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1.
An. bras. dermatol ; An. bras. dermatol;99(4): 527-534, Jul.-Aug. 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1563698

ABSTRACT

Abstract Background 5-Fluorouracil (5-FU) is a first-line drug to treat cutaneous field cancerization (CFC). There are few clinical trials with topical colchicine (COL). Objective To evaluate the effectiveness of 0.5% COL cream versus 5% 5-FU cream in the treatment of CFC. Method This was a randomized, open, self-controlled clinical trial. Forty-five patients (90 forearms), with three to ten actinic keratoses (AK) on each forearm, used 0.5% COL cream 2×/day for seven days on one forearm, and 5% 5-FU cream 2× /day, for 21 days, on the other forearm. The dosages were defined based on previous clinical trials for each drug. Adverse effects were evaluated after 14 days and outcomes after 90 days of inclusion. The primary outcome was complete AK clearance and the secondary outcomes were: partial clearance (≥50%), reduction in AK count, assessment of the Forearm Photoaging Scale (FPS), AK Severity Score (AKSS), and adverse effects. Results After 90 days, there was complete clearance of AK in 37% (95% CI 24%-49%) and partial clearance in 85% (95% CI 76%-93%) of the forearms treated with 5-FU,versus 17% (95% CI 7%-27%) and 78% (95% CI 66%-88%) for COL (p > 0.07). There was a percentage reduction of 75% in the AK count of the forearms treated with 5-FU (95% CI 66%-83%) and 64% in those treated with COL (95% CI 55%-72%). Regarding FPS and AKSS, there was improvement in both groups, with no difference regarding FPS (p = 0.654), and 5-FU superiority for AKSS (p = 0.012). Study limitations Single-center study. Conclusions 5-FU and COL are effective for treating CFC, with neither showing superiority regarding the reduction in AK counts.

2.
Arq. bras. oftalmol ; Arq. bras. oftalmol;86(1): 1-6, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1403480

ABSTRACT

ABSTRACT Purpose: To evaluate the variables possibly related to actinic keratosis and malignant skin lesions on the eyelid. Methods: A prospective study of patients with suspected eyelid malignancy was conducted. The participants underwent a 2-mm punch biopsy at two opposite sites of the lesion for diagnosis, and the results were compared with those of the histopathological study of the surgical excised specimen. The patients with an actinic keratosis component were divided into two groups (actinic keratosis-associated malignancy and actinic keratosis alone), which were compared for the following variables: age, disease duration, largest diameter, tumor area, Fitzpatrick classification, sex, tumor site and margin involvement. A cluster analysis was also performed. Results: We analyzed 174 lesions, of which 50 had an actinic keratosis component. Actinic keratosis was associated with squamous cell carcinoma in 22% of the cases and to basal cell carcinoma in 38%, which shows that both neoplasms may have contiguous actinic keratosis. Statistical analysis revealed no significant difference among the variables. In a cluster analysis, four groups were identified with malignant lesions in the medial canthus with the largest mean diameter and area. All margin involvements on the lower eyelid were related to malignancy, which means that all cases with margin involvement had an almost 100% risk of malignancy. Conclusions: Larger actinic keratosis lesions in the medial canthus and lesions with margin involvement on the lower eyelid have a greater probability of malignant association.


RESUMO Objetivo: Avaliar as possíveis variáveis relacionadas à ceratose actínica e lesões malignas cutâneas nas pálpebras. Métodos: Estudo prospectivo de pacientes com lesões palpebrais suspeitas de malignidade. Os participantes foram submetidos à biopsia por trépano (punch) de 2-mm em dois pontos opostos da lesão como método diagnóstico e os resultados foram comparados com o estudo histopatológico da peça excisada cirurgicamente. Aqueles que apresentaram ceratose actínica como resultado foram divididos em dois grupos (ceratose actínica associada com malignidade e ceratose actínica isolada) e foram comparados de acordo com as variáveis: idade, tempo de doença, maior diâmetro, área do tumor, classificação de Fitzpatrick, gênero, localização e acometimento da margem palpebral. A análise de cluster também foi realizada. Resultados: Foram analisadas 174 lesões e 50 delas tinham ceratose actínica como componente do tumor. Ceratose actínica esteve associada ao Carcinoma Espinocelular em 22% dos casos e ao Carcinoma Basocelular em 38%, mostrando que ambos podem ter ceratose actínica adjacente. A análise estatística não encontrou diferença entre as variáveis. A análise de cluster identificou quatro grupos e mostrou que lesões malignas no canto medial tinham maiores diâmetro e área. Acometimento da margem na pálpebra inferior relacionou-se em 100% com malignidade, enquanto a ausência de acometimento da margem mostrou menor chance de malignidade. Conclusões: Lesões maiores de ceratose actínica no canto medial e lesões com acometimento da margem palpebral inferior têm maiores chances de associação com malignidade.


