A set of thoughts on a series of patients with oral viral papillomas caused by the HPV 6 and 11 viruses: A brief review.

Introduction: Papillomas are associated with human papillomaviruses (HPV) and are commonly benign. Typically, the clinical presentation establishes the diagnosis, and treatment comprises excision and histological analysis. Objective: In light of our series of 39 patients with viral papillomas of the oral mucosa, we would like to express our concerns regarding the treatment of patients diagnosed with HPV 6 and 11-positive oral papillomas. Materials and Methods: The research is based on an analysis of 39 patients with oral papillomas who underwent conventional HPV viral testing. The analysis was conducted utilizing the in situ hybridization method. Patients tested positive for HPV subtypes 2, 4, 6, 11, 16, 18, 31, 33, and 51. More than fifty percent of individuals tested positive for HPV 6 and 11. Conclusion: HPV subtypes have been identified in lesions with comparable clinical presentation. Many of our patients carry the HPV subtypes 6 and 11, which have been associated to sexual transmission. However, more transmission routes are also possible. The ideal treatment for us would be a referral to a Venereologist for a thorough sexually transmitted illness examination.

Octenidine Versus Dispase Gels for Wound Healing After Cryosurgery Treatment in Patients with Basal Cell Carcinoma.

For a specific group of patients with basal cell carcinoma (small, low risk), cryosurgery could be the suggested treatment, which results in the formation of an ulcer in the lesion area. The proteolytic enzymes' contribution to the wound healing is an ongoing research goal. Preclinical animal experiments in the Laboratory of the Pharmaceutical Technology Department of the National and Kapodistrian University of Athens have showed that a dose of 5 U/mL of dispase gel after the formation of tissue rashes, significantly promoted wound healing. Herein, a feasibility study in 16 patients enrolled by the First Department of Dermatology of Andreas Syggros Hospital was designed: 5 U/mL of dispase gel (once every 3 days) versus a drug reference containing octenidine (daily administration). The evaluation of the healing effect, safety, and tolerance was done on days 1 (cryosurgery), 2, 7, 21, and 60. The study end point was considered either the ulcer complete healing or the eighth week since treatment initiation. Wound healing was faster with dispase gel and hemoglobin reduced rapidly after the seventh day. Yet, hydration was higher in the control group. Our non-parametric analysis provides evidence that the dispase gel shows faster healing compared to the reference drug, in humans, meriting further investigation in larger human sample sizes before massive production of the product.

Dermoscopy of Actinic Keratosis: Is There a True Differentiation between Non-Pigmented and Pigmented Lesions?

Dermoscopic features of actinic keratosis (AK) have been widely studied, but there is still little evidence for their diagnostic accuracy. Our study investigates whether established dermoscopic criteria are reliable predictors in differentiating non-pigmented actinic keratosis (NPAK) from pigmented actinic keratosis (PAK). For this purpose, dermoscopic images of 83 clinically diagnosed AK (45 NPAK, 38PAK) were examined, and the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were assessed. Features with statistical significance were the red pseudo-network (p = 0.02) for NPAK and the pigmented pseudo-network (p < 0.001) with a pigment intensity value even less than 10% for PAK (p = 0.001). Pigmented pseudo-network (Se: 89%, Sp: 77%, PPV: 77%, NPV: 89%) with a pigment intensity value of more than 10% (Se: 90%, Sp: 86%, PPV: 79%, NPV: 93%) had excellent diagnostic accuracy for PAK. Scale and widened follicular openings with yellowish dots surrounded by white circles were equally represented in both variants of AK. Linear wavy vessels and shiny streaks were more prominently observed in NPAK, as were rosettes in PAK, but these results failed to meet statistical significance. The red starburst pattern was near statistical significance for PAK. Therefore, pigmentation is the strongest dermoscopic predictor for the differentiation between NPAK and PAK.

Ulvan-Based Nanofibrous Patches Enhance Wound Healing of Skin Trauma Resulting from Cryosurgical Treatment of Keloids.

Keloids are skin fibroproliferative disorders, resulting from abnormal healing of deep cutaneous injuries. Cryosurgery, the most common treatment for keloids, causes skin traumas. Even though the clinical practice of cryosurgery has increased, effective wound healing therapy is still lacking. In this investigation, nonwoven nanofibrous patches composed of ulvan, a marine sulfated polysaccharide exhibiting anti-inflammatory and antioxidant activities, and polyethylene oxide (PEO) were fabricated through electrospinning and characterized. Their wound healing efficacy on skin traumas resulting from cryosurgical treatment of keloids was clinically tested and evaluated in comparison to a reference product. Twenty-four volunteer patients undergoing cryosurgery as a treatment of keloids were selected to apply either the ulvan/PEO patch or the reference product for 21 days. The ulvan/PEO patch, 21 days after cryosurgery, showed significant wound healing, elimination of skin inflammation, restoration of biophysical parameters similar to normal values and significant decrease in haemoglobin concentration, skin texture and volume, while no discomfort or adverse reaction was observed. In contrast, the reference product showed inferior performance in all evaluated parameters. The designed ulvan/PEO patch represents the first wound dressing to effectively heal skin trauma after cryosurgical treatment of keloids.

