULTS Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0-2.4]) compared to baseline (5.3 [4-7.75]). Median reduction rate was 75.5 % (61.3 %-100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0-0), 0 (0-2) and 0 (0-2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]). CONCLUSIONS S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.
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Affiliation(s)
- C Falkenberg
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany.
| | - L Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany; Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany
| | - K Dicke
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany
| | - V Dervenis
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany
| | - R M Szeimies
- Clinic for Dermatology and Allergology, Klinikum Vest, Recklinghausen, Germany
| | - T Dirschka
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany; Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany
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2
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Luger T, Dirschka T, Eyerich K, Gollnick H, Gupta G, Lambert J, Micali G, Ochsendorf F, Ständer S, Traidl-Hoffmann C. Developments and challenges in dermatology: an update from the Interactive Derma Academy (IDeA) 2019. J Eur Acad Dermatol Venereol 2021; 34 Suppl 7:3-18. [PMID: 33315305 DOI: 10.1111/jdv.17009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 01/09/2023]
Abstract
The 2019 Interactive Derma Academy (IDeA) meeting was held in Lisbon, Portugal, 10-12 May, bringing together leading dermatology experts from across Europe, the Middle East and Asia. Over three days, the latest developments and challenges in relation to the pathophysiology, diagnosis, evaluation and management of dermatological conditions were presented, with a particular focus on acne, atopic dermatitis (AD) and actinic keratosis (AK). Interesting clinical case studies relating to these key topics were discussed with attendees to establish current evidence-based best practices. Presentations reviewed current treatments, potential therapeutic approaches and key considerations in the management of acne, AK and AD, and discussed the importance of the microbiome in these conditions, as well as the provision of patient education/support. It was highlighted that active treatment is not always required for AK, depending on patient preferences and clinical circumstances. In addition to presentations, two interactive workshops on the diagnosis and treatment of sexually transmitted infections/diseases (STIs/STDs) presenting to the dermatology clinic, and current and future dermocosmetics were conducted. The potential for misdiagnosis of STIs/STDs was discussed, with dermoscopy and/or reflectance confocal microscopy suggested as useful diagnostic techniques. In addition, botulinum toxin was introduced as a potential dermocosmetic, and the possibility of microbiome alteration in the treatment of dermatological conditions emphasized. Furthermore, several challenges in dermatology, including the use of lasers, the complexity of atopic dermatitis, wound care, use of biosimilars and application of non-invasive techniques in skin cancer diagnosis were reviewed. In this supplement, we provide an overview of the presentations and discussions from the fourth successful IDeA meeting, summarizing the key insights shared by dermatologists from across the globe.
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Affiliation(s)
- T Luger
- Department of Dermatology, University of Münster, Münster, Germany
| | - T Dirschka
- Centroderm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - K Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Unit of Dermatology, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - H Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke University, Magdeburg, Germany
| | - G Gupta
- University Department of Dermatology, Edinburgh, UK
| | - J Lambert
- Department of Dermatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Ochsendorf
- Department of Dermatology, Frankfurt University Hospital, Frankfurt/Main, Germany
| | - S Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - C Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany
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Lehmann L, Hofmann S, Dirschka T, Lehmann P. Induktion einer strickleiterartigen Narbe an der Wange einer 28-jährigen Frau nach Laserung eines Naevus araneus mittels KTP-Laser. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1437-6105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie 28-jährige Patientin stellte sich zur Behandlung einer kosmetisch störenden Gefäßläsion an der Wange vor. Es wurde eine Lasertherapie vorgeschlagen und vereinbart. Es entstanden unmittelbar nach der Laserbehandlung Schmerzen und eine Rötung; später eine entstellende Narbe.Die Gutachter der Gutachterkommission bei der Ärztekammer Nordrhein beurteilten die Behandlung als fehlerhaft.Laserbehandlungen zählen insgesamt zu den risikoreicheren Therapien in der Dermatologie. Häufiger als andere Behandlungsoptionen beurteilen die Begutachter die Behandlungen als fehlerhaft.
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Affiliation(s)
- L. Lehmann
- Schwerpunkt Allgemeinmedizin, Uniklinik Köln
- Helios Universitätsklinikum Wuppertal, Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Universität Witten/Herdecke
- Fakultät für Gesundheit, Universität Witten/Herdecke
| | - S. Hofmann
- Helios Universitätsklinikum Wuppertal, Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Universität Witten/Herdecke
- Fakultät für Gesundheit, Universität Witten/Herdecke
| | - T. Dirschka
- Privatpraxis Centroderm Wuppertal
- Fakultät für Gesundheit, Universität Witten/Herdecke
| | - P. Lehmann
- Helios Universitätsklinikum Wuppertal, Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Universität Witten/Herdecke
- Fakultät für Gesundheit, Universität Witten/Herdecke
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Lehmann L, Hofmann S, Dirschka T, Lehmann P. Patientensicherheit: Die Lasertherapie gehört zu den risikoreicheren Therapieoptionen in der Dermatologie. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1419-6390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungSeit der Erstbeschreibung von Lasern und den ersten Anwendungen in der Dermatologie hat die Lasertherapie innerhalb des dermatologischen therapeutischen Armamentariums enorm an Bedeutung zugenommen.Da sie häufig bei ästhetischen Indikationen Anwendung findet, sind hohe Sicherheitsanforderungen zu gewährleisten, ansonsten kommt es zu unangenehmen juristischen Streitigkeiten. Eine retrospektive Analyse anhand der Fälle der Gutachterkammer für ärztliche Behandlungsfehler hat gezeigt, dass Lasertherapien zu den risikoreicheren therapeutischen Optionen in der Dermatologie gehören.
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Affiliation(s)
- L. Lehmann
- Schwerpunkt Allgemeinmedizin, Universitätsklinikum Köln
- Helios Universitätsklinikum Wuppertal, Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Universität Witten/Herdecke
- Fakultät für Gesundheit, Universität Witten/Herdecke
| | - S. Hofmann
- Helios Universitätsklinikum Wuppertal, Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Universität Witten/Herdecke
- Fakultät für Gesundheit, Universität Witten/Herdecke
| | - T. Dirschka
- Centroderm, Wuppertal
- Fakultät für Gesundheit, Universität Witten/Herdecke
| | - P. Lehmann
- Helios Universitätsklinikum Wuppertal, Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Universität Witten/Herdecke
- Fakultät für Gesundheit, Universität Witten/Herdecke
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5
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Moyal D, Seité S, Krutmann J, Dirschka T, Luger T. 14186 Usefulness of an emollient in a stick format to improve compliance and skin conditions of atopic patients. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Löser CR, Gauglitz G, Dirschka T. Zertifizierung: Dermatochirurgie für Pflegekräfte und Fachangestellte (DDA, BVDD, DGDC). Aktuelle Dermatologie 2020. [DOI: 10.1055/a-1122-3230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungPflegekräfte und medizinische Fachangestellte waren in der Weiterbildung auf dermatologischen Fachkongressen hinsichtlich der Dermatochirurgie lange unterrepräsentiert. Dabei spielen sie eine wichtige Rolle in der Verwirklichung einer patientenzentrierten und qualitätsgesicherten ambulanten Versorgung, gerade bei operativen Eingriffen. Deshalb wurden bereits seit 2011 in Zusammenarbeit mit der Deutschen Gesellschaft für Dermatochirurgie (DGDC) dermatochirurgische Weiterbildungsseminare für Pflegekräfte und Fachangestellte auf der jährlichen Fortbildungsveranstaltung in Frankenthal (heute „Derm“) angeboten. Diese Seminare waren nicht nur ausgezeichnet frequentiert, sondern erfreuten sich einer engagierten Mitarbeit der Teilnehmer und haben so zu einer Bedarfsanalyse beigetragen. Auf den gewonnenen Erfahrungen der Interaktion mit den Seminarteilnehmern basiert dieses Curriculum. Zunächst werden die Themen angelehnt an den Praxisablauf chronologisch aufgelistet und im zweiten Abschnitt inhaltlich präzisiert.
