Dermatosis con infiltrados plasmocitarios, ¿secundaria a queratosis actínica? / Dermatosis with plasma cell infiltration, secondary to actinic keratosis? / Dermatose com infiltrados plasmocíticos, secundária a queratose actínica?

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.

Efectividad del Heberferon en pacientes con queratosis actínica asociada a carcinoma basocelular

Las queratosis actínicas son neoformaciones dermatológicas planas oexofísticas, presentes mayormente en zonas fotoexpuestas, de evolución crónica y generalmente asintomáticas, siendo la expresión más temprana del carcinoma espinocelular, producidas por la exposición solar crónica en personas fundamentalmente de piel clara. Se realizó un estudio longitudinal prospectivo de intervención terapéutica. El universo estuvo constituido por 130 pacientes y la muestra por 116 pacientes diagnosticados con queratosis actínica que concomitaron con carcinoma basocelular que asistieron a la consulta de oncodermatología del Hospital Provincial Docente "Carlos Manuel de Céspedes" de Bayamo, en el período comprendido de enero 2019 a diciembre 2020; con el objetivo de evaluar la efectividad del tratamiento con HeberFERON® en la queratosis actínica asociada a carcinoma basocelular. Para valorar la asociación entre las variables se empleó el test de Chi Cuadrado de Mantel. Fue frecuente en el estudio el sexo masculino, las edades comprendidas entre 61 y 80 años, el fototipo cutáneo II de la clasificación de Fitzpatrick, que presentaron más de 20 lesiones de queratosis actínica, de localización frecuente en los antebrazos. El HeberFERON fue efectivo y se logró respuesta favorable al tratamiento desde el punto de vista clínico y por dermatoscopia. Los efectos adversos frecuentes tras la administración del HeberFERON® fueron la fiebre, seguido de malestar general y el dolor en el sitio de la inyección.

Actinic keratoses are flat dermatological neoformations or oexofistic, present mostly in photoexposed areas, of chronic evolution and generally asymptomatic, being the earliest expression of squamous cell carcinoma, produced by chronic sun exposure in people mainly fair-skinned. A prospective longitudinal study of therapeutic intervention was conducted. The universe consisted of 130 patients and the sample consisted of 116 patients diagnosed with actinic con queratosis who concomitated with basal cell carcinoma who attended the oncodermatology consultation of the "Carlos Manuel de Céspedes" Provincial Teaching Hospital of Bayamo, in the period from January 2019 to December 2020; with the objective of evaluating the effectiveness of treatment with HeberFERON® in actinic keratosis associated with basal cell carcinoma. To assess the association between the variables, the Mantel Chi-Square test was used. The male sex, ages between 61 and 80 years, cutaneous phototype II of the Fitzpatrick classification, which presented more than 20 lesions of actinic keratosis, of frequent location in the forearms, were frequent in the study. HeberFERON was effective and a favorable response to treatment was achieved from the clinical point of view and by dermoscopy. Common side effects following administration of HeberFERON® were fever, followed by malaise and pain at the injection site.

As ceratoses actínicas são neoformações dermatológicas planas ou oexofísticas, presentes principalmente em áreas fotoexpostas, de evolução crônica e geralmente assintomáticas, sendo a expressão mais precoce do carcinoma espinocelular, produzido pela exposição solar crônica em pessoas principalmente de pele clara. Foi realizado um estudo longitudinal prospectivo de intervenção terapêutica. O universo foi composto por 130 pacientes e a amostra por 116 pacientes diagnosticados com conqueratose actínica que se concomitaram com carcinoma basocelular e que compareceram à consulta de oncodermatologia do Hospital Universitário Provincial "Carlos Manuel de Céspedes" de Bayamo, no período de janeiro de 2019 a dezembro de 2020; com o objetivo de avaliar a eficácia do tratamento com HeberFERON® na queratose actínica associada ao carcinoma basocelular. Para avaliar a associação entre as variáveis, foi utilizado o teste Qui-Quadrado de Mantel. O sexo masculino, com idades entre 61 e 80 anos, o fototipo cutâneo II da classificação de Fitzpatrick, que apresentou mais de 20 lesões de queratose actínica, de localização frequente nos antebraços, foram frequentes no estudo. O HeberFERON foi eficaz e uma resposta favorável ao tratamento foi alcançada do ponto de vista clínico e por dermatoscopia. Os efeitos secundários frequentes após a administração de HeberFERON® foram febre, seguida de mal-estar e dor no local da injeção.