Actinic Keratoses (AK): An Exploratory Questionnaire-Based Study of Patients' Illness Perceptions.

BACKGROUND: Decreased illness perception among actinic keratoses (AK) patients is a major barrier to the effective management of AK. OBJECTIVE: We aimed to investigate patients' illness and treatment perceptions, their correlation to demographics and AK/skin cancer history, and secondarily the influence of these perspectives on treatment and sunscreen use. MATERIALS AND METHODS: Participants completed questionnaires based on the Brief Illness Perception Questionnaire and statistical analysis was performed. RESULTS: In total, 208 AK patients were enrolled. A large proportion were poorly aware of the disease (41.4%), with less than half (43%) being familiar with AK. Patients were aware of the chronic nature of the disease and its correlation to sunlight regardless of demographic characteristics. The level of education played a role in disease awareness (p = 0.006), and treatment plan perception (p = 0.002). The increase in sunscreen protection after AK diagnosis was higher in women (p = 0.009) and younger patients (p = 0.044). Patients' concerns regarding treatment were mainly related to the duration (30%) and effectivity (25%). Dermatologists' statements highlighting that AK are precancerous lesions (86.2%) influenced patients' willingness for treatment. CONCLUSION: Improved awareness of AK is necessary to increase treatment seeking and compliance, regarding both treatment and sunscreen use. Dermatologists' statements may have critical influence on patients' decisions to receive treatment for AK.

Isolated lip dermatitis (atopic cheilitis), successfully treated with topical tacrolimus 0.03% / Dermatitis labial aislada (queilitis atópica), tratado con éxito con tacrolimus tópico al 0,03%

Background: Exfoliative and erosive cheilitis, may be a source of speech and chewing discomfort, but may alsobe an aesthetic issue for the patients affected. Such a clinical presentation may implicate a variety of inflamma-tory conditions, including atopic (eczematous) cheilitis. Topical and systemic agents, e.g. corticosteroids, havebeen used to treat inflammatory lip conditions. Topical tacrolimus has also been used in some inflammatory lipconditions.Material and Methods: We performed a retrospective clinical analysis of atopic cheilitis patients.Results: Between 2015 and 2020, we addressed 7 (seven) patients with atopic dermatitis affecting only lips andwere diagnosed as atopic-eczematous cheilitis. They were treated with 0.03 per cent topical tacrolimus ointmentand responded completely.Conclusions: These cases represent an underreported atopy / eczema event;-few cases of atopic cheilitis withoutconcomitant dermal lesions appear in the literature. We are also showing and discussing yet another applicationof tacrolimus in a local atopic form of inflammation affecting the lips.(AU)

The Effectiveness of Cryosurgery Combined with Curettage and Electrodessication in the Treatment of Keratoacanthoma: A Retrospective Analysis of 90 Cases.

BACKGROUND: There are several treatment options for keratoacanthoma (KA). However, there are limited data available on the use of cryosurgery. OBJECTIVE: To evaluate the effectiveness and safety of a combination treatment for KA and to evaluate the cosmetic outcome. MATERIALS AND METHODS: The combination treatment incorporates the use of curettage, electrodessication, and cryotherapy. A retrospective study was conducted on 90 patients with KA who had been treated with this method between 2000 and 2014. The follow-up period lasted 2 years and photographs were available for every visit of the patients to the department. RESULTS: The success rate was found to be 97.8%. No serious adverse events were observed. No infections were reported. The cosmetic outcome was evaluated as excellent for all patients. DISCUSSION: The combination method appears to combine the advantages of both destructive treatment and surgical excision. It appears to be a safe and effective treatment method. However, there are certain limitations to this study. CONCLUSIONS: More studies are needed to evaluate the effectiveness and safety of this method.

Imiquimod 3.75% for field-directed therapy of actinic keratosis: results of a prospective case-series study in Greece.

BACKGROUND: Imiquimod 3.75% is a field-directed treatment for actinic keratosis that can detect and treat clinical and subclinical lesions across an entire sun-exposed field. The detection of subclinical lesions is evidenced by an increase in lesions to the maximum lesion count during treatment (Lmax ). We report clinical outcomes for the first 15 patients treated with imiquimod 3.75% in daily clinical practice in Greece. METHODS: Fifteen patients with actinic keratosis lesions were treated with imiquimod 3.75% in an outpatient setting in two 2-week treatment cycles separated by a 2-week treatment-free interval. Actinic keratosis lesions were counted before treatment, at the end of the first treatment cycle (Week 2; Lmax ), and 2 weeks after the second treatment cycle (Week 8). Local skin reactions (LSR) were also evaluated at Weeks 2 and 8. RESULTS: The median baseline actinic keratosis lesion count was 25, which increased to a median Lmax of 29 at Week 2 and decreased to a median of 5 at Week 8. The median percentage and absolute reduction in actinic keratosis lesions from Lmax to Week 8 were 87% and 23%, respectively. Most of the LSR were mild-to-moderate in intensity at Week 2 and had resolved by Week 8. CONCLUSION: Imiquimod 3.75% effectively detected and cleared both the clinical and subclinical actinic keratosis lesions across the entire sun-exposed field in this cohort of Greek patients. Treatment was well tolerated.