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Affiliation(s)
- C. R. Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen
| | - G. Gauglitz
- Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - T. Dirschka
- CentroDerm Klinik, Heinz-Fangman-Straße 57, 42287 Wuppertal
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Gollnick H, Dirschka T, Ostendorf R, Kerl H, Kunstfeld R. Long-term clinical outcomes of imiquimod 5% cream vs. diclofenac 3% gel for actinic keratosis on the face or scalp: a pooled analysis of two randomized controlled trials. J Eur Acad Dermatol Venereol 2019; 34:82-89. [PMID: 31407414 DOI: 10.1111/jdv.15868] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/08/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Actinic keratosis (AK) is an early in situ epidermal cancer which can progress to invasive squamous cell carcinoma (SCC). Imiquimod 5% cream (IMIQ) and diclofenac 3% gel (DIC) are frequently used to treat AK; however, their long-term effects following repeated treatment cycles have never been compared. OBJECTIVE To compare IMIQ and DIC in the treatment of AK with respect to the risk of change to grade III AK or invasive SCC, after 3 years. METHODS Data were pooled from two randomized, active-controlled, open-label, multicentre, multinational, phase IV studies (Clinicaltrials.gov NCT00777127/NCT01453179), with two parallel groups. Studies were conducted between 2008 and 2015 and were almost identical in design. Patients eligible for inclusion were immunocompetent adults with 5-10 visible AK lesions on the face/scalp and grade I/II AK. The primary endpoint was inhibition of histological change to grade III AK or invasive SCC in the study treatment area, observed until month 36. Patients applied either IMIQ or DIC for a maximum of six treatment cycles. RESULTS In total, 479 patients (IMIQ 242; DIC 237) were included in the full analysis set. Histological change to grade III AK or invasive SCC was observed until month 36 in 13 (5.4%) patients treated with IMIQ, compared with 26 (11.0%) patients treated with DIC (absolute risk difference -5.6% [95% confidence interval -10.7%, -0.7%]). Time to histological change was greater in the IMIQ group than the DIC group (P = 0.0266). Frequency of progression to invasive SCC was lower with IMIQ than with DIC at all time points. Initial clearance rate was higher in the IMIQ group compared with the DIC group, while recurrence rate was lower. Both treatments were well tolerated. CONCLUSIONS Over 3 years, IMIQ was superior to DIC in clearing AK lesions and preventing histological change to grade III AK or invasive SCC and recurrence.
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Affiliation(s)
- H Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke University, Magdeburg, Germany
| | - T Dirschka
- Centroderm Clinic, Wuppertal, Germany.,Faculty of Health, University of Witten-Herdecke, Witten, Germany
| | | | - H Kerl
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - R Kunstfeld
- Dermatology Clinic, General Hospital, Vienna, Austria
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8
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von Dobbeler C, Schmitz L, Dicke K, Szeimies R, Dirschka T. PDT with PPIX absorption peaks adjusted wavelengths: Safety and efficacy of a new irradiation procedure for actinic keratoses on the head. Photodiagnosis Photodyn Ther 2019; 27:198-202. [DOI: 10.1016/j.pdpdt.2019.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023]
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9
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Blume-Peytavi U, Fowler J, Kemény L, Draelos Z, Cook-Bolden F, Dirschka T, Eichenfield L, Graeber M, Ahmad F, Alió Saenz A, Rich P, Tanghetti E. Long-term safety and efficacy of trifarotene 50 μg/g cream, a first-in-class RAR-γ selective topical retinoid, in patients with moderate facial and truncal acne. J Eur Acad Dermatol Venereol 2019; 34:166-173. [PMID: 31306527 PMCID: PMC7004112 DOI: 10.1111/jdv.15794] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 06/27/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Treatment for both facial and truncal acne has not sufficiently been studied. OBJECTIVES To evaluate the long-term safety and efficacy of trifarotene in both facial and truncal acne. METHODS In a multicentre, open-label, 52-week study, patients with moderate facial and truncal acne received trifarotene 50 μg/g cream (trifarotene). Assessments included local tolerability, safety, investigator and physician's global assessments (IGA, PGA) and quality of life (QOL). A validated QOL questionnaire was completed by the patient at Baseline, Week 12, 26 and 52/ET. RESULTS Of 453 patients enrolled, 342 (75.5%) completed the study. Trifarotene-related treatment-emergent adverse events (TEAEs) were reported in 12.6% of patients, and none was serious. Most related TEAEs were cutaneous and occurred during the first 3 months. Signs and symptoms of local tolerability were mostly mild or moderate and severe signs, and symptoms were reported for 2.2% to 7.1% of patients for the face and 2.5% to 5.4% for the trunk. Local irritation increased during the first week of treatment on the face and up to Weeks 2 to 4 on the trunk with both decreasing thereafter. At Week 12, IGA and PGA success rates were 26.6% and 38.6%, respectively. Success rates increased to 65.1% and 66.9%, respectively at Week 52. Overall success (both IGA and PGA success in the same patient) was 57.9% at Week 52. At Week 52 visit, 92/171 (53.8%) patients who had completed their assessments had scores from 0 to 1 (i.e. no effect of acne on their QOL) vs. 47/208 (22.6%) patients at Baseline visit. CONCLUSION In this 52-week study, trifarotene was safe, well tolerated and effective in moderate facial and truncal acne.
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Affiliation(s)
- U Blume-Peytavi
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Fowler
- Division of Dermatology, University of Louisville, Louisville, KY, USA
| | - L Kemény
- Department of Dermatology and Allergy, University of Szeged, Szeged, Hungary
| | - Z Draelos
- Dermatology Consulting Services, PLLC, High Point, NC, USA
| | | | | | - L Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego, School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - M Graeber
- Galderma Research and Development LLC, Fort Worth, TX, USA
| | - F Ahmad
- Galderma Research and Development LLC, Fort Worth, TX, USA
| | - A Alió Saenz
- Galderma Research and Development LLC, Fort Worth, TX, USA
| | - P Rich
- Oregon Dermatology and Research, Portland, OR, USA
| | - E Tanghetti
- Center for Dermatology and Laser Surgery, Sacramento, CA, USA
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10
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Schmitz L, Grinblat B, Novak B, Hoeh AK, Händschke K, von Dobbeler C, Bierhoff E, Szeimies RM, Gambichler T, Torezan L, Festa-Neto C, Stockfleth E, Dirschka T. Somatic mutations in kinetochore gene KNSTRN are associated with basal proliferating actinic keratoses and cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2019; 33:1535-1540. [PMID: 30972880 DOI: 10.1111/jdv.15615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Mutations in kinetochore gene KNSTRN accelerate the development of cutaneous squamous cell carcinoma (SCC) and may correlate with different histological classifications of actinic keratosis (AKs). OBJECTIVE To determine KNSTRN gene mutation frequency in healthy skin (HS), actinically damaged skin (ADS), in AKs with different histomorphological gradings and invasive SCCs. METHODS All samples were histologically evaluated. AK lesions were additionally classified according to their upwards (AK I-III) and downwards (PRO I-III) directed growth pattern. Mutation analyses of all samples were performed using the Sanger method. RESULTS With one exception, all detected mutations in KNSTRN gene showed an alanine-to-glutamate substitution at codon 40 (p.Ala40Glu). p.Ala40Glu mutation was found in 6.9% (2/29) of HS, in 16.1% (5/31) of ADS, in 18.3% (20/109) of AKs and in 30.0% (9/30) of invasive SCCs. Further stratification of AKs using the common AK classification of Röwert-Huber revealed the p.Ala40Glu mutation in 14.7% (5/43), 13.3% (4/30) and 24.4% (11/45) (AK I, II and III). In contrast, the new PRO classification showed a distribution of 3.6% (1/28) in PRO I, 21.7% (13/60) in PRO II and 28.6% (6/21) in PRO III. Mutation frequency in HS showed significant differences compared to AKs classified as PRO III and invasive SCCs (P < 0.05). In contrast, there were no statistically significant differences between HS and AKs when classified according to Röwert-Huber. CONCLUSIONS Recurrent somatic mutation p.Ala40Glu in KNSTRN gene is associated with basal proliferating AKs in accordance with invasive SCCs. This supports the impact of basal proliferative pattern in terms of progression.
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - B Grinblat
- Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - B Novak
- Department of Animal Physiology, Ruhr-University, Bochum, Germany
| | - A-K Hoeh
- CentroDerm GmbH, Wuppertal, Germany
| | | | | | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - R-M Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
| | - T Gambichler
- Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - L Torezan
- Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - C Festa-Neto
- Department of Dermatology, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - E Stockfleth
- Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - T Dirschka
- CentroDerm GmbH, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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11
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Schmitz L, Gupta G, Stücker M, Doerler M, Gambichler T, Welzel J, Szeimies RM, Bierhoff E, Stockfleth E, Dirschka T. Evaluation of two histological classifications for actinic keratoses - PRO classification scored highest inter-rater reliability. J Eur Acad Dermatol Venereol 2019; 33:1092-1097. [PMID: 30887613 DOI: 10.1111/jdv.15580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Actinic keratoses (AKs) can histologically be classified by the extent of atypical keratinocytes throughout the epidermis or their pattern of basal proliferation. Currently, no data on the inter-rater reliability of both scores is available. OBJECTIVE To evaluate the inter-rater reliability of the two classification schemes; histological grade (AK I-III) and basal proliferation (PRO I-III). METHODS Histological images of 54 AKs were classified by 21 independent dermatopathologists with regard to basal proliferation (PRO I-III), histological grade (AK I-III) and assumed risk of progression into invasive carcinoma. RESULTS Overall, of the 54 AKs 16.7% (9/54) were classified as AK I, 66.7% (36/54) as AK II, and 16.7% (9/54) as AK III. With regards to basal growth pattern, 25.9% (14/54) were classified as PRO I, 42.6% (23/54) as PRO II, and 31.5% (17/54) as PRO III. We observed a highly significant inter-rater reliability for PRO-grading (P < 0.001) which was higher than for AK-grading (Kendall's W coefficient: AK = 0.488 vs. PRO = 0.793). We found substantial agreement for assumed progression risk for AKs with worsening basal proliferation (k = 0.759) compared to moderate agreement (k = 0.563) for different AK-gradings. CONCLUSIONS Histological classification of basal growth pattern (PRO) showed higher inter-rater reliability compared to the established classification of atypical keratinocytes throughout epidermal layers. Moreover, experienced dermatopathologists considered basal proliferation to be more important in terms of progression risk than upwards directed growth patterns. It should be considered to classify AKs according to their basal proliferation pattern (PRO I-III).