Tirbanibulin: review of its novel mechanism of action and how it fits into the treatment of actinic keratosis. / Tirbanibulina: revisión de su mecanismo de acción novedoso y de cómo encaja en el tratamiento de la queratosis actínica.

Actinic keratosis (AK) is a skin condition characterized by the proliferation of mutated keratinocytes that can develop into squamous cell carcinoma. Available therapies, although effective, are associated with a high frequency of severe local skin reactions. Tirbanibulin, one of the treatments for AK currently in development, is a new synthetic chemical entity with anti-proliferative and anti-tumor effects, both in vitro and in vivo, with proved efficacy in the treatment of AK, which has been recently demonstrated in two phase III clinical trials. In the present review, the tirbanibulin mechanism of action, based on the relevant literature and the results of several unpublished preclinical studies, is shown. In addition, the current scenario regarding the available treatments and how the novel tirbanibulin mechanism of action fits into the treatment of AK is raised.

Tirbanibulina: revisión de su mecanismo de acción novedoso y de cómo encaja en el tratamiento de la queratosis actínica / Tirbanibulin: review of its novel mechanism of action and how it fits into the treatment of actinic keratosis

La queratosis actínica (QA) es una afección cutánea caracterizada por la proliferación de queratinocitos mutados que pueden convertirse en carcinoma escamoso cutáneo. Las terapias disponibles, aunque efectivas, están asociadas con una alta frecuencia de reacciones cutáneas locales graves. Tirbanibulina, uno de los tratamientos para la QA actualmente en desarrollo, es un nuevo fármaco sintético de origen químico con potentes efectos antiproliferativos y antitumorales in vitro e in vivo con eficacia probada en el tratamiento de la QA, demostrada recientemente en dos ensayos clínicos de faseIII. En la presente revisión se muestra el mecanismo de acción de tirbanibulina en base a la literatura relevante y los resultados de varios estudios preclínicos no publicados. Además, se plantea el escenario actual en cuanto a los tratamientos disponibles y cómo el mecanismo de acción novedoso de tirbanibulina encaja en el tratamiento de la QA (AU)

Actinic keratosis (AK) is a skin condition characterized by the proliferation of mutated keratinocytes that can develop into squamous cell carcinoma. Available therapies, although effective, are associated with a high frequency of severe local skin reactions. Tirbanibulin, one of the treatments for AK currently in development, is a new synthetic chemical entity with anti-proliferative and anti-tumor effects, both in vitro and in vivo, with proved efficacy in the treatment of AK, which has been recently demonstrated in two phase III clinical trials. In the present review, the tirbanibulin mechanism of action, based on the relevant literature and the results of several unpublished preclinical studies, is shown. In addition, the current scenario regarding the available treatments and how the novel tirbanibulin mechanism of action fits into the treatment of AK is raised (AU)

[Translated article] Tirbanibulin: review of its novel mechanism of action and how it fits into the treatment of actinic keratosis / Tirbanibulina: revisión de su mecanismo de acción novedoso y de cómo encaja en el tratamiento de la queratosis actínica

Actinic keratosis (AK) is a skin condition characterized by the proliferation of mutated keratinocytes that can develop into squamous cell carcinoma. Available therapies, although effective, are associated with a high frequency of severe local skin reactions. Tirbanibulin, one of the treatments for AK currently in development, is a new synthetic chemical entity with anti-proliferative and anti-tumor effects, both in vitro and in vivo, with proved efficacy in the treatment of AK, which has been recently demonstrated in two phase III clinical trials. In the present review, the tirbanibulin mechanism of action, based on the relevant literature and the results of several unpublished preclinical studies, is shown. In addition, the current scenario regarding the available treatments and how the novel tirbanibulin mechanism of action fits into the treatment of AK is raised (AU)