Subject(s)
Humans , Eyelid Diseases , Keratosis, Actinic , Neoplasms , Prospective Studies , Eyelid Diseases/pathology , Keratosis, Actinic/pathology , Neoplasms/pathology
3.
Chinese Journal of Dermatology ; (12): 724-736, 2023.
Article in Chinese | WPRIM | ID: wpr-1028826

ABSTRACT

Objective:To determine the expression of Brahma-related gene 1 (BRG1) in cutaneous squamous cell carcinoma (cSCC) tissues and cells, and to investigate molecular mechanisms underlying the regulatory effect of its interaction with activating transcription factor 2 (ATF2) on the proliferation, migration and invasion of cSCC cells.Methods:From 2015 to 2021, 66 paraffin-embedded actinic keratosis (AK) tissue samples and 80 paraffin-embedded cSCC (including squamous cell carcinoma in situ) tissue samples were collected from the Department of Dermatology, Affiliated Hospital 2 of Nantong University, and the diagnoses of all the cases were confirmed histopathologically; at the same time, 35 paraffin-embedded normal skin tissue samples obtained by cosmetic surgery served as normal control group. Immunohistochemical staining was performed to determine the BRG1 expression in cSCC, AK, and normal skin tissues, and correlations between BRG1 expression and clinicopathological parameters of cSCC patients were analyzed. Fresh tissue samples were collected from 12 cSCC patients and 12 healthy controls, and cSCC cell lines A431 and Scl-1 and a human immortalized keratinocyte cell line HaCaT were routinely cultured; real-time fluorescence-based quantitative PCR (qRT-PCR) was performed to determine the mRNA expression of BRG1 in tissues and cells, and co-immunoprecipitation assay and cellular immunofluorescence staining were conducted to analyze the interaction between BRG1 and ATF2. The expression of BRG1 (BRG1 siRNA1 - 5 groups) and ATF2 (ATF2-shRNA group) in A431 and Scl-1 cells was knocked down by RNA interference, and cells transfected with negative control siRNA or shNC served as controls (control siRNA group and shNC group, respectively), cell counting kit-8 (CCK8) assay, colony formation assay, cell scratch assay, and Transwell assay were conducted to evaluate effects of knocking down BRG1 and ATF2 on the proliferation, migration, and invasion of cSCC cells. Comparisons of measurement data among multiple groups were conducted using one-way analysis of variance, and multiple comparisons were conducted using Dunnett- t test. Results:Immunohistochemical staining showed that the expression intensity of BRG1 protein was significantly lower in the cSCC and AK tissues than in the normal skin tissues ( χ2 = 44.40, P < 0.001). qRT-PCR showed that the mRNA expression level of BRG1 was significantly lower in the cSCC tissues (1.345 ± 0.956) than in the normal skin tissues (2.499 ± 1.501, t = 2.25, P = 0.035), and also significantly lower in A431 and Scl-1 cells (0.041 ± 0.002, 0.026 ± 0.003, respectively) than in HaCaT cells (0.135 ± 0.033, t = 4.95, 5.73, P = 0.008, 0.005, respectively). The low expression of BRG1 was associated with tumors at sun-exposed sites ( P = 0.041), low tumor differentiation ( P = 0.001), and high Broder′s grade ( P < 0.001) in the cSCC patients. In both A431 cells and Scl-1 cells, the BRG1 siRNA1 group and BRG1 siRNA2 group showed significantly increased numbers of cell colonies, migratory cells and invasive cells, as well as cell migration rates compared with the control siRNA group (all P < 0.05). Co-immunoprecipitation assay showed that BRG1 protein could bind to ATF2 protein in A431 and Scl-1 cells, and immunofluorescence staining showed that the two proteins were co-localized; compared with the control siRNA group, the BRG1 siRNA1 group (both A431 and Scl-1 cells) and BRG1 siRNA2 group (A431 cells) both showed increased phosphorylation and activation of ATF2 (all P < 0.05) ; in both A431 cells and Scl-1 cells, the shATF2 group showed significantly decreased numbers of cell colonies (both P = 0.001), cellular proliferative activity at 24 - 96 hours (all P < 0.001), and numbers of migratory cells and invasive cells compared with the shNC group (all P ≤ 0.001) . Conclusion:BRG1 was lowly expressed in the cSCC and AK tissues, and could inhibit the proliferation, migration, and invasion of cSCC cells; ATF2 could promote the proliferation, migration, and invasion of cSCC cells; BRG1 may exert an anti-tumor effect by interacting with ATF2 protein and inhibiting phosphorylation-dependent activation of ATF2.