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - G Gupta
- Department of Dermatology, University Hospital Monklands, Lanarkshire, UK.,School of Medicine, University of Glasgow, Glasgow, UK
| | - M Stücker
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - M Doerler
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - J Welzel
- Department of Dermatology and Allergology, General Hospital Augsburg, Augsburg, Germany
| | - R M Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
| | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr University, Bochum, Germany
| | - T Dirschka
- CentroDerm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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12
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Dirschka T, Gupta G. Treatments for actinic keratoses - still a challenge for clinicians. Br J Dermatol 2019; 180:701. [PMID: 30933327 DOI: 10.1111/bjd.17614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Dirschka
- CentroDerm Clinic, Heinz-Fangman-Straße 57, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, Witten, Germany
| | - G Gupta
- Department of Dermatology, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, U.K
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13
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Dirschka T, Ekanayake-Bohlig S, Dominicus R, Aschoff R, Herrera-Ceballos E, Botella-Estrada R, Hunfeld A, Kremser M, Schmitz B, Lübbert H, Puig S. A randomized, intraindividual, non-inferiority, Phase III study comparing daylight photodynamic therapy with BF-200 ALA gel and MAL cream for the treatment of actinic keratosis. J Eur Acad Dermatol Venereol 2018; 33:288-297. [PMID: 30022544 PMCID: PMC6585804 DOI: 10.1111/jdv.15185] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/12/2018] [Indexed: 01/05/2023]
Abstract
Background The most effective treatment modality for actinic keratosis (AK) is photodynamic therapy (PDT). Major obstacles of PDT are the need of a special illumination device and pain accompanying the illumination. These issues may be overcome by replacing an artificial high‐power light source with natural daylight for more extended illumination at lower light doses. Objective To determine whether BF‐200 ALA (a nanoemulsion gel containing 7.8% 5‐aminolaevulinic acid) is non‐inferior to MAL (a cream containing 16% methyl‐aminolaevulinate) in the treatment of mild‐to‐moderate AK with daylight PDT (dPDT). Non‐inferiority of the primary efficacy variable (total lesion clearance rate per patient's side 12 weeks after PDT) is established if the mean response for BF‐200 ALA is no worse than for MAL, within a statistical margin of Δ = −12.5%. Methods The study was performed as an intraindividual comparison with 52 patients in seven centres in Germany and Spain. Each patient received one dPDT. Results include clinical endpoints as well as 1‐year follow‐up results. Results Twelve weeks after a single dPDT, 79.8% of the AK lesions treated with BF‐200 ALA gel and 76.5% of the lesions treated with MAL cream were completely cleared. The median of differences was 0.0 with a one‐sided 97.5% CI of 0.0, establishing non‐inferiority (P < 0.0001). Results for secondary efficacy parameters were in line with the primary outcome. Recurrence rates 1 year after the treatment were 19.9% for lesions treated with BF‐200 ALA and 31.6% for lesions treated with MAL. Adverse reactions including pain were mostly mild and transient and identical to those previously described for dPDT. Conclusion Daylight PDT of AK with BF‐200 ALA is well‐tolerated and non‐inferior to MAL/dPDT. The study demonstrates a trend towards higher efficacies after 3 months and significantly lower recurrence rates after 1 year follow‐up.
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Affiliation(s)
- T Dirschka
- CentroDerm GmbH, Wuppertal, Germany.,Faculty of Health, University Witten/Herdecke, Witten, Germany
| | | | | | - R Aschoff
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - E Herrera-Ceballos
- Department of Dermatology, Hospital Clinico Virgen de la Victoria, Malaga, Spain
| | - R Botella-Estrada
- University of Valencia, Valencia, Spain.,Department of Dermatology, Hospital Universitari i Politécnic la Fe, Valencia, Spain
| | - A Hunfeld
- Biofrontera Bioscience GmbH, Leverkusen, Germany
| | - M Kremser
- Biofrontera Bioscience GmbH, Leverkusen, Germany
| | - B Schmitz
- Biofrontera Bioscience GmbH, Leverkusen, Germany
| | - H Lübbert
- Biofrontera Bioscience GmbH, Leverkusen, Germany
| | - S Puig
- Hospital Clinic de Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
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14
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Schmitz L, Gambichler T, Kost C, Gupta G, Stücker M, Stockfleth E, Dirschka T. Cutaneous squamous cell carcinomas are associated with basal proliferating actinic keratoses. Br J Dermatol 2018. [DOI: 10.1111/bjd.16536] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - C. Kost
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - G. Gupta
- Department of Dermatology University Hospital Monklands Lanarkshire U.K
- School of Medicine University of Glasgow Glasgow U.K
| | - M. Stücker
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology Ruhr‐University Gudrunstraße 56 D‐44791 Bochum Germany
| | - T. Dirschka
- CentroDerm Clinic Heinz‐Fangman‐Straße 57 Wuppertal Germany
- Faculty of Health University Witten‐Herdecke Alfred‐Herrhausen‐Straße 50 Witten Germany
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15
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Pellacani G, Gupta G, Micali G, Malvehy J, Stratigos A, Casari A, Chester J, Kaleci S, Dirschka T. Actinic Keratosis Area Severity Index (AKASI): reproducibility study and comparison with total lesion count. Br J Dermatol 2018; 179:763-764. [DOI: 10.1111/bjd.16559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Italy
| | - G. Gupta
- Department of Dermatology; University Hospital Monklands; Airdrie U.K
- University of Glasgow; Glasghow U.K
| | - G. Micali
- Dermatology Clinic; University of Catania; Catania Italy
| | - J. Malvehy
- Dermatology Department; Melanoma Unit; Hospital Clínic de Barcelona; IDIBAPS; Universitat de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER); Valencia Spain
| | - A.J. Stratigos
- First Department of Dermatology - Venereology; National and Kapodistrian University of Athens Medical School; Andreas Sygros Hospital; Athens Greece
| | - A. Casari
- Department of Dermatology; University of Modena and Reggio Emilia; Italy
| | - J. Chester
- Department of Dermatology; University of Modena and Reggio Emilia; Italy
| | - S. Kaleci
- Department of Dermatology; University of Modena and Reggio Emilia; Italy
| | - T. Dirschka
- Centroderm Clinic; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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16
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Morton C, Dominicus R, Radny P, Dirschka T, Hauschild A, Reinhold U, Aschoff R, Ulrich M, Keohane S, Ekanayake-Bohlig S, Ibbotson S, Ostendorf R, Berking C, Gröne D, Schulze H, Ockenfels H, Jasnoch V, Kurzen H, Sebastian M, Stege H, Staubach P, Gupta G, Hübinger F, Ziabreva I, Schmitz B, Gertzmann A, Lübbert H, Szeimies RM. A randomized, multinational, noninferiority, phase III trial to evaluate the safety and efficacy of BF-200 aminolaevulinic acid gel vs. methyl aminolaevulinate cream in the treatment of nonaggressive basal cell carcinoma with photodynamic therapy. Br J Dermatol 2018; 179:309-319. [DOI: 10.1111/bjd.16441] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2018] [Indexed: 01/26/2023]
Affiliation(s)
- C.A. Morton
- Dermatology Department; Stirling Community Hospital; NHS Forth Valley; Stirling U.K
| | | | - P. Radny
- Private Dermatological Practice; Friedrichshafen Germany
| | - T. Dirschka
- CentroDerm GmbH, Wuppertal, and Faculty of Health; University Witten/Herdecke; Witten Germany
| | - A. Hauschild
- Dermatologikum Kiel and Department of Dermatology; University Hospital Schleswig-Holstein (UKSH); Kiel Germany
| | | | - R. Aschoff
- Department of Dermatology; University Hospital Carl Gustav Carus; Technical University Dresden; Dresden Germany
| | - M. Ulrich
- CMB Collegium Medicum Berlin GmbH; Berlin Germany
| | - S. Keohane
- St Mary's Hospital; Portsmouth Dermatology Centre; NHS Trust; Portsmouth U.K
| | | | - S. Ibbotson
- Photobiology Unit; University of Dundee; Ninewells Hospital and Medical School; Dundee U.K
| | | | - C. Berking
- Department of Dermatology and Allergology; University Hospital Munich; Munich Germany
| | - D. Gröne
- Dermatological Private Practice; Clinical Research and Laser Medicine; Berlin Germany
| | - H.J. Schulze
- Specialist Hospital Hornheide; Department of Dermatology; Münster Germany
| | - H.M. Ockenfels
- Dermatology and Allergology Practice at the Clinical Centre Hanau; Hanau Germany
| | - V. Jasnoch
- Centre for Dermatology Vechta; Vechta Germany
| | | | | | - H. Stege
- Department of Dermatology; Clinical Centre Lippe GmbH Detmold; Detmold Germany
| | - P. Staubach
- Department of Dermatology; University Hospital Johannes Gutenberg University Mainz; Clinical Research Center; Mainz Germany
| | - G. Gupta
