Extensive Actinic Keratoses Research Articles

Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp

Topical photodynamic therapy (PDT) is an effective method when treating extensive areas of sun-damaged skin with multiple actinic keratoses (AKs) (field cancerization) on areas such as the forehead and scalp, and offers excellent cosmetic outcome. The major side-effect of PDT is the pain experienced during treatment. To investigate whether nerve blocks could provide adequate pain relief during PDT of AKs on the forehead and scalp. Ten men with symmetrically distributed and extensive AKs on the forehead and scalp were included in the study. Prior to PDT one side of the forehead and scalp was anaesthetized by nerve blocks while the other side served as control. The mean visual analogue scale (VAS) score on the anaesthetized side was 1 compared with 6.4 on the nonanaesthetized side during PDT. This difference was significant (P<0.0001), implying that nerve blocks reduce VAS scores during PDT. The results of the study support the use of nerve blocks as pain relief during PDT of field cancerization on the forehead and scalp, although individual considerations must be taken into account to find the most adequate pain-relieving method for each patient.

Treatment of multiple actinic keratoses with topical diclofenac 3% gel in organ transplant recipients: a series of six cases

Non-melanoma skin cancer (NMSC) represents a significant cause of morbidity in organ transplant patients; the relative risk of squamous cell carcinoma and actinic keratosis (AK) is 100 and 250 times higher, respectively, compared with immunocompetent patients. The aim of this study was to investigate the effects of 3% diclofenac gel on the clearance rates of multiple AKs in organ transplant recipients (OTRs). An open-label study was conducted in six patients (three kidney, one liver and two heart transplant patients) with histories of multiple NMSCs and extensive actinic keratoses (AKs). Patients were treated with diclofenac 3% gel, twice daily for 16 weeks. Complete and partial clearance rates of AKs were assessed after 16 weeks and biopsies were performed 4 weeks post-therapy on clinically typical AKs identified prior to the start of treatment. Three out of six patients showed complete clinical and histological clearance after 16 weeks of treatment with diclofenac 3% gel. Two further patients showed a marked (> or = 75% lesion reduction) improvement in their overall AK lesion count in the treatment area. One patient showed a 30% lesion reduction in the area treated. Local adverse events at the site of application were very mild and included mild erythema and marginal erosion. No systemic side effects were reported. Results suggest that diclofenac 3% gel may be useful in the treatment and control of multiple AK lesions in OTRs. Further studies are needed to investigate the efficacy and safety of this therapy for the local treatment of AK in greater numbers of immunosuppressed patients.

Superficial Squamous Cell Carcinomas and Extensive Actinic Keratoses of the Scalp Treated with Radiation Therapy

Address correspondence and reprint requests to: Dr. Hugh M. Gloster Jr., MD, 9275 Montgomery Road, Suite 100, Cincinnati, OH 45242-7779, or e-mail: [email protected] *All authors are affiliated with Department of Dermatology, University of Cincinnati, Cincinnati, OH Michelle A. Pipitone, MD, and Hugh M. Gloster Jr., MD, have indicated no significant interest with commercial supporters. Acknowledgment We would like to acknowledge Dr. John Breneman, from the Department of Radiation Oncology, for his expertise and care for this patient.

Superficial Squamous Cell Carcinomas and Extensive Actinic Keratoses of the Scalp Treated with Radiation Therapy

Superficial Squamous Cell Carcinomas and Extensive Actinic Keratoses of the Scalp Treated with Radiation Therapy

Pain, pain relief and other practical issues in photodynamic therapy

In our study of ALA PDT with EMLA, we noted considerable interpatient variation in the pain experience, with 5‐10% of patients experiencing quite severe pain, mainly with extensive actinic keratoses, and about the same percentage experiencing no pain at all. The remainder had an intermediate level of pain that could be managed with cool fans and cool water. 2 Assessment of the pain levels associated with treatment of different lesions types found that solar keratoses (S K) resulted in most pain, and BCC the least. Lesions on the head caused more pain than those on the trunk and extremities. On the head itself, more pain occurred on the scalp and forehead, and larger areas caused more pain than smaller areas. No differences in pain were observed for different skin types. 2

Aktinische Keratosen - erfolgreicher Einsatz von Imiquimod

In der vorliegenden Kasuistik wird über den erfolgreichen Einsatz von Imiquimod bei einem 80-jährigen Patienten mit ausgeprägten aktinischen Keratosen berichtet. Nach dreimal wöchentlicher Anwendung für 10œ Wochen von Imiquimod über Nacht konnte eine komplette Abheilung beobachtet werden.

Radiotherapy of skin tumors.

The incidence of cancers of the skin is increasing, as is life expectancy among most of the population. Besides surgery, all skin cancers can be treated with radiotherapy, with excellent results. Unfortunately, both less training and less equipment are available than earlier, which means that dermatologists also have less experience in this field. We would like to propose radiotherapy for medium-sized or larger lesions, especially on the face in elderly people. Good indications are keratoacanthomas, extensive actinic keratoses, Bowen's disease including erythroplasia of Queyrat, basal cell and squamous cell carcinomas, but also lentigo maligna and lentigo maligna melanomas. These tumors can be treated in a curative way. Excellent results of palliative X-ray therapy are achieved in Kaposi's sarcoma and in lymphomas, and also in Merkel cell tumors. After 100 years of treatment of skin cancers by radiotherapy, dermatologists should not forget that if appropriate principles are followed and precautions are taken, X-ray treatment is still a safe and effective method.