Assessment of cryotherapy for the treatment of verrucous epidermal naevi.

Epidermal naevi are hamartomas that are characterized by hyperplasia of the epidermis and adnexal structures and may be associated with serious disfiguration. Management of epidermal naevi is challenging. We present here our experience with cryosurgery in the treatment of verrucous epidermal naevi. The aim of this study was to determine the efficacy and safety of cryosurgery for the treatment of epidermal naevi. Nine patients with verrucous epidermal naevi and two with extensive unilateral epidermal naevus were treated with cryosurgery. Two cycles of open spray technique were used, 10-15 sec each, depending on the size and extent of the naevus. Ten patients had their naevi treated successfully in 2-5 sessions with two cycles of therapy, and the cosmetic result was excellent with no scarring. One patient showed a relapse within 8 months after the treatment. One patient with phototype IV developed hypochromic scarring, but repigmentation occurred after 6 months. Postoperative healing time was 10-20 days. Cryosurgery is an extremely effective therapeutic modality for the treatment of epidermal naevi. The low cost, the simplicity of the technique and the good cosmetic result makes cryosurgery an excellent therapeutic modality for the treatment of epidermal naevus.

Comparison of cryotherapy to imiquimod 5% in the treatment of anogenital warts.

The aim of this study was to compare the efficacy of crotherapy versus imiquimod 5% in the treatment of anogenital warts. Eighty HIV-negative males were included in the analysis; 35 of them were treated with imiquimod 5% three times a week for 6-10 hours and 45 of them with cryotherapy once in three weeks. Follow-up appointments were arranged every month for the first three months and then at six and 12 months, or in between whenever the patients noticed any signs of recurrence. Treatment for both groups was continued for a total of 12 weeks or until the warts cleared. At the end of three months, irrespective of the type of treatment, 78.8% of the patients demonstrated 100% improvement. Cryotherapy was more effective, as 86.7% of patients showed 100% improvement compared with 68.6% of patients in the imiquimod group. On the contrary, 17.1% of the imiquimod group did not show any signs of improvement, compared with 2.2% of the cryotherapy group (P = 0.017). However, patients treated with imiquimod tended to improve earlier than patients on cryotherapy (P = 0.012). No statistically significant difference was observed regarding the recurrence rate between the two groups (P = 0.138). Treatment with imiquimod was less painful than cryotherapy (P = 0.034). Cryotherapy was more effective than imiquimod 5% for the treatment of anogenital warts in males but was more inconvenient.

Treatment of cutaneous leishmaniasis with cryosurgery.

BACKGROUND: The management of cutaneous leishmaniasis with topical methods, if effective, can spare patients from long and costly inpatient treatments. METHODS: Seventeen patients with cutaneous leishmaniasis were treated with cryosurgery using liquid nitrogen as the cryogen. Two cycles of 10-30 s freezing time were used and repeated at 3-week intervals. RESULTS: All patients responded well to therapy with excellent cosmetic results and no relapse in any case. Side-effects were rare. CONCLUSIONS: Cutaneous leishmaniasis can be successfully treated with a simple protocol of cryosurgery with minor side-effects.

Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study.

BACKGROUND: The treatment of keloids remains unsatisfactory. Intralesional 5-fluorouracil (FU) has not been much investigated as a monotherapy in the treatment of keloids. OBJECTIVE: We sought to evaluate the use of intralesional injections of 5-FU in the treatment of keloids. METHODS: A total of 20 patients (11 male and 9 female) were treated once weekly with intralesional injections of 5-FU (50 mg/mL). Patients received an average of 7 treatments. Average injection volumes were 0.2 to 0.4 mL/cm2. All patients had full blood cell count, liver function tests, and renal function tests before and after treatment was commenced. A total of 10 patients had biopsy specimens taken before starting treatment as a baseline and after 6 sessions. Routine hematoxylin-eosin and immunohistochemical analysis detecting Ki-67 and transforming growth factor-beta were performed on paraffin sections. All patients were followed up for 12 months, or until recurrence was noted. RESULTS: Of 20 patients, 17 (85%) showed more than 50% improvement. Only one did not respond favorably. Small and previously untreated lesions improved the most. Pain (20 of 20), hyperpigmentation (20 of 20), and tissue sloughing (6 of 20) were the main adverse effects. Histopathologic and immunohistochemical evaluation were consistent with the clinical observations. Ki-67 proliferative index was significantly reduced (P = .0001) after treatment. Transforming growth factor-beta was reduced less significantly. Recurrence was noted in 47% (9 of 19) of patients who responded to treatment within 1 year. A correlation was found ( P = .028) between the duration of the lesions and recurrence. CONCLUSION: Our study demonstrates that intralesional 5-FU may be effective in the treatment of keloids, but recurrence is common and further investigation is required.