- Monklands Hospital; NHS Lanarkshire; Airdrie and University of Glasgow; Glasgow U.K
| | | | | | - B. Schmitz
- Biofrontera Bioscience GmbH; Leverkusen Germany
| | | | - H. Lübbert
- Biofrontera Bioscience GmbH; Leverkusen Germany
| | - R.-M. Szeimies
- Department of Dermatology and Allergology; Vest Clinic; Recklinghausen Germany
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17
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance. Br J Dermatol 2018. [DOI: 10.1111/bjd.16612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. 基底细胞癌光学相干断层成像:位置、亚型、观察者变化和图像质量对诊断性能的影响. Br J Dermatol 2018. [DOI: 10.1111/bjd.16631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance. Br J Dermatol 2018; 178:1102-1110. [DOI: 10.1111/bjd.16154] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Affiliation(s)
- J. Holmes
- Michelson Diagnostics Ltd; Maidstone Kent U.K
| | - T. von Braunmühl
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - C. Berking
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - E. Sattler
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - M. Ulrich
- Private Dermatology Office/CMB Collegium Medicum Berlin GmbH; Berlin Germany
| | - U. Reinhold
- Dermatology Center Bonn Friedensplatz; Bonn Germany
| | - H. Kurzen
- Private Dermatology Office; Freising Germany
| | - T. Dirschka
- Private Dermatology Office; Wuppertal Germany
| | - C. Kellner
- St Bernard-Hospital; Kamp Lintfort Germany
| | - S. Schuh
- General Hospital Augsburg; Department of Dermatology and Allergology; Augsburg Germany
| | - J. Welzel
- General Hospital Augsburg; Department of Dermatology and Allergology; Augsburg Germany
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20
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Seifarth D, Dirschka T, Altmeyer P, El Gammal S. Abheilen eines Morpheaherdes im Bereich einer Vena-saphena-magna-Varikosis nach Sklerosierungstherapie. Phlebologie 2017. [DOI: 10.1055/s-0037-1617313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungBei einer 65jährigen Patientin mit der Diagnose einer Seitenastvarikosis der Vena saphena magna bei Muskelpumpeninsuffizienz Grad II mit besserbarer Venenfunktion am linken Bein wurde eine Sklerosierungstherapie mit Natriumjodid/Jod (Varigloban® 4%) und Polidocanol (Aethoxysklerol® 3%) durchgeführt. Bei der Patientin bestand ein Morphea-Plaque am linken lateralen Oberschenkel im Bereich der Seitenastvarikosis der Vena saphena magna, welcher sich nach Abschluß der Sklerosierung komplett zurückbildete. Wir nehmen an, daß es bei unserer Patientin nach Änderung der lokalen Terrainfaktoren mittels Sklerosierungstherapie zu einem Abheilungsreiz für den Morphea-Plaque am Oberschenkel gekommen ist. Ob die chronische Veneninsuffizienz die Entstehung der Morphea-Plaques durch eine lokale Entzündung und/oder durch z. B. Druck begünstigt hat, muß offenbleiben.
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21
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Schmitz L, Gambichler T, Gupta G, Stücker M, Dirschka T. Actinic keratosis area and severity index (AKASI) is associated with the incidence of squamous cell carcinoma. J Eur Acad Dermatol Venereol 2017; 32:752-756. [DOI: 10.1111/jdv.14682] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/17/2017] [Indexed: 12/14/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - G. Gupta
- Department of Dermatology; Monklands Hospital; Lanarkshire UK
- University of Glasgow; Glasgow UK
| | - M. Stücker
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - T. Dirschka
- CentroDerm Clinic; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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22
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Figueras Nart I, Cerio R, Dirschka T, Dréno B, Lear JT, Pellacani G, Peris K, Ruiz de Casas A. Defining the actinic keratosis field: a literature review and discussion. J Eur Acad Dermatol Venereol 2017; 32:544-563. [PMID: 29055153 DOI: 10.1111/jdv.14652] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite the chronic and increasingly prevalent nature of actinic keratosis (AK) and existing evidence supporting assessment of the entire cancerization field during clinical management, a standardized definition of the AK field to aid in the understanding and characterization of the disease is lacking. The objective of this review was to present and appraise the available evidence describing the AK cancerization field, with the aim of determining a precise definition of the AK field in terms of its molecular (including genetic and immunological), histological and clinical characteristics. Eight European dermatologists collaborated to conduct a review and expert appraisal of articles detailing the characteristics of the AK field. Articles published in English before August 2016 were identified using PubMed and independently selected for further assessment according to predefined preliminary inclusion and exclusion criteria. In addition, a retrospective audit of patients with AK was performed to define the AK field in clinical terms. A total of 32 review articles and 47 original research articles provided evidence of sun-induced molecular (including genetic and immunological) and histological skin changes in the sun-exposed area affected by AK. However, the available literature was deemed insufficient to inform a clinical definition of the AK field. During the retrospective audit, visible signs of sun damage in 40 patients with AK were assessed. Telangiectasia, atrophy and pigmentation disorders emerged as 'reliable or very reliable' indicators of AK field based on expert opinion, whereas 'sand paper' was deemed a 'moderately reliable' indicator. This literature review has revealed a significant gap of evidence to inform a clinical definition of the AK field. Therefore, the authors instead propose a clinical definition of field cancerization based on the identification of visible signs of sun damage that are reliable indicators of field cancerization based on expert opinion.
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Affiliation(s)
- I Figueras Nart
- Department of Dermatology, Bellvitge Hospital, Barcelona, Spain
| | - R Cerio
- Department of Cutaneous Medicine and Surgery, The Royal London Hospital and QMUL, Bart's Health NHS Trust, London, UK
| | - T Dirschka
- CentroDerm® Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - B Dréno
- Department of Dermato-Cancerology, University of Nantes, Nantes, France
| | - J T Lear
- Manchester Academic Health Science Centre, MAHSC, Manchester University and Salford Royal NHS Foundation Trust, Royal Infirmary, The University of Manchester, Manchester, UK
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - K Peris
- Department of Dermatology, Catholic University of Rome, Rome, Italy
| | - A Ruiz de Casas
- Dermatology Unit, Virgen Macarena University Hospital, Seville, Spain
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23
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Schmitz L, Gambichler T, Gupta G, Stücker M, Stockfleth E, Szeimies R, Dirschka T. Actinic keratoses show variable histological basal growth patterns - a proposed classification adjustment. J Eur Acad Dermatol Venereol 2017; 32:745-751. [DOI: 10.1111/jdv.14512] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L. Schmitz
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - T. Gambichler
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - G. Gupta
- Department of Dermatology; Monklands Hospital; Lanarkshire UK
- University of Glasgow; Glasgow UK
| | - M. Stücker
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - E. Stockfleth
- Department of Dermatology, Venereology and Allergology; Ruhr-University; Bochum Germany
| | - R.M. Szeimies
- Department of Dermatology and Allergology; Vest Hospital; Academic Teaching Hospital University of Bochum; Recklinghausen Germany
| | - T. Dirschka
- CentroDerm Clinic; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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24
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Dirschka T, Pellacani G, Micali G, Malvehy J, Stratigos AJ, Casari A, Schmitz L, Gupta G. A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index. J Eur Acad Dermatol Venereol 2017; 31:1295-1302. [PMID: 28401585 DOI: 10.1111/jdv.14267] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/16/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients. OBJECTIVES To develop and perform an initial pilot validation of a new easy-to-use quantitative tool for assessing AK severity on the head. METHODS The actinic keratosis area and severity index (AKASI) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index (PASI). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment (PGA) and AKASI. To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AKs was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness. RESULTS There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean (SD) AKASI increased from 2.88 (1.18) for 'light' to 5.33 (1.48) for 'moderate', 8.28 (1.89) for 'severe', and 8.73 (3.03) for 'very severe' PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories. CONCLUSIONS Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice.