4.
Rev. med. Urug ; 39(1): e703, 2023.
Article in Spanish | LILACS, BNUY | ID: biblio-1431906

ABSTRACT

Las dermatosis plasmocitarias son un conjunto de enfermedades inflamatorias poco frecuentes, cuyo diagnóstico definitivo se realiza mediante el hallazgo histopatológico de un infiltrado dérmico de células plasmáticas policlonales sin una causa subyacente demostrable. Presentamos el caso de una mujer de 89 años que desarrolló en la evolución de una queratosis actínica un infiltrado plasmocitario denso. Hasta esta publicación no se han encontrado reportes de casos de dermatosis plasmocitaria secundaria a queratosis actínica.


Cutaneous plasmacytosis is an uncommon cutaneous disorder, the final diagnosis of which is done when cutaneous polyclonal plasma cell skin infiltrations without underlying proven causes are found. The study presents the case of an 89-year-old patient with actinic keratosis who developed dense plasma cell infiltration. There were no case reports of cutaneous plasmacytosis secondary to actinic keratosis in literature until this study was published.


As dermatoses plasmocitárias constituem um grupo de doenças inflamatórias raras, cujo diagnóstico definitivo é feito pelo achado histopatológico de um infiltrado dérmico de plasmócitos policlonais sem causa subjacente demonstrável. Apresentamos o caso de uma mulher de 89 anos que desenvolveu um infiltrado plasmocítico denso durante o curso de queratose actínica. Até esta publicação, não havia relato de caso de dermatose plasmocitária secundária a queratose actínica.


Subject(s)
Plasma Cells/pathology , Keratosis, Actinic
5.
Surg. cosmet. dermatol. (Impr.) ; 14: e20220083, jan.-dez. 2022.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1369367

ABSTRACT

Introdução: as queratoses actínicas são lesões pré-malignas com risco de transformação para carcinoma espinocelular invasivo. Não há correlação identificada entre classificação clínica e grau histológico destas lesões. Objetivos: correlacionar as características clínicas das queratoses actínicas dos antebraços e dorso das mãos com o grau de atipia histológica (Keratinocyte Intraepidermal Neoplasia); desenvolver e validar uma escala de gravidade clínica correlacionada ao grau histológico das queratoses actínicas. Métodos: estudo transversal com 162 queratoses actínicas avaliadas clinicamente quanto a diâmetro, eritema, infiltração, hiperqueratose e exulceração; biopsiadas 34 lesões com diferentes padrões. As características clínicas foram correlacionadas com o grau de atipia histológica e a expressão de p53 e Ki-67. Resultados: apenas o diâmetro das lesões correlacionou-se significativamente com o grau de atipia (p=0,04), e apenas o eritema, a hiperqueratose e o diâmetro correlacionaram-se com as marcações imuno-histoquímicas. Foi desenvolvido um escore clínico incluindo o diâmetro, a hiperqueratose e a exulceração, o qual se correlacionou significativamente com o grau de atipia (Rho de Spearman=0,43; p=0,01). Conclusões: desenvolveu-se um escore composto por diâmetro, hiperqueratose e exulceração correlacionado com o grau histológico das queratoses actínicas dos membros superiores.


Introduction: Actinic keratoses are premalignant lesions with a risk of transformation to invasive squamous cell carcinoma. There is no identified correlation between clinical classification and histological grade of these lesions. Objectives: To correlate the clinical characteristics of actinic keratoses of the forearms and back of the hands with the degree of histological atypia (Keratinocyte Intraepidermal Neoplasia); to develop and validate a clinical severity scale correlated with the histological grade of actinic keratoses. Methods: Cross-sectional study with 162 actinic keratoses clinically evaluated for diameter, erythema, infiltration, hyperkeratosis, and exulceration and 34 lesions with different patterns were biopsied. Clinical features were correlated with the degree of histological atypia and p53 and Ki-67 expression. Results: Only the diameter of the lesions was significantly correlated with the degree of atypia (p=0.04), and only the erythema, hyperkeratosis, and the diameter linked with the immunohistochemical markings. A clinical score including diameter, hyperkeratosis, and exulceration was developed, which associated significantly with the degree of atypia (Spearman's Rho=0.43; p=0.01). Conclusions: A score composed of diameter, hyperkeratosis, and exulceration correlated with the histological grade of actinic keratoses of the upper limbs was developed.

6.
Chinese Journal of Dermatology ; (12): 1023-1027, 2021.
Article in Chinese | WPRIM | ID: wpr-911549

ABSTRACT

Actinic keratosis (AK) is a kind of precancerous skin lesions related to long-term light exposure, and photodynamic therapy is one of its main treatment methods. Compared with conventional photodynamic therapy, daylight photodynamic therapy (DL-PDT) with daylight as a light source has advantages of more convenient operation, less pain and higher patient acceptability, but it is liable to be affected by weather and other factors. DL-PDT is suitable for the treatment of grade Ⅰ or Ⅱ AK on the head and face, and its efficacy may be affected by pretreatment, photosensitizers, irradiation dose, etc. This review mainly elaborates the advantages of DL-PDT and introduces its operation methods to help clinicians choose the best treatment protocol for AK.

