ABSTRACT
BACKGROUND: Aminolevulinic acid hydrochloride (ALA, Levulan) applied topically to actinic keratoses (AKs) leads to accumulation of the photosensitizer protoporphyrin IX, which, when activated by exposure to light, eradicates AKs. OBJECTIVE: We examined the safety and efficacy of photodynamic therapy using topical 20% ALA in a solution formulation and varying blue light doses to treat multiple AKs on the face and scalp. METHOD: This is a multicenter, investigator-blinded, randomized, vehicle-controlled study. RESULTS: Thirty-six patients with clinically typical AKs were treated with 20% ALA; 14 to 18 hours later, they were irradiated with a nonlaser fluorescent blue light source. With the optimal light dose of 10 J/cm(2), 88% of the AKs completely cleared 8 weeks after a single photodynamic treatment, compared with 6% after treatment with vehicle and light. CONCLUSION: Topical ALA PDT using a nonlaser, blue light source is an effective treatment for multiple AKs.
Subject(s)
Aminolevulinic Acid/therapeutic use , Keratosis/drug therapy , Photochemotherapy , Administration, Topical , Adult , Aged , Aged, 80 and over , Female , Humans , Keratosis/pathology , Male , Middle Aged , Single-Blind Method , Treatment OutcomeABSTRACT
This double-blind, vehicle-controlled, multicenter study evaluated the efficacy and safety of a new topical antineoplastic agent, masoprocol, in the treatment of actinic keratoses of the head and neck. Of the 113 patients who applied topical masoprocol twice a day for 14 to 28 days, there was a mean decrease in actinic keratoses from 15.0 to 5.4 and a median percent reduction from baseline actinic keratosis count of 71.4% at the 1-month follow-up visit. Comparable numbers for the vehicle-treated group were 13.4 to 11.1 actinic keratoses and 4.3% median percent reduction. Irritation, as manifested by erythema or flaking, occurred in 61.5% of topical masoprocol-treated patients versus 26.7% of those treated with vehicle and did not correlate with clinical response. Topical masoprocol appears to be useful in the treatment of actinic keratoses.
Subject(s)
Facial Dermatoses/drug therapy , Keratosis/drug therapy , Masoprocol/therapeutic use , Administration, Cutaneous , Adolescent , Adult , Aged , Aged, 80 and over , Clinical Protocols , Double-Blind Method , Facial Dermatoses/pathology , Female , Head , Humans , Keratosis/pathology , Male , Masoprocol/administration & dosage , Masoprocol/adverse effects , Middle Aged , OintmentsABSTRACT
A prospective study of the histology and ultrastructure of liver biopsies and analysis of liver tissue for retinoid was performed in twenty psoriasis patients treated with etretinate for 6 months. Nonspecific ultrastructural changes were noted in several liver specimens. Etretinate was detected in all samples. We find no significant hepatotoxicity after a 6 month course of etretinate. Body fat is probably a more important site than the liver for storage of etretinate.
Subject(s)
Etretinate/therapeutic use , Liver/drug effects , Psoriasis/drug therapy , Adult , Aged , Biopsy, Needle , Etretinate/metabolism , Etretinate/toxicity , Female , Humans , Liver/metabolism , Liver/ultrastructure , Male , Microscopy, Electron , Middle Aged , Prospective Studies , Psoriasis/pathology , Time FactorsABSTRACT
Etretinate was used to treat twenty patients who had severe, disabling psoriasis and an increased risk of liver damage. Potential hepatotoxicity was evaluated by obtaining liver biopsies prior to starting therapy and after a 6-month course on a dosage of 0.75 mg/kg/day. In comparing pretreatment biopsies to posttreatment biopsies, five of twenty patients demonstrated a morphologic change in their liver. Three showed progressive fatty metamorphosis, and two showed liver cell necrosis and progressive fibrosis. One of these was due to heavy alcohol intake. Based on our 6-month evaluation, etretinate does not produce a consistent toxic effect on the liver.
