ABSTRACT
Continuous immunosuppression after organ transplantation is associated with an increased risk of developing keratinocyte neoplastic lesions. Topical photodynamic therapy represents a therapeutic approach for different keratinocyte neoplastic lesions. However, the specific efficacy and safety of this treatment in this immunocompromised population remains largely unknown. In this case report series, we show the efficacy and safety of photodynamic therapy with BF-200 ALA gel using red-light and daylight in immunocompromised patients. Out of 8 patients presented here, 1 was treated for 8 basal cell carcinomas, 1 for 2 Bowen´s disease lesions and 6 were treated for field cancerization including 4 to 10 actinic keratoses. Treatment response rates were above 75 %. The adverse events, including pain, did not differ from those already described for PDT. These data suggest that PDT with BF-200 ALA gel could be an effective and safe option to add to the treatment portfolio for neoplastic keratinocyte lesions in this high-risk population.
Subject(s)
Aminolevulinic Acid/analogs & derivatives , Bowen's Disease , Carcinoma, Basal Cell , Keratosis, Actinic , Organ Transplantation , Photochemotherapy , Skin Neoplasms , Humans , Keratosis, Actinic/drug therapy , Bowen's Disease/drug therapy , Photochemotherapy/methods , Photosensitizing Agents/therapeutic use , Immunocompromised Host , Carcinoma, Basal Cell/drug therapy , Skin Neoplasms/drug therapyABSTRACT
Alopecia areata (AA) is a polygenic autoimmune disease. The immunosuppressant drugs taken by patients who undergo solid organ transplantation might therefore be useful in its control. The literature, however, contains conflicting information in this regard. This contribution describes seven patients with AA, all of whom had undergone solid organ transplantation and were receiving treatment with immunosuppressant drugs. Patterns were sought that might suggest whether the administration of these drugs was affecting the appearance, progress, or resolution of AA. Only seven out of 469 patients (incidence 1.5%) who had undergone solid organ transplantation presented at our dermatology clinic with AA. All seven had undergone kidney transplantation. Five patients also had another autoimmune disease. Two of the seven patients developed AA before undergoing transplantation. No relationship was seen between the appearance or progress of AA and treatment with immunosuppressant drugs. The present results provide further evidence that AA may appear alongside other autoimmune disease. No clear picture emerges regarding whether immunosuppressants prevent the appearance of AA, help in its resolution, or encourage its onset. (SKINmed. 2019;17:18-22).
Subject(s)
Alopecia Areata/immunology , Autoimmune Diseases/immunology , Immunosuppressive Agents/administration & dosage , Kidney Transplantation/methods , Adult , Aged , Disease Progression , Female , Humans , Immunosuppressive Agents/immunology , Male , Middle Aged , Transplant RecipientsABSTRACT
Clear cell acanthoma is a rare, epidermal tumor not common in the area of the nipples; indeed, the literature describes only 8 cases, all showing unilateral presentation. We here report the first case of bilateral clear cell acanthoma with good response to topical corticosteroids. CASE REPORT: A sixteen-year old girl presented with 2 excrescent, fleshy, and exudative tumor masses in both nipples and areola mammae. A biopsy was conducted and confirmed clear cell acanthoma histopathologically. Treatment with strong corticosteroids resulted in rapid improvement and resolution. After one year of follow-up, the patient developed atopic dermatitis. DISCUSSION: We describe the first case of bilateral clear cell acanthoma localized in the nipple/areola that resolved with powerful corticosteroids, suggesting a reactive etiology of the lesion.
Subject(s)
Acanthoma , Clobetasol/administration & dosage , Glucocorticoids/administration & dosage , Neoplasms, Multiple Primary , Nipples , Skin Neoplasms , Acanthoma/drug therapy , Acanthoma/pathology , Administration, Topical , Adolescent , Biopsy , Female , Humans , Neoplasms, Multiple Primary/drug therapy , Neoplasms, Multiple Primary/pathology , Nipples/pathology , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology , Treatment OutcomeABSTRACT
Abstract: Clear cell acanthoma is a rare, epidermal tumor not common in the area of the nipples; indeed, the literature describes only 8 cases, all showing unilateral presentation. We here report the first case of bilateral clear cell acanthoma with good response to topical corticosteroids. Case report: A sixteen-year old girl presented with 2 excrescent, fleshy, and exudative tumor masses in both nipples and areola mammae. A biopsy was conducted and confirmed clear cell acanthoma histopathologically. Treatment with strong corticosteroids resulted in rapid improvement and resolution. After one year of follow-up, the patient developed atopic dermatitis. Discussion: We describe the first case of bilateral clear cell acanthoma localized in the nipple/areola that resolved with powerful corticosteroids, suggesting a reactive etiology of the lesion.