7.
An. bras. dermatol ; An. bras. dermatol;95(1): 63-66, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1088728

ABSTRACT

Abstract Topical use of immune response modifiers, such as imiquimod, has increased in dermatology. Although its topical use is well tolerated, it may be associated with exacerbations of generalized cutaneous inflammatory diseases, possibly through the systemic circulation of pro-inflammatory cytokines. This report describes a case of development of pityriasis rubra pilaris, a rare erythematous-papulosquamous dermatosis, in a woman aged 60 years during treatment with imiquimod 5% cream for actinic keratosis. It evolved with erythrodermic conditions and palmoplantar keratoderma, presenting progressive clinical resolution after the introduction of methotrexate. The authors emphasize the importance of recognizing possible systemic reactions associated with the topical use of imiquimod.


Subject(s)
Humans , Female , Pityriasis Rubra Pilaris/chemically induced , Pityriasis Rubra Pilaris/pathology , Keratosis, Actinic/drug therapy , Imiquimod/adverse effects , Antineoplastic Agents/adverse effects , Pityriasis Rubra Pilaris/drug therapy , Biopsy , Methotrexate/therapeutic use , Treatment Outcome , Adrenal Cortex Hormones/therapeutic use , Dermatologic Agents/therapeutic use , Middle Aged
8.
An. bras. dermatol ; An. bras. dermatol;94(6): 698-703, Nov.-Dec. 2019. tab, graf
Article in English | SES-SP, LILACS, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1054877

ABSTRACT

Abstract Background: A skin field cancerization is a cutaneous area with subclinical changes resultant from chronic sun exposure, with a higher predisposition to development of pre-neoplastic and neoplastic lesions. So far, there are no well-defined objective parameters that can indicate their degree of activity. Objectives: To describe and compare morphometric aspects and expression of factors related to apoptosis and cell proliferation in actinic keratosis (AK), in both photoexposed and photoprotected epidermis. Methods: A cross-sectional study of patients with actinic keratosis in the forearms, biopsied at two points: the actinic keratosis and the axillary region. The biopsies of the actinic keratosis, perilesional area, and axilla were evaluated through keratinocyte intraepithelial neoplasia (KIN), and immunohistochemistry of p53, survivin, and Ki67. Nuclear morphometry of basal layer cells was performed through digital image analysis: entropy, area, perimeter, Ra, fractal dimension, circularity, color intensity, and largest diameter. Results: There were 13 patients included and 38 actinic keratosis biopsied. In morphometry, 1039 nuclei were analyzed, of which 228 represented axillary skin, 396 demonstrated actinic keratosis, and 415 represented the perilesional area to the actinic keratosis. There was a significant difference (p < 0.05) in all variables tested for the topographies evaluated. A significant correlation was identified between nucellar morphometric elements, KIN, proliferation markers, and apoptosis. Joint patterns of p53, Ki67, and KIN discriminated the topographies sampled. Study limitations: This was a cross-sectional study with a small number of patients. Conclusions: There are patterns of proliferation, resistance to apoptosis, and different cellular morphometrics between photoprotected skin and photoexposed skin. The joint expression of p53, Ki67, and KIN can characterize skin field cancerization activity.


Subject(s)
Humans , Adult , Skin Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Keratosis, Actinic/pathology , Skin/anatomy & histology , Skin Neoplasms/diagnosis
9.
An. bras. dermatol ; An. bras. dermatol;94(6): 637-657, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054878

ABSTRACT

Abstract Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.


Subject(s)
Humans , Dermoscopy/methods , Keratosis, Actinic/therapy , Keratosis, Actinic/diagnostic imaging , Skin Neoplasms/pathology , Skin Neoplasms/diagnostic imaging , Severity of Illness Index , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/diagnostic imaging , Risk Factors , Keratosis, Actinic/pathology
10.
An. bras. dermatol ; An. bras. dermatol;94(5): 503-520, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054862

ABSTRACT

Abstract Oculocutaneous albinism is an autosomal recessive disease caused by the complete absence or decrease of melanin biosynthesis in melanocytes. Due to the reduction or absence of melanin, albinos are highly susceptible to the harmful effects of ultraviolet radiation and are at increased risk of actinic damage and skin cancer. In Brazil, as in other parts of the world, albinism remains a little known disorder, both in relation to epidemiological data and to phenotypic and genotypic variation. In several regions of the country, individuals with albinism have no access to resources or specialized medical care, and are often neglected and deprived of social inclusion. Brazil is a tropical country, with a high incidence of solar radiation during the year nationwide. Consequently, actinic damage and skin cancer occur early and have a high incidence in this population, often leading to premature death. Skin monitoring of these patients and immediate therapeutic interventions have a positive impact in reducing the morbidity and mortality associated with this condition. Health education is important to inform albinos and their families, the general population, educators, medical professionals, and public agencies about the particularities of this genetic condition. The aim of this article is to present a review of the epidemiological, clinical, genetic, and psychosocial characteristics of albinism, with a focus in skin changes caused by this rare pigmentation disorder.