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Affiliation(s)
- T Dirschka
- Centroderm Clinic, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain
| | - A J Stratigos
- First Department of Dermatology, Andreas Sygros Hospital, University of Athens Medical School, Athens, Greece
| | - A Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Schmitz
- Centroderm Clinic, Wuppertal, Germany.,Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - G Gupta
- Department of Dermatology, Monklands Hospital, Lanarkshire, UK.,University of Glasgow, Glasgow, UK
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Dirschka T. Response to: a network meta-analysis of the relative efficacy of treatments for actinic keratosis of the face or scalp in Europe. J Eur Acad Dermatol Venereol 2016; 31:e166-e167. [DOI: 10.1111/jdv.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. Dirschka
- CentroDerm GmbH; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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26
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Reinhold U, Dirschka T, Ostendorf R, Aschoff R, Berking C, Philipp‐Dormston W, Hahn S, Lau K, Jäger A, Schmitz B, Lübbert H, Szeimies R. A randomized, double‐blind, phase
III
, multicentre study to evaluate the safety and efficacy of
BF
‐200
ALA
(Ameluz
®
) vs. placebo in the field‐directed treatment of mild‐to‐moderate actinic keratosis with photodynamic therapy (PDT) when using the
BF
‐Rhodo
LED
®
lamp. Br J Dermatol 2016; 175:696-705. [DOI: 10.1111/bjd.14498] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- U. Reinhold
- Dermatological Center Bonn Friedensplatz Bonn Germany
| | - T. Dirschka
- Private Practice Wuppertal‐Barmen Germany
- Faculty of Health University Witten/Herdecke Witten Germany
| | | | - R. Aschoff
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - C. Berking
- Department of Dermatology and Allergology University Hospital Munich Germany
| | | | - S. Hahn
- Accovion GmbH Eschborn Germany
| | - K. Lau
- Accovion GmbH Eschborn Germany
| | - A. Jäger
- Biofrontera Bioscience GmbH Leverkusen Germany
| | - B. Schmitz
- Biofrontera Bioscience GmbH Leverkusen Germany
| | - H. Lübbert
- Biofrontera Bioscience GmbH Leverkusen Germany
| | - R.‐M. Szeimies
- Department of Dermatology and Allergology Vest Clinic Recklinghausen Germany
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Schmitz L, Kahl P, Majores M, Bierhoff E, Stockfleth E, Dirschka T. Actinic keratosis: correlation between clinical and histological classification systems. J Eur Acad Dermatol Venereol 2016; 30:1303-7. [PMID: 26955898 DOI: 10.1111/jdv.13626] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are several clinical and histological classification systems for grading actinic keratosis (AK) lesions. The Olsen clinical classification scheme grades AK lesions according to their thickness and degree of hyperkeratosis (grades 1-3). The Roewert-Huber histological classification system grades AK lesions based on the extent of epidermal atypical keratinocytes (AK I-III). OBJECTIVE The aim of this study was to determine whether there is a correlation between these clinical and histological AK classification schemes. METHODS One AK lesion from patients in three pivotal clinical studies and routine practice was assessed clinically and histologically. A match in grading was defined as Olsen grade 1 being classified histologically as AK I, Olsen grade 2 as AK II and Olsen grade 3 as AK III. RESULTS Of the 892 lesions included, 29.0% were classified as Olsen grade 1, 59.6% as Olsen grade 2 and 11.3% as Olsen grade 3; 19.2% were histologically classified as AK I, 69.6% as AK II and 11.2% as AK III. Only 480 lesions (53.8%) had a matching clinical and histological classification. Of these matches, most were 'Olsen grade 2 = AK II' (83.1%). The Spearman's rank correlation coefficient for clinical and histological classification was r = 0.0499 (P = 0.137). CONCLUSIONS Clinical classification of AK lesions using the system of Olsen does not accurately match histological classification of the same lesions using the system of Roewert-Huber. Consequently, it is not possible to draw conclusions about the histology of AK lesions from their clinical appearance. This finding reinforces the need to treat all AK lesions as well as field cancerization.
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Affiliation(s)
- L Schmitz
- Department of Dermatology, Ruhr-University, Bochum, Germany.,CentroDerm GmbH, Wuppertal, Germany
| | - P Kahl
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - M Majores
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Bierhoff
- Heinz-Werner-Seifert-Institute of Dermatopathology, Bonn, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University, Bochum, Germany
| | - T Dirschka
- CentroDerm GmbH, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
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Dirschka T, Peris K, Gupta G, Alomar A, Aractingi S, Dakovic R, Stockfleth E. Imiquimod 3.75% in actinic keratosis: efficacy in patients with and without rest periods during treatment. J Eur Acad Dermatol Venereol 2015; 30:1416-7. [DOI: 10.1111/jdv.13260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Dirschka
- Dermatological Practice Centre; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
| | - K. Peris
- Department of Dermatology; Catholic University of Rome; Largo A. Gemelli 8 00168 Rome Italy
| | - G. Gupta
- Department of Dermatology; Monklands Hospital; Airdrie Lanarkshire ML6 0JS UK
| | - A. Alomar
- Department of Dermatology; Institut Universitari Quiron Dexeus; Av. Carles III 71-75 8028 Barcelona Spain
| | - S. Aractingi
- Service de Dermatologie Allergologie; Hôpital Cochin; 89 rue d'Assas 75006 Paris France
- Université Paris 5 Descartes; Paris France
| | - R. Dakovic
- Meda Pharma GmbH & Co. KG; Benzstrasse 1 61353 Bad Homburg Germany
| | - E. Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie; St. Josef-Hospital; Ruhr-Universität Bochum; Bochum Germany
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29
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Ulrich M, von Braunmuehl T, Kurzen H, Dirschka T, Kellner C, Sattler E, Berking C, Welzel J, Reinhold U. The sensitivity and specificity of optical coherence tomography for the assisted diagnosis of nonpigmented basal cell carcinoma: an observational study. Br J Dermatol 2015; 173:428-35. [PMID: 25904111 DOI: 10.1111/bjd.13853] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnostic criteria for basal cell carcinoma (BCC) using optical coherence tomography (OCT) have been described previously, but the clinical value of these findings remains unknown. OBJECTIVES To investigate the diagnostic value of OCT for BCC in a typical clinical setting. The primary efficacy end point was a diagnosis of BCC for each lesion. Secondary end points were the diagnosis of other possible conditions. METHODS This was an observational, prospective, multicentre study in which consecutive patients with nonpigmented pink lesions suspicious for BCC underwent clinical assessment, dermoscopy and OCT, with the diagnosis recorded at each stage. Once all diagnoses had been recorded, the histological results were disclosed. In total 164 patients with 256 lesions were recruited. Histology was missing for 21 lesions, leaving 235 lesions in 155 patients for analysis. RESULTS Sixty per cent of lesions (141 of 235) were identified as BCC by histology. A slight increase of sensitivity was noted following OCT, which did not reach statistical significance. The specificity increased significantly from 28·6% by clinical assessment to 54·3% using dermoscopy and to 75·3% with the addition of OCT (P < 0·001). The positive predictive value for the diagnosis of BCC using OCT was 85·2% [95% confidence interval (CI) 78·6-90·4], and the negative predictive value was 92·1% (95% CI 83·6-97·0). The accuracy of diagnosis for all lesions increased from 65·8% with clinical evaluation to 76·2% following additional dermoscopy and to 87·4% with the addition of OCT. CONCLUSIONS OCT significantly improved the diagnostic specificity for BCC compared with clinical assessment and dermoscopy alone.
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Affiliation(s)
- M Ulrich
- Private Dermatology Office/CMB Collegium Medicum Berlin GmbH, Luisenstraße 54/55, 10117, Berlin, Germany.,Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T von Braunmuehl
- Department of Dermatology and Allergology, University Hospital Munich, Munich, Germany
| | - H Kurzen
- Private Dermatology Office, Freising, Germany
| | - T Dirschka
- Private Dermatology Office Prof Thomas Dirschka, Wuppertal, Germany
| | - C Kellner
- Dermatology Center Bonn Friedensplatz, Bonn, Germany
| | - E Sattler
- Department of Dermatology and Allergology, University Hospital Munich, Munich, Germany
| | - C Berking
- Department of Dermatology and Allergology, University Hospital Munich, Munich, Germany
| | - J Welzel
- Department for Dermatology and Allergology, General Hospital Augsburg, Augsburg, Germany
| | - U Reinhold
- Dermatology Center Bonn Friedensplatz, Bonn, Germany
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30
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Pflugfelder A, Andonov E, Weide B, Dirschka T, Schempp C, Stockfleth E, Stratigos A, Krüger-Krasagakis S, Bauer J, Garbe C, Eigentler TK. Lack of activity of betulin-based Oleogel-S10 in the treatment of actinic keratoses: a randomized, multicentre, placebo-controlled double-blind phase II trial. Br J Dermatol 2015; 172:926-32. [PMID: 25124939 DOI: 10.1111/bjd.13342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Betulinic acid and other triterpenes have shown strong antitumour activity in vitro and in vivo. A triterpene extract of birch bark formed the base of Oleogel-S10 and allowed topical application. Two previous trials have shown efficacy and tolerability in the treatment of actinic keratoses (AKs) with betulin-based Oleogel-S10. OBJECTIVES To confirm the efficacy and tolerability/safety of Oleogel-S10 in the treatment of AKs in a multicentre placebo-controlled study. METHODS Patients (n = 165) were treated topically for 3 months in a four-arm parallel study design, randomly allocated to A (n = 53) Oleogel-S10 once daily, B (n = 51) Oleogel-S10 twice daily, or C (n = 25) or D (n = 28) placebo (petroleum jelly) once or twice daily, respectively. Clinical efficacy in this double-blind study was assessed by the investigators. Final and baseline biopsies were evaluated by central histopathology. RESULTS Complete clearance of the target lesions was seen in 4% of patients in group A and 7% in group B, but not in the placebo groups. A clearance rate of > 75% was seen for 15% and 18% of patients in groups A and B, respectively, and for 13% in the placebo groups. These differences were not statistically significant. Histopathologically, 43·9% of patients showed a downgrading or clearance of the marker AK with no significant differences between the groups. Treatment with Oleogel-S10 was well tolerated. The tolerability as assessed by the investigator was mostly 'very good' (78·8%), followed by 'good' (18·2%) and only 1·2% assessed it as 'intolerable'. Patient-assessed tolerability was graded mostly 'very good' (56·4%) or 'good' (34·5%). CONCLUSIONS Treatment with Oleogel-S10 was well tolerated during a treatment period of 3 months, yet was no better than placebo in terms of efficacy in the treatment of AKs.