La queratosis actínica (QA) es una afección cutánea caracterizada por la proliferación de queratinocitos mutados que pueden convertirse en carcinoma escamoso cutáneo. Las terapias disponibles, aunque efectivas, están asociadas con una alta frecuencia de reacciones cutáneas locales graves. Tirbanibulina, uno de los tratamientos para la QA actualmente en desarrollo, es un nuevo fármaco sintético de origen químico con potentes efectos antiproliferativos y antitumorales in vitro e in vivo con eficacia probada en el tratamiento de la QA, demostrada recientemente en dos ensayos clínicos de faseIII. En la presente revisión se muestra el mecanismo de acción de tirbanibulina en base a la literatura relevante y los resultados de varios estudios preclínicos no publicados. Además, se plantea el escenario actual en cuanto a los tratamientos disponibles y cómo el mecanismo de acción novedoso de tirbanibulina encaja en el tratamiento de la QA (AU)

Quality of Life, Behaviour and Attitudes towards Actinic Keratosis in Spain: The PIQA Study. / Calidad de vida, comportamiento y actitudes hacia la queratosis actínica en España: estudio PIQA.

OBJECTIVE: This study was aimed to examine patients' knowledge, behaviours and attitudes regarding actinic keratosis (AK) lesions and the impact of the disease on patients' quality of life (QoL). METHODS: Observational study of patients with AK lesions in Spain. QoL was evaluated with the validated version of Spanish AKQoL questionnaire. Skin self-examination, sun-exposure, habits and attitudes towards AK's treatment were recorded using different questionnaires. The adherence was assessed by means of the Morisky-Green test. Among other variables, QoL and adherence to treatment were compared by using Pearson's χ2 test and one-way ANOVA tests. Inferential analysis regarding such factors and length of treatment were also performed. RESULTS: A total of 1240 patients (73.6 [10.5] years old) were recruited. Overall, patients that showed higher levels of concern were also showed a higher impairment on QoL. AK had greater effects on women's QoL and those who performed skin self-examination, think that AK is a disease and/or believe that moisturizers can prevent skin aging (P<.05). Adherence and length of treatment were strongly related, since patients with treatments intended for <1week were more likely to show good adherence and complete remission of AK (Odds Ratio [95%CI]: 6.25 [4.55-8.33] and 2.63 [1.96-3.45]), respectively). CONCLUSIONS: Concerns due to AK are mainly related to sex and to the consideration of AK as a disease. More concerned patients tend to have lower QoL and good adherence to treatment. Short length of treatment was associated with better adherence and complete remission of AK lesions.

Dermoscopy of Pigmented Actinic Keratosis of the Face: A Study of 232 Cases.

The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. OBJECTIVE: To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. METHODS: Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings' abnormalities (FSA) and follicular keratosis' abnormalities (FKA). RESULTS: FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p≤0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. CONCLUSIONS: The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications.

[Actinic keratosis: New concept and therapeutic update]. / Queratosis actínica: nuevo concepto y actualización terapéutica.

Actinic keratosis (AK) is a common reason for consultation in both Primary Care and Specialised Care. It is the third or fourth most common reason for consultation in dermatology, accounting for up to 5-6% of patients attended. It has also been observed that its prevalence has been increasing in the last 10years, compared to other dermatoses. This is also expected to continue to increase due to longer life expectancy, and by the changes in sun exposure habits since the middle of the last century. The aim of this article is to update the concepts of AK, cancerisation field and to present the currently available therapeutic tools.

Precancerous Skin Lesions. / Precáncer cutáneo.

Certain clinically and histologically recognizable skin lesions with a degree of risk of progression to squamous cell carcinoma have been traditionally grouped as precancerous skin conditions but now tend to be classified as in situ carcinomas. This consensus statement discusses various aspects of these lesions: their evaluation by means of clinical and histopathologic features, the initial evaluation of the patient, the identification of risk factors for progression, and the diagnostic and treatment strategies available today.