Subject(s)
Humans , Male , Female , Albinism/genetics , Albinism/pathology , Skin Neoplasms/etiology , Skin Neoplasms/physiopathology , Ultraviolet Rays/adverse effects , Brazil/epidemiology , Carcinoma, Basal Cell/etiology , Carcinoma, Basal Cell/pathology , Carcinoma, Squamous Cell/etiology , Carcinoma, Squamous Cell/pathology , Albinism/complications , Albinism/epidemiology , Prevalence , Risk Factors , Keratosis, Actinic/etiology , Keratosis, Actinic/pathology , Melanins/deficiency
11.
An. bras. dermatol ; An. bras. dermatol;94(3): 313-319, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011106

ABSTRACT

Abstract: Background: Actinic keratosis (AK) represents a risk of progression to squamous cell carcinoma. Ingenol mebutate gel is a novel therapeutic option for field-directed treatment. Objectives: To evaluate the safety, tolerability and patients' perspectives, related to the therapeutic success of managing AKs on the face and scalp with ingenol mebutate gel in Brazilian individuals. Methods: This was an observational, retrospective and descriptive study of 68 areas of actinic keratosis on the face and scalp treated with Ingenol mebutate gel involving a total of 37 patients. The drug was applied for three consecutive days on an area of of 25 cm2 and documentation was performed on baseline and days 4, 8, 15, 60 and 180. On day 4, the composite local skin reaction score was calculated. At the end, a questionnaire was applied to evaluate patients' perspectives about the treatment. Results: Adherence was 100%, no serious adverse events were recorded and the mean composite local skin reaction score (standard deviation) was 8.61±4.22. The treatment was considered optimum by 75.68% of the patients. Study limitations: Calculation of composite local skin reaction score performed only on the fourth day. Conclusions: Treatment with ingenol mebutate gel was considered safe and tolerable in Brazilian subjects. Patients had a maximum adherence rate and a great improvement in self-esteem. The results of this research reproduce the findings of the literature.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Dermatologic Agents/therapeutic use , Diterpenes/therapeutic use , Keratosis, Actinic/drug therapy , Gels/therapeutic use , Scalp Dermatoses/drug therapy , Administration, Cutaneous , Brazil , Surveys and Questionnaires , Retrospective Studies , Treatment Outcome , Facial Dermatoses/drug therapy
12.
Surg. cosmet. dermatol. (Impr.) ; 11(1): 26-30, Jan.-Mar. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1008239

ABSTRACT

Introdução: A queratose actínica (QA) é lesão pré-maligna que pode progredir para carcinoma espinocelular. O diagnóstico é clínico, dermatoscópico e por microscopia confocal. Atualmente, aborda-se o tratamento do campo cancerizável, abrangendo QAs clinicamente visíveis e subclínicas, sendo a terapia fotodinâmica (PDT) uma opção terapêutica. Objetivo: Avaliar melhora das QAs e campo cancerizável em pacientes submetidos a PDT com luz do dia, com análise clínica, dermatoscópica e por microscopia confocal. Métodos: Foram selecionados dez pacientes, com múltiplas QAs na face. Realizada a PDT utilizando luz do dia com aminolevulinato de metila e feita documentação fotográfica clínica, dermatoscópica e por microscopia confocal antes do tratamento e 60 dias após seu início. Resultados: Dos nove pacientes que completaram o tratamento, oito (88,8%) apresentaram melhora clínica e regressão no grau da QA com uma sessão. Na dermatoscopia, quatro pacientes (44,4%) apresentaram melhora significativa, três pacientes (33,3%) apresentaram melhora parcial e dois pacientes (22,2%) tiveram suas lesões estáveis. Na microscopia confocal, seis (66,6%) pacientes tiveram regressão no grau da lesão. Conclusões: A PDT com luz do dia se mostrou eficaz para tratamento de QAs, apresentando alto grau de tolerabilidade e eficácia, além de bom perfil de segurança.


Introduction: Actinic keratosis (AK) is a pre-malignant lesion that can progress to squamous cell carcinoma. The diagnosis is through clinical, dermatoscopic and confocal microscopy assessment. Currently, the approach is the treatment of the field cancerization, comprising of clinically visible and subclinical AKs, for which photodynamic therapy (PDT) is a therapeutic option. Objective: To evaluate improvement of AKs and cancerization field in patients submitted to daylight PDT, with clinical, dermatoscopic and confocal microscopy assessment. Methods: Ten patients with multiple AKs on the face were selected. Daylight PDT was performed using methyl aminolevulinate and clinical, dermatoscopic and confocal microscopy photographic documentation was performed before and 60 days after the treatment. Results: Of the nine patients who completed the treatment, 8 (88.8%) showed clinical improvement and reduction in the severity of AK with one treatment. On dermatoscopy, 4 patients (44.4%) showed significant improvement, 3 patients (33.3%) showed partial improvement and 2 patients (22.2%) had no change. On confocal microscopy, 6 (66.6%) patients presented reduction in the severity of the lesion. Conclusions: Daylight PDT proved to be effective for the treatment of AKs, with high tolerability and efficacy, besides a good safety profile.