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Affiliation(s)
- A Pflugfelder
- Center for Dermatooncology, Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
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Peris K, Stockfleth E, Gupta G, Aractingi S, Dakovic R, Dirschka T, Alomar A. Efficacy of imiquimod 3.75% from Lmax according to the number of actinic keratosis lesions. J Eur Acad Dermatol Venereol 2014; 29:2470-3. [PMID: 25351284 DOI: 10.1111/jdv.12782] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/19/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Imiquimod 3.75% reduces 92.2% of all actinic keratosis (AK) lesions, assumed to include both subclinical and clinical lesions, across a large sun-exposed field such as the full face or balding scalp. OBJECTIVE To evaluate the efficacy of imiquimod 3.75% using the reduction in lesions from Lmax (the maximum lesion count during treatment) in subgroups of patients with low and high AK lesion counts. METHODS Patients from two 14-week, placebo-controlled, double-blind studies were subgrouped according to whether they had ≤ 10 or >10 AK lesions at baseline. Treatment was applied to the full face or balding scalp during two 2-week treatment cycles separated by a 2-week treatment-free interval. RESULTS Overall, 167 patients had ≤ 10 lesions and 152 patients had >10 AK lesions at baseline. With imiquimod 3.75%, the median percentage reduction in AK lesions from Lmax to end of study was similar in patients with ≤ 10 and >10 baseline lesions (91.5% and 93.0% respectively). The median absolute reduction in AK lesions from Lmax to end of study was 24.0 for patients with >10 baseline lesions and 10.0 for those with ≤ 10 baseline lesions. The median percentage and absolute reductions in lesions from Lmax were significantly greater with imiquimod 3.75% vs. placebo (P < 0.0001). CONCLUSIONS Imiquimod 3.75% is effective regardless of disease severity as shown in this study by the reduction of over 90% of lesions from Lmax in patients with low or high AK lesion counts.
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Affiliation(s)
- K Peris
- Department of Dermatology, Catholic University of Rome, Rome, Italy
| | - E Stockfleth
- Department of Dermatology, Charité - University Medical Centre Berlin, Berlin, Germany
| | - G Gupta
- Department of Dermatology, Monklands Hospital, Airdrie, Lanarkshire, UK
| | - S Aractingi
- Service de Dermatologie Allergologie, Hôpital Cochin, Paris, France.,Université Paris 5 Descartes, Paris, France
| | - R Dakovic
- Meda Pharma GmbH & Co. KG, Bad Homburg, Germany
| | - T Dirschka
- Dermatological Practice Centre, Wuppertal, Germany.,Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - A Alomar
- Department of Dermatology, Institut Universitari Quiron Dexeus, Barcelona, Spain
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Malvehy J, Hauschild A, Curiel-Lewandrowski C, Mohr P, Hofmann-Wellenhof R, Motley R, Berking C, Grossman D, Paoli J, Loquai C, Olah J, Reinhold U, Wenger H, Dirschka T, Davis S, Henderson C, Rabinovitz H, Welzel J, Schadendorf D, Birgersson U. Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety. Br J Dermatol 2014; 171:1099-107. [PMID: 24841846 PMCID: PMC4257502 DOI: 10.1111/bjd.13121] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Even though progress has been made, the detection of melanoma still poses a challenge. In light of this situation, the Nevisense electrical impedance spectroscopy (EIS) system (SciBase AB, Stockholm, Sweden) was designed and shown to have the potential to be used as an adjunct diagnostic tool for melanoma detection. OBJECTIVES To assess the effectiveness and safety of the Nevisense system in the distinction of benign lesions of the skin from melanoma with electrical impedance spectroscopy. METHODS This multicentre, prospective, and blinded clinical study was conducted at five American and 17 European investigational sites. All eligible skin lesions in the study were examined with the EIS-based Nevisense system, photographed, removed by excisional biopsy and subjected to histopathological evaluation. A postprocedure clinical follow-up was conducted at 7 ± 3 days from the initial measurement. A total of 1951 patients with 2416 lesions were enrolled into the study; 1943 lesions were eligible and evaluable for the primary efficacy end point, including 265 melanomas - 112 in situ and 153 invasive melanomas with a median Breslow thickness of 0·57 mm [48 basal cell carcinomas (BCCs) and seven squamous cell carcinomas (SCCs)]. RESULTS The observed sensitivity of Nevisense was 96·6% (256 of 265 melanomas) with an exact one-sided 95% lower confidence bound estimated at 94·2% and an observed specificity of 34·4%, and an exact two-sided 95% confidence bound estimated at 32·0-36·9%. The positive and negative predictive values of Nevisense were 21·1% and 98·2%, respectively. The observed sensitivity for nonmelanoma skin cancer was 100% (55 of 48 BCCs and seven SCCs) with an exact two-sided 95% confidence bound estimated at 93·5-100·0%. CONCLUSIONS Nevisense is an accurate and safe device to support clinicians in the detection of cutaneous melanoma.
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Affiliation(s)
- J Malvehy
- Department of Dermatology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Simon JC, Dominicus R, Karl L, Rodríguez R, Willers C, Dirschka T. A prospective randomized exploratory study comparing the efficacy of once-daily topical 0.5% 5-fluorouracil in combination with 10.0% salicylic acid (5-FU/SA) vs. cryosurgery for the treatment of hyperkeratotic actinic keratosis. J Eur Acad Dermatol Venereol 2014; 29:881-9. [PMID: 25257941 DOI: 10.1111/jdv.12702] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/17/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Actinic keratoses (AKs) are clinically significant and require therapy. Efficacy of low-dose (0.5%) 5-fluorouracil with 10% salicylic acid (5-FU/SA) has been shown in randomized comparative trials of hyperkeratotic lesions of various grades. OBJECTIVES To evaluate the efficacy, tolerability and safety of low-dose 5-FU/SA topical solution vs. cryosurgery in patients with moderate/severe (grade II/III) hyperkeratotic AKs (NCT01358851). METHODS In an exploratory, open, randomized study, patients with histologically confirmed moderate/severe hyperkeratotic AKs on the face/forehead or bald scalp received 6 weeks of once-daily topical 0.5% 5-FU/SA, or up to two cryosurgery treatments (3 weeks apart). Histological outcomes were determined from punch biopsies. Clinical, cosmetic and tolerability outcomes were also assessed. RESULTS Sixty-six patients received treatment (33 per arm). The baseline total number of lesions was 266 (8.1/patient) in the 0.5% 5-FU/SA and 263 (8.0/patient) in the cryosurgery group. Most (74.5%) lesions were grade II (grade III, 25.5%). Mean change in lesion count from baseline to Day 98 was -5.2 and -5.7 lesions per patient for 0.5% 5-FU/SA and cryotherapy groups respectively. Histological AK clearance rates on Day 98 were 62.1% and 41.9% respectively. At 6-month posttreatment follow-up, recurrence of cleared lesions (no clinically visible lesions in treatment area) occurred in 39.4% of 0.5% 5-FU/SA and 84.8% of cryosurgery patients. Drug-related adverse events (AEs), including local skin reactions considered 'severe' by the investigator, were reported in 24.2% of 0.5% 5-FU/SA and 6.1% of cryosurgery patients. All drug-related AEs were skin reactions. CONCLUSIONS Although the study was not powered to explore statistical differences in clinical efficacy between treatments, a short (6-week) schedule of topical treatment with 0.5% 5-FU/SA achieved greater histological clearance and lower recurrence of grade II/III hyperkeratotic AKs than cryosurgery. AE incidence across both treatment groups was relatively low and AEs were generally mild or moderate. Clinical trials.gov identifier: NCT01358851.