PREVALÊNCIA DE CERATOSE ACTÍNICA EM IDOSOS DE UMA REGIÃO NEOTROPICAL / PREVALENCE OF ACTINIC KERATOSIS IN THE ELDERLY OF A NEOTROPICAL REGION / PREVALENCIA DE QUERATOSIS ACTÍNICA EN LOS ADULTOS MAYORES DE UNA REGIÓN NEOTROPICAL

Objetivo: identificar a prevalência de ceratose actínica (CA) em idosos residentes no município de Palmas, TO, Brasil. Método: estudo epidemiológico, observacional, transversal realizado no município de Palmas, no período de janeiro a junho de 2016, com pessoas, de ambos os sexos, com idade acima de 60 anos. Resultados: fizeram parte do estudo 259 idosos, com predomínio na faixa etária entre 60 e 69 anos, média de idade de 72 anos. A prevalência de CA foi de 2,3%, com predomínio no sexo feminino (66,7%), na faixa etária entre 68 e 91, e que se declararam brancos (66,7%). Conclusão: estudos alertam quanto ao risco de desenvolvimento de CA por pessoas idosas, relacionando a exposição solar ao longo da vida. Embora esse estudo não tenha investigado os hábitos de vida quanto ao histórico de exposição solar, os resultados confirmam o risco para idosos. Evidencia a importância de cuidados preventivos com a pele, especialmente quanto a exposição solar, visando a prevenção da CA.

Objective: Identify the prevalence of Actinic Keratosis (CA) in elderly residents in the city of Palmas, TO, Brazil. Method: it is an observational, cross-sectional epidemiologic study, conducted in the city of Palmas from January to June of 2016, with subjects of both sexes, aged above 60 years. Results: two hundred sixty-nine elders were part of this study, most of them aged between 60 and 69 years, with an average age of 72 years. The CA prevalence was 2.3%, mostly women (66.7%), aged between 68 and 91, and who declared themselves white (66.7%). Conclusion: Studies warn about the risk of elderly people developing CA related to solar exposure throughout the life. Although this study did not investigate the life habits related to sun exposure, the results confirm this risk for seniors. This study highlights the importance of preventive skin care, especially related to sun exposure, aiming the CA prevention.

Objetivo: identificar la prevalencia de queratosis actínica (CA) en los adultos mayores residentes en la ciudad de Palmas, Tocantins, Brasil. Método: estudio epidemiológico, observacional, transversal, realizado en la ciudad de Palmas, en el período de enero a junio de 2016, con las personas de ambos sexos, mayores de 60 años. Resultados: los sujetos fueron 259 ancianos, predominantemente con edades comprendidas entre 60 y 69 años, con una edad media de 72 años. La prevalencia de la CA fue de 2,3%, con predominio en mujeres (66,7%), con edades comprendidas entre los 68 y 91, y que se declararon raza blanca (66,7%). Conclusión: estudios advierten sobre el riesgo de desarrollo de CA para las personas ancianas que une la exposición al sol durante toda la vida. Aunque este no estudio ha investigado los hábitos de vida como la historia de la exposición al sol, los resultados confirman el riesgo para ancianos. Destaca la importancia de la atención preventiva de la piel, sobre todo por exposición al sol, con el objetivo de la prevención del CA.

Prevalence of actinic keratosis among dermatology outpatients in Spain.

BACKGROUND: Actinic keratoses (AKs) are common skin lesions associated with an increased risk of developing squamous cell carcinoma. Few studies in Europe have focused on AK prevalence. AIM: To determine the point prevalence of AKs in a dermatology outpatient population in Spain, to describe the clinical characteristics of these lesions and to characterise the profile of AK patients. METHODS: Observational, cross-sectional, multicentre study conducted in 19 hospitals (dermatology outpatient services) around Spain. A total of 204 consecutive patients per hospital who were ≥45 years old were screened for the presence of AKs. RESULTS: 3877 patients were assessed and the overall AKs prevalence was 28.6%. Prevalence was significantly higher in men than women (38.4% vs. 20.8%, p<0.0001) and increased with age for both sexes (45.2% in 71-80 years). Scalp and ear lesion locations were significantly more frequent in men (51.9% vs. 2.7% and 16.9% vs. 2.4%, respectively, p<0.0001 both cases) and the cheek, nose and neckline in women (46.3% vs. 34.0% [p<0.0001], 43.0% vs. 24.8% [p<0.0001] and 5.3% vs. 1.8% [p=0.002]). Men showed a significantly higher frequency of ≥2 affected areas than women (42.7% vs. 20.3%, p<0.0001). Among patients with AK lesions, only 65% confirmed that they were the reason for the visit to the clinic. CONCLUSIONS: Approximately a quarter of the dermatology outpatient population in Spain aged ≥45 years old have AKs, with the prevalence rate being highest in men and in older age groups. AK is underdiagnosed and a proactive strategy is needed for the diagnosis and early treatment of these lesions.