Subject(s)
Methods , Photochemotherapy , Microscopy, Confocal , Dermoscopy , Keratosis, Actinic
13.
An. bras. dermatol ; An. bras. dermatol;93(4): 535-538, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-949908

ABSTRACT

Abstract: Background: Recent studies that investigated the effect of vitamin D on skin cancer risk have exhibited inconsistent results. Objective: The aim of the study was to evaluate vitamin D status in patients with actinic keratosis. Methods: A cross-sectional study was conducted on 31 patients with actinic keratosis and 29 healthy controls. Serum vitamin D levels in the study group were determined by liquid chromatography/tandem mass spectrometry. Results: Serum 25(OH)D levels in patients with actinic keratosis were significantly higher than those of the healthy controls (P=0.04). Prevalence of 25(OH)D deficiency was significantly higher in the healthy controls (75.9%) compared to the patients with actinic keratosis (54.8%), but the difference was not statistically significant (P= 0.09). Study limitations: The cross-sectional design of the study, data on smoking based on patient self-report, and subjects' different dietary habits, which can influence 25(OH)D levels, are the study's limitations. Conclusion: Serum vitamin D level can be used as a marker for ultraviolet B radiation from sun exposure; therefore, it can be used in individuals at risk of actinic keratosis. Oral intake of vitamin D through diet or supplements is proposed instead of prolonged ultraviolet exposure to maintain adequate vitamin D serum levels. Further research is needed to elucidate the role of vitamin D in skin carcinogenesis.


Subject(s)
Humans , Male , Female , Aged , Vitamin D/blood , Keratosis, Actinic/blood , Biomarkers/blood , Case-Control Studies , Cross-Sectional Studies , Chromatography, High Pressure Liquid , Tandem Mass Spectrometry
14.
An. bras. dermatol ; An. bras. dermatol;93(4): 529-534, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-949909

ABSTRACT

Abstract: Background: Actinic keratoses are benign intraepithelial skin neoplasms that develop in photoexposed areas and can progress to invasive carcinoma. They are seen frequently in dermatological practice, occurring in 5.1% of consultations. Ingenol mebutate (IM) was recently approved in Brazil as a topical therapy for field cancerization in actinic keratosis. Objective: To evaluate the clearance rate and adverse events in the treatment of actinic keratoses with ingenol mebutate. Methods: A longitudinal, prospective, non-randomized, interventional, open, single-center study was conducted. Patients with actinic keratoses applied ingenol mebutate on a 25cm2 area of the face and/or scalp for three consecutive days (0.015%) or on the forearm for two days (0.05%). Results: 27 patients completed the protocol, of whom 13 on the face and/or scalp and 14 on the forearm. Complete clearance occurred in 53.8% in the first group and 42.8% in the second. Partial response was observed in 15.4% and 35.7%, respectively. The most common side effects were erythema, edema, desquamation, pruritus, and local erosion. Study limitations: The study had a small sample and was not randomized, double-blind, placebo-controlled, or vehicle-controlled. Conclusion: Ingenol mebutate is well-tolerated for the treatment of actinic keratosis, with good patient adherence thanks to the short treatment period.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Diterpenes/therapeutic use , Keratosis, Actinic/drug therapy , Double-Blind Method , Prospective Studies , Longitudinal Studies , Treatment Outcome , Diterpenes/adverse effects , Diterpenes/pharmacokinetics , Keratosis, Actinic/metabolism
15.
Surg. cosmet. dermatol. (Impr.) ; 10(1): 61-64, Jan.-Mar. 2018. ilus.
Article in English, Portuguese | LILACS | ID: biblio-884679

ABSTRACT

O diagnóstico das lesões pigmentadas da face é considerado desafiador uma vez que lesões benignas e malignas podem compartilhar características clínicas e dermatoscópicas semelhantes, principalmente em lesões iniciais, sendo muitas vezes difícil de identificar as lesões de lentigo maligno da face. Assim, a microscopia confocal de reflectância pode se tornar uma ferramenta útil no diagnóstico dos lentigos malignos bem como para o seu planejamento cirúrgico.


The diagnosis of pigmented facial lesions is considered challenging since benign and malignant lesions might have similar clinical and dermoscopic features ­ especially in the early stages of the lesion ­ entailing that it is often difficult to identify lentigo maligna lesions in the face. In this way, confocal reflectance microscopy has the potential to become a useful tool both in the diagnosis and surgical planning of lentigo maligna.