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Affiliation(s)
- J-C Simon
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, Leipzig, Germany
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Gupta G, Stockfleth E, Peris K, Aractingi S, Alomar A, Dakovic R, Dirschka T. Long-term sustained lesion clearance from Lmax with imiquimod 3.75%, a new field-directed treatment for actinic keratosis. J Eur Acad Dermatol Venereol 2014; 29:1840-2. [DOI: 10.1111/jdv.12697] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- G. Gupta
- Department of Dermatology; Monklands Hospital; Airdrie Lanarkshire UK
| | - E. Stockfleth
- Department of Dermatology; Charité - University Medical Centre Berlin; Berlin Germany
| | - K. Peris
- Department of Dermatology; Catholic University of Rome; Rome Italy
| | - S. Aractingi
- Service de Dermatologie Allergologie; Hôpital Cochin; Paris France
- Université Paris 5 Descartes; Paris France
| | - A. Alomar
- Department of Dermatology; Institut Universitari Quiron Dexeus; Barcelona Spain
| | - R. Dakovic
- Meda Pharma GmbH & Co. KG; Bad Homburg Germany
| | - T. Dirschka
- Dermatological Practice Centre; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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Dirschka T. Follow-up analysis of the efficacy of photodynamic therapy in actinic keratosis: reply from the authors. Br J Dermatol 2013; 169:1156-7. [DOI: 10.1111/bjd.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. Dirschka
- Private Dermatological Practice Centre; Wuppertal Germany
- Faculty of Health; University Witten-Herdecke; Witten Germany
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36
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Schmitz L, Bierhoff E, Dirschka T. Optical Coherence Tomography Imaging of Erythroplasia of Queyrat and Treatment with Imiquimod 5% Cream: A Case Report. Dermatology 2013; 228:24-6. [DOI: 10.1159/000354652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/27/2013] [Indexed: 11/19/2022] Open
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Dirschka T, Radny P, Dominicus R, Mensing H, Brüning H, Jenne L, Karl L, Sebastian M, Oster-Schmidt C, Klövekorn W, Reinhold U, Tanner M, Gröne D, Deichmann M, Simon M, Hübinger F, Hofbauer G, Krähn-Senftleben G, Borrosch F, Reich K, Berking C, Wolf P, Lehmann P, Moers-Carpi M, Hönigsmann H, Wernicke-Panten K, Hahn S, Pabst G, Voss D, Foguet M, Schmitz B, Lübbert H, Szeimies RM. Long-term (6 and 12 months) follow-up of two prospective, randomized, controlled phase III trials of photodynamic therapy with BF-200 ALA and methyl aminolaevulinate for the treatment of actinic keratosis. Br J Dermatol 2013; 168:825-36. [PMID: 23252768 PMCID: PMC3660784 DOI: 10.1111/bjd.12158] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Two phase III trials of photodynamic therapy (PDT) with BF-200 ALA, a recently approved nanoemulsion formulation of 5-aminolaevulinic acid (ALA) demonstrated high clearance rates in mild-to-moderate actinic keratosis (AK). The comparison to a registered methyl aminolaevulinate (MAL) cream demonstrated significantly superior total patient clearance rates. Objectives To evaluate long-term efficacy and safety of PDT for AK 6 and 12 months after the last PDT with BF-200 ALA, MAL or placebo. Methods The follow-up phase (FUP) was performed with patients of two phase III studies. Both studies compared BF-200 ALA with placebo, one of the studies additionally with MAL. Overall recurrence rates and various subgroups (light source, lesion severity, lesion location, complete responders after first PDT) were assessed 6 and 12 months after the last PDT. Results Recurrence rates were similar for BF-200 ALA and MAL, with a tendency to lower recurrence rates for BF-200 ALA. The proportion of patients who were fully cleared during PDT and remained completely clear for at least 12 months after PDT were 47% for BF-200 ALA (both studies) and 36% for MAL treatment. The subgroup that was illuminated with narrow wavelength LED lamps reached 69% and 53% for BF-200 ALA (both studies, respectively) and 41% for MAL. No safety concerns were reported. Conclusions The FUP data confirmed the high efficacy and safety of PDT with BF-200 ALA. The slightly lower recurrence rates after BF-200 ALA treatment compared with MAL treatment enhanced the better treatment outcome due to the significantly superior efficacy.
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Affiliation(s)
- T Dirschka
- Private Dermatological Practice Centre, Wuppertal, Germany
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Müller C, Berensmeier A, Hamm H, Dirschka T, Reich K, Fischer T, Rzany B. Efficacy and safety of methantheline bromide (Vagantin(®) ) in axillary and palmar hyperhidrosis: results from a multicenter, randomized, placebo-controlled trial. J Eur Acad Dermatol Venereol 2012; 27:1278-84. [PMID: 23004926 DOI: 10.1111/j.1468-3083.2012.04708.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Focal hyperhidrosis can severely affect quality of life. So far, knowledge on the effect of systemic therapy of focal hyperhidrosis is limited. OBJECTIVE To assess the efficacy and safety of methantheline bromide (MB) in the treatment of axillary and palmar-axillary hyperhidrosis. METHODS A multicenter controlled randomized double-blind clinical trial was conducted in patients with axillary or palmar-axillary hyperhidrosis defined by a sweat production >50 mg/5 min. Patients received 3 × 50 mg MB daily or placebo over a period of 28 ± 1 days. Main outcome criterion was the reduction of sweat as measured by gravimetry on day 28 ± 1. Quality of life was assessed by Dermatology Life Quality Index (DLQI) and Hyperhidrosis Disease Severity Score (HDSS). RESULTS A total of 339 patients were randomly assigned to receive MB or placebo. On day 28 ± 1, the mean axillary sweat production was 99 mg for MB and 130 mg for placebo compared with 168 mg and 161 mg respectively at baseline (P = 0.004). Patient's HDSS score decreased in the MB group from 3.2 to 2.4 compared with 3.2 to 2.7 for placebo (P = 0.002). Similar results could be obtained for the DLQI with 9.7 for MB and 12.2 for placebo, which decreased from 16.4 or 17 respectively (P = 0.003). Tolerability was good for both groups. The most frequent adverse event was dry mouth. CONCLUSION Fifty milligrams methantheline bromide three times a day is an effective and safe treatment of axillary hyperhidrosis.
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Affiliation(s)
- C Müller
- Department of Medical Science and Operations, RIEMSER Arzneimittel AG, Greifswald, Germany Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany Private Dermatological Practice Centre, Wuppertal, Germany SCIderm Research Institute and Dermatologikum Hamburg, Hamburg, Germany Skin and Laser Center Potsdam, Potsdam, Germany Division of Evidence-Based Medicine, Klinik für Dermatologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Dirschka T, Radny P, Dominicus R, Mensing H, Brüning H, Jenne L, Karl L, Sebastian M, Oster-Schmidt C, Klövekorn W, Reinhold U, Tanner M, Gröne D, Deichmann M, Simon M, Hübinger F, Hofbauer G, Krähn-Senftleben G, Borrosch F, Reich K, Berking C, Wolf P, Lehmann P, Moers-Carpi M, Hönigsmann H, Wernicke-Panten K, Helwig C, Foguet M, Schmitz B, Lübbert H, Szeimies RM. Photodynamic therapy with BF-200 ALA for the treatment of actinic keratosis: results of a multicentre, randomized, observer-blind phase III study in comparison with a registered methyl-5-aminolaevulinate cream and placebo. Br J Dermatol 2011; 166:137-46. [PMID: 21910711 DOI: 10.1111/j.1365-2133.2011.10613.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) or its methylester [methyl-5-aminolaevulinate (MAL) or 5-amino-4-oxopentanoate] was recently ranked as first-line therapy for the treatment of actinic keratosis (AK) and is an accepted therapeutic option for the treatment of neoplastic skin diseases. BF-200 ALA (Biofrontera Bioscience GmbH, Leverkusen, Germany) is a gel formulation of ALA with nanoemulsion for the treatment of AK which overcomes previous problems of ALA instability and improves skin penetration. OBJECTIVES To evaluate the efficacy and safety of PDT of AKs with BF-200 ALA in comparison with a registered MAL cream and with placebo. METHODS The study was performed as a randomized, multicentre, observer-blind, placebo-controlled, interindividual trial with BF-200 ALA, a registered MAL cream and placebo in a ratio of 3:3:1. Six hundred patients, each with four to eight mild to moderate AK lesions on the face and/or the bald scalp, were enrolled in 26 study centres in Germany, Austria and Switzerland. Patients received one PDT. If residual lesions remained at 3months after treatment, PDT was repeated. RESULTS PDT with BF-200 ALA was superior to placebo PDT with respect to patient complete clearance rate (78·2% vs. 17·1%; P<0·0001) and lesion complete clearance rate (90·4% vs. 37·1%) at 3months after the last PDT. Moreover, superiority was demonstrated over the MAL cream regarding the primary endpoint patient complete clearance (78·2% vs. 64·2%; P<0·05). Significant differences in the patient and lesion complete clearance rates and severity of treatment-related adverse events were observed for the narrow- and broad-spectrum light sources. CONCLUSIONS BF-200 ALA is a very effective, well-tolerated new formulation for AK treatment with PDT and is superior to a registered MAL medication. Efficacies and adverse events vary greatly with the different light sources used.
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Affiliation(s)
- T Dirschka
- Private Dermatological Practice Centre, Wuppertal, Germany
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Pflugfelder A, Welter AK, Leiter U, Weide B, Held L, Eigentler TK, Dirschka T, Stockfleth E, Nashan D, Garbe C. Open label randomized study comparing 3 months vs. 6 months treatment of actinic keratoses with 3% diclofenac in 2.5% hyaluronic acid gel: a trial of the German Dermatologic Cooperative Oncology Group. J Eur Acad Dermatol Venereol 2011; 26:48-53. [PMID: 21414035 DOI: 10.1111/j.1468-3083.2011.04005.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Actinic keratoses (AK) are carcinomata in situ with the potential to develop into invasive carcinoma. Several studies have demonstrated that 3% diclofenac in 2.5% hyaluronic acid gel (HA) is effective and well tolerated in the treatment of AK. To date there are no large randomized multicentre trials with treatment durations longer than 90 days and histopathological control of treatment outcome. OBJECTIVE The aim of this study was to investigate whether a prolonged treatment with diclofenac in HA of 6 vs. 3 months adds to the efficacy in treatment for AK and if this will influence tolerability and quality of life (QoL). METHODS This was a multicentre, randomized open-label study in which 418 patients with mild to moderate AKs were randomized into two treatment groups. Group A received diclofenac in HA for 3 months and group B for 6 months. Treatment efficacy was assessed by size measurement and a final biopsy of a defined marker AK. Quality of life was measured using the Dermatology Life Quality Index questionnaire. RESULTS Clinical complete clearance was observed in 40% in group A and in 45% in group B (P = 0.38). Histopathological clearance was confirmed in 30% in group A and in 40% in group B (P = 0.16). Treatment was well tolerated and QoL was significantly improved after treatment in both treatment groups. CONCLUSION Treatment with diclofenac in HA is effective and well tolerated during a treatment period of 3 months as well as 6 months. Prolongation of the treatment duration did not significantly affect treatment outcome.