Queilitis actínica: aspectos histológicos, clínicos y epidemiológicos / Actinic cheilitis: histological, clinical and epidemiological characteristics

Introducción: la destrucción de la capa de ozono ha provocado un aumento en la incidencia de lesiones de la piel, a la que se suma la queilitis actínica. Objetivo: describir los aspectos histológicos, clínicos y epidemiológicos de la queilitis actínica a partir de la literatura reciente. Métodos: se revisaron las bases electrónicas PubMed, SciELO y Google Scholar con los términos claves en inglés y español: queilitis, queratosis, actínica, solar. Se incluyeron artículos originales, de revisión, reportes de casos, tesis y libros de la especialidad publicados preferentemente en el período 2005-2014. Resultados: La queilitis actínica es un trastorno potencialmente maligno inducido por la exposición solar y caracterizado por alteraciones micro y macroestructurales del labio. Factores de riesgo que interaccionan con la exposición solar son el fototipo (piel clara), hábito tabáquico, sexo (hombres), edad y ocupación (aire libre). Entre las alteraciones histológicas se encuentran la displasia epitelial y la elastosis solar; sin embargo, la severidad de estas no correlacionan con la gravedad clínica. Los pacientes con queilitis actínica presentan alteraciones de color, descamación, ulceraciones, difuminación del bermellón, entre otras. En muchas ocasiones la consulta y el diagnóstico son tardíos; se realizan cuando el cuadro ha evolucionado a cáncer. El diagnóstico es principalmente clínico, sumado a la biopsia de las lesiones con presentaciones moderadas y severas. Actualmente la terapia incluye métodos quirúrgicos y farmacológicos, y métodos innovadores como la fototerapia. Sin duda, la estrategia de prevención más importante es aumentar el uso de protectores solares, especialmente en la población de alto riesgo ocupacional. Conclusiones: la queilitis actínica es una patología relevante para los países sudamericanos, debido a que los factores de riesgo están presentes diariamente en las actividades de millones de trabajadores de nuestra región, por eso es necesario potenciar la investigación que permita mejorar la prevención, tratamiento y rehabilitación de esta patología(AU)

Introduction: depletion of the ozone layer has brought about an increase in the incidence of skin lesions, including actinic cheilitis. Objective: describe the histological, clinical and epidemiological characteristics of actinic cheilitis based on a review of recent literature. Methods: a search was conducted in the databases PubMed, SciELO and Google Scholar using the descriptors cheilitis, keratosis, actinic, solar, and their counterparts in Spanish. The search included original papers, review papers, case reports, theses and books about the specialty preferably published from 2005 to 2014. Results: actinic cheilitis is a potentially malignant condition induced by sun exposure and characterized by micro- and macrostructural alterations of the lip. The risk factors interacting with sun exposure are the skin phototype (light skin), smoking, gender (male), age and occupation (outdoor jobs). Histological alterations include epithelial dysplasia and solar elastosis, though their severity does not correlate with the degree of clinical seriousness. Patients with actinic cheilitis present color alterations, desquamation, ulceration and blurring of the vermillion border, among other signs and symptoms. On many occasions patients do not seek care during the early stages of the disease. As a result, diagnosis is made when the condition has already evolved into cancer. The diagnosis is basically clinic, with the support of the biopsy of lesions with moderate to severe characteristics. Current therapy includes surgery and medication, as well as innovative techniques like phototherapy. The most important strategy is no doubt the use of sunscreens, especially by the population at high occupational risk. Conclusions: actinic cheilitis is a condition relevant to South American countries, since its risk factors are present in the daily activities of millions of workers from our region. It is therefore necessary to foster research aimed at improving its prevention, treatment and rehabilitation(AU)

Cost-Effectiveness and Cost-Utility Analysis of Ingenol Mebutate Versus Diclofenac 3% and Imiquimod 5% in the Treatment of Actinic Keratosis in Spain. / Análisis de coste-efectividad y coste-utilidad de ingenol mebutato versus diclofenaco 3% e imiquimod 5% en el tratamiento de la queratosis actínica en España.