16.
Chinese Journal of Dermatology ; (12): 220-223, 2018.
Article in Chinese | WPRIM | ID: wpr-710364

ABSTRACT

Objective To investigate the diagnostic value of rosette sign under a polarized dermoscope.Methods Lesions with rosette sign were selected from polarized dermoscopic image database of the Department of Dermatology of Peking University Third Hospital between September 2014 and March 2017.Then,histopathologically confirmed lesions were further chosen,and the correlations between the rosette sign and diseases were analyzed.These histopathologically confirmed lesions were divided into actinic keratosis (AK) group and non-AK group,and differences in clinical and dermoscopic features were analyzed between the 2 groups.Statistical analysis was carried out by nonparametric test for comparisons of the number of rosette sign between the AK group and non-AK group,as well as between different body sites.Results A total of 4 956 dermoscopic images of skin lesions were analyzed retrospectively,among which there were 144 (2.91%) skin lesions with rosette signs.Among the 144 skin lesions,74 were histopathologically diagnosed,37 (50.00%) of which were diagnosed as AK.Compared with the non-AK group,the AK group showed significantly higher proportions of lesions on the face (x2 =23.786,P < 0.001) and at sun-exposed sites (x2 =12.921,P < 0.001),and prevalence of superficial scales (x2 =7.056,P =0.008),keratotic plugs (x2 =6.167,P =0.013) and hair follicle openings surrounded by a white halo (x2 =4.893,P =0.027) under a dermoscope.Moreover,the number of rosette sign was significantly higher in facial lesions than in non-facial lesions (Z =-2.581,P =0.010),as well as in lesions at exposed sites than in those at unexposed sites (Z =-2.098,P =0.036).Conclusions The rosette sign is mainly observed in AK lesions.If lesions on the face or at sun-exposed sites are characterized by rosette sign,and superficial scales,keratotic plugs and hair follicle openings surrounded by a white halo can be observed under a dermoscope,these lesions can be diagnosed as AK with a high probability.

17.
An. bras. dermatol ; An. bras. dermatol;92(3): 363-366, May-June 2017.
Article in English | LILACS | ID: biblio-886957

ABSTRACT

Abstract The tretinoin peel, also known as retinoic acid peel, is a superficial peeling often performed in dermatological clinics in Brazil. The first study on this was published in 2001, by Cuce et al., as a treatment option for melasma. Since then, other studies have reported its applicability with reasonable methodology, although without a consistent scientific background and consensus. Topical tretinoin is used for the treatment of various dermatoses such as acne, melasma, scars, skin aging and non-melanoma skin cancer. The identification of retinoids cellular receptors was reported in 1987, but a direct cause-effect relation has not been established. This article reviews studies evaluating the use of topical tretinoin as agent for superficial chemical peel. Most of them have shown benefits in the treatment of melasma and skin aging. A better quality methodology in the study design, considering indication and intervention is indispensable regarding concentration, vehicle and treatment regimen (interval and number of applications). Additionally, more controlled and randomized studies comparing the treatment with tretinoin cream versus its use as a peeling agent, mainly for melasma and photoaging, are necessary.


Subject(s)
Humans , Skin Diseases/drug therapy , Tretinoin/administration & dosage , Skin Aging/drug effects , Chemexfoliation/methods , Keratolytic Agents/administration & dosage
18.
An. bras. dermatol ; An. bras. dermatol;92(1): 142-144, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-1038244

ABSTRACT

ABSTRACT Daylight photodynamic therapy has been used in countries with high latitudes during the summer for actinic keratoses treatment with reports of similar efficacy to conventional photodynamic therapy. We evaluate its safety in 20 patients in the city of Fortaleza, a local with low latitude and high brightness. Sixteen patients did not report any discomfort due to the procedure. Daylight photodynamic therapy is an easy application method with great tolerability by the patient and has the possibility of being performed throughout the year in these regions. It can mean a promising tool in the control of skin cancer.


Subject(s)
Humans , Photochemotherapy/methods , Scalp Dermatoses/drug therapy , Sunlight , Facial Dermatoses/drug therapy , Keratosis, Actinic/drug therapy , Time Factors , Treatment Outcome , Photosensitizing Agents/therapeutic use , Dose-Response Relationship, Radiation , Aminolevulinic Acid/analogs & derivatives , Aminolevulinic Acid/therapeutic use
19.
Chinese Journal of Dermatology ; (12): 247-251, 2017.
Article in Chinese | WPRIM | ID: wpr-511363

