Quality of life and side effects in patients with actinic keratosis treated with ingenol mebutate: a pilot study.

INTRODUCTION: Actinic keratosis (AK) lesions are in situ squamous cell carcinoma. These lesions have a low risk of progressing to invasive disease but significant impact on patients' quality of life (QoL). The aim of this study was to assess QoL and side effects in patients with AK receiving treatment with ingenol mebutate. MATERIAL AND METHODS: This was a prospective, non-randomized pilot study carried out in Spain. The target population was adults with a clinical diagnosis of AK affecting any part of the body. Outcomes were assessed on the basis of a QoL questionnaire (Skindex-29), local skin response, the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), and clinical response. RESULTS: A total of 19 patients were studied. Most of the participants were men (89.5%) and mean age was 76.2 years. After treatment with ingenol mebutate, significant improvement was observed in the Skindex-29 subscales relating to symptom severity (P=.041), the patients' emotional state (P=.026), and in the overall score (P=.014). Erythema, crusting, and flaking or scaling were the local skin responses with highest median score (2.0 in all 3 cases). Imiquimod 5% and ingenol mebutate achieved higher median scores for effectiveness and global satisfaction than any other previous treatments (as measured by TSQM 1.4). In the patients' assessment of convenience, ingenol mebutate had a higher median score than previous treatments. Over half of the patients (52.6%) had an improvement of at least 75% at month 3. CONCLUSIONS: QoL in patients with AK improves after treatment with ingenol mebutate. The presence of side effects did not affect QoL or patient satisfaction with treatment.

[Severe metabolic alkalosis during hemodialysis]. / Alcalosis metabólica severa durante la hemodiálisis.

Severe metabolic alkalosis in a patient while being hemodialysed with dialysate of bicarbonate is presented. The evolution was satisfactory after a session of hemodialysis with a bath of acetate. Disorders in the acid-base balance which appear following dialytic technics more complex each time are discussed.

[Meningeal carcinomatosis in giant cell lung cancer]. / Meningitis carcinomatosa en neoplasia pulmonar de células grandes.

A case of patient with symptoms of L3-L4 roots affliction and IV cranial nerve lesion, caused by meningeal carcinomatosis secondary to giant cell lung cancer, is presented. The clinical features, diagnosis methods, and therapeutic possibilities in this case are commented on.

[Apocrine nevus]. / Nevus apocrino.

We present the case of a 32-year-old woman with a congenital lesion on her left cheek that histopathologically was composed of numerous mature apocrine glands. The diagnosis of pure apocrine nevus, a rare lesion of that our case probably represents the sixth described in the literature, was made.

[Systemic calciphylaxis and acquired perforating disease in a uremic patient]. / Calcifilaxis sistémica y enfermedad perforante adquirida en paciente urémico.

We show the case of a patient suffering from a chronic renal failure in hemodialysis. He had a ischemic necrosis that was quickly progressive in his fingers and toes. It was necessary to amputate them. Diffuse vascular calcifications were recorded so radiologically than pathologically. PTH and phosphocalcic product were raised. Parathyroidectomy was practised with a quick initial improvement but immediately new distal ischemic lesions and keratotic papules with histologic perforation, that became necrosed, appeared in his buttocks and inferior extremities. The coexistence of acquired perforating disease and calciphylaxis in uremic patients has not been reported until now.