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Affiliation(s)
- A Pflugfelder
- Centre for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Berlin, Germany.
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Dirschka T, Reich K, Bissonnette R, Maares J, Brown T, Diepgen TL. An open-label study assessing the safety and efficacy of alitretinoin in patients with severe chronic hand eczema unresponsive to topical corticosteroids. Clin Exp Dermatol 2010; 36:149-54. [DOI: 10.1111/j.1365-2230.2010.03955.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Szeimies RM, Radny P, Sebastian M, Borrosch F, Dirschka T, Krähn-Senftleben G, Reich K, Pabst G, Voss D, Foguet M, Gahlmann R, Lübbert H, Reinhold U. Photodynamic therapy with BF-200 ALA for the treatment of actinic keratosis: results of a prospective, randomized, double-blind, placebo-controlled phase III study. Br J Dermatol 2010; 163:386-94. [PMID: 20518784 DOI: 10.1111/j.1365-2133.2010.09873.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) provides a therapeutic option for the treatment of actinic keratosis (AK). Different strategies are applied to overcome the chemical instability of ALA in solution and to improve skin penetration. A new stable nanoemulsion-based ALA formulation, BF-200 ALA, is currently in clinical development for PDT of AK. OBJECTIVES To evaluate the efficacy and safety of PDT of AK with BF-200 ALA. METHODS The study was performed as a randomized, multicentre, double-blind, placebo-controlled, interindividual, two-armed trial with BF-200 ALA and placebo. A total of 122 patients with four to eight mild to moderate AK lesions on the face and/or the bald scalp were included in eight German study centres. The efficacy of BF-200 ALA after one and two PDT treatments was evaluated. BF-200 ALA was used in combination with two different light sources under illumination conditions defined by European competent authorities. RESULTS PDT with BF-200 ALA was superior to placebo PDT with respect to patient complete clearance rate (per-protocol group: 64% vs. 11%; P < 0.0001) and lesion complete clearance rate (per-protocol group: 81% vs. 22%) after the last PDT treatment. Statistically significant differences in the patient and lesion complete clearance rates and adverse effect profiles were observed for the two light sources, Aktilite CL128 and PhotoDyn 750, at both time points of assessment. The patient and lesion complete clearance rates after illumination with the Aktilite CL128 were 96% and 99%, respectively. CONCLUSIONS BF-200 ALA is a very effective new formulation for the treatment of AK with PDT. Marked differences between the efficacies and adverse effects were observed for the different light sources used. Thus, PDT efficacy is dependent both on the drug and on the characteristics of the light source and the illumination conditions used.
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Affiliation(s)
- R-M Szeimies
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany
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Wollenberg A, Kroth J, Hauschild A, Dirschka T. Hautreaktionen unter EGFR-Inhibitoren – Klinik und Management. Dtsch Med Wochenschr 2010; 135:149-54. [DOI: 10.1055/s-0029-1244831] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zschocke I, Lotzin A, Sebastian M, Dirschka T, Zielke A, Reich K. Wirksamkeit einer kombinierten Therapie der atopischen Dermatitis mit Triclosan und Flumetasonpivalat (DuoGalen ®Creme). Akt Dermatol 2009. [DOI: 10.1055/s-0029-1214754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dirschka T, Bierhoff E, Pflugfelder A, Garbe C. Topical 3.0% diclofenac in 2.5% hyaluronic acid gel induces regression of cancerous transformation in actinic keratoses. J Eur Acad Dermatol Venereol 2009; 24:258-63. [PMID: 19709346 DOI: 10.1111/j.1468-3083.2009.03399.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Actinic keratoses (AKs) are frequently diagnosed in dermatological patients. As they represent in situ carcinomas, effective treatment is required. OBJECTIVES We investigated the effect of topical 3.0% diclofenac in 2.5% hyaluronic acid gel on AK. METHODS Sixty-five patients with AKs were clinically evaluated before and after 3 months' treatment with topical 3.0% diclofenac in 2.5% hyaluronic gel. Biopsy specimens were taken and stained with haematoxylin-eosin and immunohistological markers. Specimens were evaluated for histological type of AKs using the AK classification scheme suggested by Röwert-Huber et al. [(early) in situ squamous cell carcinoma type AK Grade I-III], number of mitoses per high-power field and expression of immunohistological markers. RESULTS Complete clinical resolution was observed in 11 patients (16.9%). A significant (P<0.001) downgrading of AK grade was observed. Complete histological resolution was achieved in 15 patients (23.1%). The number of mitoses per high-power field was reduced significantly (P<0.001). The expression of anti-p53-antibody decreased significantly (P=0.009), as did the expression of anti-MiB-1 antibody (P=0.021). CONCLUSIONS 3.0% diclofenac in 2.5% hyaluronic acid gel causes regression of signs of cancerous transformation after 3 months' therapy.
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Affiliation(s)
- T Dirschka
- Dermatological Practice Center, Wuppertal, Germany.
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Abstract
A 15-year-old patient developed scleroderma en coup de sabre on right temple at 5 years of age. Multiple treatments (3 cycles of intravenous penicillin, topical glucocorticosteroids, topical calcipotriol, and cream PUVA phototherapy combined with topical calcipotriol) produced no improvement. The patient suffered greatly from the psychosocial stigmatization, so that the entire lesion was resected at 14 years of age. One year after the operation a thin non-sclerotic scar was present; tiny lateral areas of sclerosis not included in the operative field were unchanged. The operation greatly improved the patient's daily life. The surgical therapy of scleroderma en coup de sabre offers an interesting therapeutic alternative.
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Affiliation(s)
- T Dirschka
- Dermatologische Praxis Wuppertal, Schuchardstrasse 15, 42275 Wuppertal, Germany.
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Abstract
Malignant tumors are increasingly being treated with therapeutic agents having molecular mechanisms of action (so-called biologics). These include therapeutic agents for the blockade of epidermal growth factor receptor (EGFR). The adverse drug reaction profile associated with EGFR inhibitors is dominated by cutaneous lesions. Most common are acneiform skin reactions followed by xerosis, eczema and changes to the hair and nails. The cutaneous changes vary greatly between individuals and may be relatively insignificant. However, they may also prevent continuation of therapy. During the use of EGFR inhibitors, a correlation was observed between the severity of cutaneous changes and the effectiveness of the therapeutic agent, a finding potentially useful for individual dose adjustment.
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Affiliation(s)
- E Bierhoff
- Institut für Dermatopathologie, Trierer Strasse 70-72, 53115 Bonn.
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Abstract
Outpatient surgery in dermatology is likely to become increasingly important in future, for a number of reasons. Current social legislation favors outpatient surgery, because hospitals must justify performing any procedure in the outpatient catalogue on an inpatient basis. The range of conditions being treated is also broadening, for example due to the growing popularity of aesthetic enhancement procedures. Epidemiological trends in skin cancer will also lead to considerable growth in demand for outpatient dermatological surgery. This article analyses current trends in ambulatory dermato-surgery, taking into account social, legislative, hygienic, legal and economic aspects. Measures to promote quality assurance are also described. The difficult cost situation facing outpatient surgery is creating a need for new forms of cooperation between primary care physicians and hospitals.
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Abstract
BACKGROUND Rosacea and perioral dermatitis (PD) are common dermatoses, the aetiology and pathogenesis of which remain speculative. Objectives To investigate skin barrier function and features of atopy in both diseases. METHODS We studied 75 patients with rosacea and 75 with PD. Transepidermal water loss (TEWL) was measured in three regions of the face (lateral chin, perinasal cheek, side of the nose) and the patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX1). The control group consisted of 125 individuals with no history of rosacea, PD or active atopic disease. RESULTS In patients with PD, TEWL was significantly increased (P < 0.001) at all measurement points in comparison with the rosacea and control groups. Significantly (P < 0.001) higher values were also found regarding history and clinical signs of an atopic diathesis, prick test reactivity and specific IgE against aeroallergens. CONCLUSIONS PD is characterized by a skin barrier disorder of facial skin. It differs from rosacea in that it involves a significantly increased TEWL and features of an atopic diathesis. However, it remains disputed as to whether PD is an individual skin disease or a subtype of rosacea in atopic patients.
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Affiliation(s)
- T Dirschka
- Dermatological Practice Centre, Wuppertal, Germany.
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