ABSTRACT

Objective To measure the expression of protein kinase D1 (PKD1),tyr463-phosphorylaed PKD1 (pPKD1-tyr463) and ser916-phos-phorylaed PKD1 (pPKD1-ser916) in squamous cell carcinoma (SCC),Bowen's disease (BD) and actinic keratosis (AK),and to explore their significance.Methods Fresh tissue samples were resected from lesions of patients with SCC (SCC group),BD (BD group) and AK (AK group),as well as from normal skin of healthy human controls (control group),and each group had a sample size of 10.Real-time RT-PCR was performed to measure the mRNA expression of protein kinase D1 gene (PRKD1),and Western blot analysis to determine the protein expression of PKD1,pPKD1-tyr463 and pPKD1-ser916.In addition,immunohistochemical study was conducted to determine the expression of PKD1,pPKD1-tyr463 and pPKD1-ser916 in another 50 paraffin-embedded skin samples of SCC,20 samples of BD,20 samples of AK and 10 normal skin samples.Results PRKD1 mRNA expression significantly differed among the control group (0.64 ± 0.09),SCC group (5.37 ± 1.06),BD group (2.69 ± 0.72) and AK group (2.43 ± 0.46) (F =21.37,P < 0.05),and was significantly higher in the SCC,BD and AK groups than that in the control group (P < 0.05),as well as in the SCC group than that in the AK and BD groups (both P < 0.05).However,no significant difference in the PRKD1 mRNA expression was observed between the BD group and AK group (P > 0.05).Immunohistochemical study showed that the total PKD1 protein and pPKD1-tyr463 in the SCC and BD groups were mainly expressed in the cytoplasm and cell membrane of spinous layer cells and atypical cells,and their expression rates were significantly higher than those in the AK group and control group (all P < 0.01).The pPKD1-ser916 was only slightly expressed in some cancer nests of well-differentiated SCC tissues,but not in poorly-differentiated SCC,AK,BD tissues and normal skin tissues.In the SCC group,the expression rate of PKD1 increased with the increase of the pathological grade of SCC,and the PKD1 expression was positively correlated with pPKD1-tyr463 expression (rcc =0.479,P < 0.05).Western blot results were consistent with immunohistochemical findings.Conclusion PKD1 and pPKD1-tyr463 may be involved in the development and differentiation of skin tumors derived from stratified squamous epithelium,and PKD1 may exert promotive effects on the formation of cutaneous SCC by activating the Tyr463 phosphorylation site.

20.
Chinese Journal of Dermatology ; (12): 487-492, 2017.
Article in Chinese | WPRIM | ID: wpr-616665

ABSTRACT

Objective To investigate the value of dermoscopy in differential diagnosis of actinic keratosis (AK).Methods Pathologically confirmed facial AK lesions were selected from the dermoscopic database of Peking University Third Hospital,and served as case group.At the same time,the facial lesions of other diseases were selected and served as control group,which were firstly suspected to be AK,but pathologically confirmed as other diseases.Dermoscopic features were compared between the two groups.Diagnostic test was used to evaluate the diagnostic value of dermoscopy for AK,based on the gold standard pathological examination.Results There were 43 facial AK lesions in the case group and 22 facial lesions of other diseases in the control group.Eight dermoscopic features were observed more frequently in the case group than in the control group (all P < 0.05),including a background erythema and red pseudonetwork (88.37% [38/43] vs.36.36% [8/22]),hair follicle openings surrounded by a white halo (90.70% [39/43] vs.36.36%[8/22]),hair follicle openings filled with yellowish keratotic plugs (95.35% [41/43] vs.45.45% [10/22]),white to yellow surface scales or keratin mass (97.67% [42/43] vs.72.73%[16/22]),rosette sign (60.47% [26/43] vs.22.73% [5/22]),large irregular linear vessels surrounding the hair follicles (44.19% [19/43] vs.18.18% [4/22]),fine,linear-wavy vessels surrounding the hair follicles (67.44% [29/43] vs.36.36% [8/22]) and peripheral pigmentation (32.56% [14/43] vs.4.55% [1/22]).Among the above eight dermoscopic features,hair follicle openings surrounded by a white halo,a background erythema and red pseudonetwork,hair follicle openings filled with yellowish keratotic plugs and rosette sign showed higher Youden's indices of 0.54,0.52,0.50 and 0.38 respectively,white to yellow surface scales or keratin mass showed the highest sensitivity of 97.67%,and peripheral pigmentation showed the highest specificity of 95.45%.The combination of 3 features (including a background erythema and red pseudonetwork,hair follicle openings surrounded by a white halo and follicular plugs) showed the highest diagnostic value,and the sensitivity,specificity,positive predictive value,negative predictive value and Youden's index of the combination were 90.70%,81.82%,90.70%,81.82% and 0.73,respectively,with the coincidence rate between dermoscopy and pathological diagnosis being 80.00%.Conclusion Facial AK shows characteristic dermoscopy patterns,and the combination of the 3 features (a background erythema and red pseudonetwork,hair follicle openings surrounded by a white halo and follicular plugs) shows the highest diagnostic value for AK.

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