Cryopeeling (extensive cryosurgery) for treatment of actinic keratoses: an update and comparison.

The treatment of actinic keratoses is the most common procedure in dermatology and liquid nitrogen freezing is the most used method of destruction. Yet it is criticized for its limitations of treating only small areas and its tendency to leave hypopigmented skin. 5-fluorouracil (5-FU) treatment is also widely utilized. It has the advantage of treating large areas, but the disadvantages of length of treatment, morbidity, and only partial effectiveness in removing deep or hyperkeratotic actinic keratoses. Long-term follow-up results are reported on the use of extensive cryosurgery to treat areas of widespread solar damage. The literature is reviewed comparing the advantages and disadvantages versus 5-FU treatment. Three hundred and seventy-three patients were initially treated for extensive actinic keratoses in a private dermatology office in an retirement community in Florida. Individual lesions were counted under good lighting conditions with the aid of a 2.5x stereoscopic lens. The treated areas were predominately on the face and scalp areas, although some arms and hands were treated. A total of 34,604 were initially treated by spraying each individual keratosis with liquid nitrogen as well as the entire surrounding skin area. The data show that cryopeeling was approximately twice as effective as 5-FU when measured at 1-3 years postoperatively. In addition, the ease of application, its availability, the low cost of materials, its versatility in treating all forms of actinic keratoses, the reduced healing times, and its predictably good cosmetic results make this procedure a logical choice for treating widespread actinic keratoses. The number of squamous cell carcinoma recorded over the entire 6. 5-year study was 33 with no metastases, much lower than predicted for patients with actinic keratoses left untreated. Extensive cryosurgery (cryopeeling) is a highly effective method for removing actinic keratoses and preventing recurrences. The subsequent incidence of squamous cell carcinoma is also greatly reduced.

Photodynamic Therapy vs. 5-Fluorouracil for Actinic Keratoses

Extensive actinic keratoses are a challenge to treat, and patients require multiple visits. In this randomized, paired comparison study from England, 17 patients with extensive actinic keratoses on their forearms and hands had 1 dorsal hand treated with 5% 5-fluorouracil (5-FU) cream twice per day for 3 weeks, …

Trichloroacetic Acid Chemexfoliation (Chemical Peel) for Extensive Premalignant Actinic Damage of the Face and Scalp

Trichloroacetic acid chemexfoliation is an effective, versatile, and safe therapeutic option for patients with extensive actinic keratoses of the face and scalp. With an experienced and skilled operator, the associated complications are rare and tend to be mild. Cosmetically, the patient not only benefits from removal of the erythematous, scaly actinic keratoses but also obtains cosmetically pleasing rejuvenation of facial skin and diminution of fine facial wrinkles. Two representative cases are presented. In comparison with other available treatment modalities, trichloroacetic acid chemexfoliation involves a shorter treatment period and wound healing time and is not dependent on patient compliance.

Isotretinoin and Staphylococcus aureus Infection

The use of isotretinoin (13-cis-retinoic acid) in the treatment of numerous dermatologic disorders, as well as the side effects encountered with use of the drug, have increased remarkably since its release. We encountered a case of Staphylococcus aureus endocarditis in a patient with chronic stable aortic insufficiency undergoing therapy with isotretinoin for extensive actinic keratoses. Although significant dysfunction of the immune system has not been demonstrated with isotretinoin, nasal colonization with S aureus has been shown to occur. Changes in skin fragility caused by the drug may provide a portal of entry for the organism. Physicians should be alert for this potential complication in patients with an underlying cardiac valvular lesion; antibiotic prophylaxis may be indicated in this group during isotretinoin therapy.

Selective Cytotoxic Effect of Topical 5-Fluorouracil

As an investigative procedure, a hydro(5-FU) ointment containing 20% 5-fluorouracil (5-FU) was applied to the skin of patients with extensive actinic keratoses of the face and neck, for a period of four weeks. This resulted in a selective inflammation, erosion, and disappearance of the keratoses without significant alteration of the normal skin. Transitory adverse reactions included corneal and conjunctival irritations, phototoxic reactions, and erosion of the lower lip border. No evidence of systemic absorption was detected. Only preliminary follow-up observations are available, and no conclusion can be drawn as to the long-term results.

SELECTIVE CYTOTOXIC EFFECT OF TOPICAL 5-FLUOROURACIL.

As an investigative procedure, a hydrophilic ointment containing 20% 5-fluorouracil (5-FU) was applied to the skin of patients with extensive actinic keratoses of the face and neck, for a period of four weeks. This resulted in a selective inflammation, erosion, and disappearance of the keratoses without significant alteration of the normal skin. Transitory adverse reactions included corneal and conjunctival irritations, phototoxic reactions, and erosion of the lower lip border. No evidence of systemic absorption was detected. Only preliminary follow-up observations are available, and no conclusion can be drawn as to the long-term results.