OBJECTIVE: To perform a cost-effectiveness and cost-utility analysis of ingenol mebutate in the treatment of actinic keratosis in Spain. METHODS: We used an adapted Markov model to simulate outcomes in a cohort of patients (mean age, 73 years) with actinic keratosis over a 5-year period. The comparators were diclofenac 3% and imiquimod 5%. The analysis was performed from the perspective of the Spanish National Health System based on direct costs (2015 retail price plus value added tax less the mandatory discount). A panel of experts estimated resources, taking unit costs from national databases. An annual discount rate of 3% was applied. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The effectiveness of ingenol mebutate-with 0.192 and 0.129 more clearances gained in treatments for face and scalp lesions and trunk and extremity lesions, respectively-was superior to diclofenac's. The total costs of treatment with ingenol mebutate were lower at € 551.50 (face and scalp) and € 622.27 (trunk and extremities) than the respective costs with diclofenac (€ 849.11 and € 844.93). The incremental cost-effectiveness and cost-utility ratios showed that ingenol mebutate was a dominant strategy vs diclofenac. Ingenol mebutate also proved to be more effective than imiquimod, based on 0.535 and 0.503 additional clearances, and total costs of € 551.50 and € 527.89 for the two drugs, respectively. The resulting incremental cost-effectiveness ratio was € 728.64 per clearance gained with ingenol mebutate vs imiquimod. CONCLUSIONS: Ingenol mebutate was a dominant treatment option vs diclofenac and was efficient vs imiquimod (i.e., more effective at a higher cost, achieving an incremental cost-utility ratio of<€30000/quality-adjusted life-years).

Adaptation and validation of the Spanish version of the Actinic Keratosis Quality of Life questionnaire. / Adaptación y validación de la versión española del cuestionario Actinic Keratosis Quality of Life (AKQoL).

BACKGROUND AND OBJECTIVE: While there are questionnaires for evaluating the effects of skin cancer on patient quality of life, there are no specific questionnaires available in Spanish for evaluating quality of life in patients with actinic keratosis. The aim of this study was to translate and culturally adapt the Actinic Keratosis Quality of Life (AKQoL) questionnaire into Spanish. PATIENTS AND METHODS: The original questionnaire was translated into Spanish following the guidelines for the cross-cultural adaptation of self-report measures. Several measures of general reliability and validity were calculated, including Cronbach α for internal consistency and the Spearman rank-order correlation coefficient and a Bland-Altman plot for test-retest reliability. To test concurrent validity, we used the Pearson correlation coefficient to measure the correlation between AKQoL and Skindex-29 scores. RESULTS: The final version of the questionnaire was administered to 621 patients with actinic keratosis, who scored a mean (SD) of 5.25 (4.73) points (total possible score, 0-25). The Cronbach α reliability coefficient analysis was 0.84. The correlation between the mean (SD) score on the Skindex-29 (1.87 [4.07]) and on the AKQoL (1.97 [2.98] was 0.344 (P=.002, Spearman's rho), with a proportion of shared variance of 11.8%. CONCLUSIONS: The translation, cross-cultural adaptation, and validation of the original AKQoL produced a reliable, easily understandable questionnaire for evaluating the impact of actinic keratosis on the quality of life of patients in our setting.

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.

Clinical Response to Ingenol Mebutate in Patients With Actinic Keratoses.

Cryotherapy is the most common treatment for actinic keratosis, but its effect is limited to individual lesions. Several topical drugs, however, are available that, in addition to treating individual actinic keratoses, target field cancerization and thereby act on subclinical lesions. Examples are 5-fluorouracil, imiquimod, diclofenac, and ingenol mebutate. We report on 17 patients with actinic keratoses treated with ingenol mebutate and describe our findings on treatment effectiveness, adherence, and tolerance. Complete and partial response rates were 35% and 53%, respectively. Ninety-four percent of patients fully adhered to treatment and 18% developed severe local reactions. Ingenol mebutate is an effective treatment for actinic keratosis. Although it has a similar rate of local reactions to other treatments available for actinic keratosis, its short treatment regimen favors better adherence.

Guía de Práctica Clínica con evaluación económica para la prevención, diagnóstico, tratamiento y seguimiento del cáncer de piel no melanoma: queratosis actínica: para uso de profesionales de la salud / Clinical Practice Guide with economic evaluation for the prevention, diagnosis, treatment and follow-up of non-melanoma skin cancer: actinic keratosis: for use by health professionals

La guía está dirigida al personal clínico asistencial que brinda cuidados a pacientes con queratosis actínicas en los temas de prevención, diagnóstico, tratamiento y seguimiento, en los diferentes grados de complejidad de los servicios de la atención en salud en el marco del SGSSS (médicos familiares, médicos generales, médicos especialistas en dermatología, oncólogos, cirujanos plásticos, patólogos, radioterapeutas, cirujanos de cabeza y cuello, profesionales de enfermería y otros profesionales de la salud relacionados con el manejo de las queratosis actínicas). Los manejos de condiciones específicas por parte de los subespecialistas ameritan recomendaciones que exceden el alcance del presente documento. Esta GPC también, se dirige a tomadores de decisiones, generadores de políticas de salud, pagadores del gasto y todo el personal relacionado, que se desempeñe en el ámbito hospitalario o de las aseguradoras en salud. Esta GPC ofrece recomendaciones específicas para las preguntas definidas, y excede el alcance de la misma, definir las competencias profesionales del equipo involucrado en el manejo de esta patología

Guía de Práctica Clínica con evaluación económica para la prevención, diagnóstico, tratamiento y seguimiento del cáncer de piel no melanoma: queratosis actínica: para profesionales de la salud / Clinical Practice Guide with economic evaluation for the prevention, diagnosis, treatment and follow-up of non-melanoma skin cancer: actinic keratosis: for health professionals

La guía está dirigida al personal clínico asistencial que brinda cuidados a pacientes con queratosis actínicas en los temas de prevención, diagnóstico, tratamiento y seguimiento, en los diferentes grados de complejidad de los servicios de la atención en salud en el marco del SGSSS (médicos familiares, médicos generales, médicos especialistas en dermatología, oncólogos, cirujanos plásticos, patólogos, radioterapeutas, cirujanos de cabeza y cuello, profesionales de enfermería y otros profesionales de la salud relacionados con el manejo de las queratosis actínicas). Los manejos de condiciones específicas por parte de los subespecialistas ameritan recomendaciones que exceden el alcance del presente documento. Esta GPC también, se dirige a tomadores de decisiones, generadores de políticas de salud, pagadores del gasto y todo el personal relacionado, que se desempeñe en el ámbito hospitalario o de las aseguradoras en salud. Esta GPC ofrece recomendaciones específicas para las preguntas definidas, y excede el alcance de la misma, definir las competencias profesionales del equipo involucrado en el manejo de esta patología.

Confocal microscopy patterns in nonmelanoma skin cancer and clinical applications.

Reflectance confocal microscopy is currently the most promising noninvasive diagnostic tool for studying cutaneous structures between the stratum corneum and the superficial reticular dermis. This tool gives real-time images parallel to the skin surface; the microscopic resolution is similar to that of conventional histology. Numerous studies have identified the main confocal features of various inflammatory skin diseases and tumors, demonstrating the good correlation of these features with certain dermatoscopic patterns and histologic findings. Confocal patterns and diagnostic algorithms have been shown to have high sensitivity and specificity in melanoma and nonmelanoma skin cancer. Possible present and future applications of this noninvasive technology are wide ranging and reach beyond its use in noninvasive diagnosis. This tool can also be used, for example, to evaluate dynamic skin processes that occur after UV exposure or to assess tumor response to noninvasive treatments such as photodynamic therapy. We explain the characteristic confocal features found in the main nonmelanoma skin tumors and discuss possible applications for this novel diagnostic technique in routine dermatology practice.