Treatment Of Actinic Keratosis Research Articles

Neoadjuvant Photodynamic Therapy: An Updated Therapeutic Approach for Non-Melanoma Skin Cancers.

Non-melanoma skin cancers (NMSCs) are the most common malignancy and surgical excision is considered treatment of choice for the majority of cases. However, surgery can be very extensive in cases of large, multiple, or cosmetic-sensitive tumors located on areas such as scalp and face or genital region, leading to significant functional and cosmetic deficit. Aminolaevulinic acid photodynamic therapy (ALA-PDT) has emerged as a widely used approach in a variety of skin diseases, demonstrating remarkable efficacy in treatment of actinic keratosis, Bowen disease and basal cell carcinoma. Besides, when employed as a preoperative intervention, ALA-PDT effectively reduces tumor size and minimizes subsequent local surgical morbidity. With its minimally invasive nature and proven effectiveness, ALA-PDT holds significant promise as a neoadjuvant treatment option for NMSCs. In cases where the tumor is large, invasive, multiple, or located in cosmetically and functionally sensitive areas, or when considering patient factors such as age, comorbidity, willingness to undergo surgery, and post-operative quality-of-life, surgical intervention or radiotherapy alone may be impracticable or unacceptable. In such scenarios, neoadjuvant ALA-PDT can offer remarkable outcomes. In order to further ensure the maximum benefit of patients from neoadjuvant PDT, collaboration with multidisciplinary teams and whole-process management may be in need.

Anti-aging Effects of Tirbanibulin 1% Ointment: A Real-Life Experience.

Tirbanibulin 1% ointment has been licensed to treat non-hyperkeratotic actinic keratosis (AKs) on the face and scalp in adults to ensure excellent patient tolerability due to the mild side effects and the brief application time compared to other topical therapies on the market. A growing body of evidence suggests that, beyond their primary function, the treatments for AKs and the cancerization field may inadvertently confer substantial cosmetic benefits to patients. We report a single-center retrospective case series of patients referred to the Dermatology Unit of the University Hospital of Messina, Italy, between February and December 2023 seeking treatment for AKs in the context of photodamaged areas in which the application of tirbanibulin 1% ointment induced, besides clearance of AKs, anti-aging effects on both skin texture and solar lentigos. Seven patients affected by Olsen grade1-2 AKs experienced a powerful rejuvenating effect in the treated areas, with a marked efficacy in skin lightening and clearance of solar lentigo. Tirbanibulin 1% ointment seems able to improve skin aging as a desirable side effect at the site of application for AKs on chronic photodamaged skin. Such preliminary observation needs further confirmation in real-life studies on larger cohorts of patients, to explain the pathogenic mechanisms responsible for such aesthetically relevant results.

Exploring the burden of actinic keratoses through development of a patient decision aid: a mixed methods study.

Actinic keratoses (AKs) present on sun-exposed sites and are considered precursors of cutaneous squamous cell carcinoma (cSCC). A better understanding of the experiences of patients with this condition may improve patient-provider relationships and guide the introduction of shared-decision making (SDM) to treatment decisions. To develop a patient decision aid (PDA) for field treatment of multiple actinic keratoses in line with the International Patient Decision Aid Standards (IPDAS), by (i) characterising the burden and lived experiences of patients with multiple AKs, (ii) understanding the decisional needs of patients requiring field treatment and (iii) exploring clinician preferences regarding field treatment for multiple AKs. This mixed methods study followed the most up-to-date guidelines set out by the IPDAS Collaboration; a voluntary body which aims to enhance the quality of PDAs by developing an evidence-based systematic process for the development of unbiased and effective PDAs. Multiple actinic keratoses have a psychosocial impact on patients. Patients feel supported through the integration of evidence-based information to guide SDM. We propose that the use of a PDA for multiple AKs provides a key role in supporting informed shared patient-provider decision making and empowers patient involvement in their prospective treatment strategy.

Tirbanibulin 1% Ointment Effectiveness for Actinic Keratosis Treatment Evaluated by Dynamic Optical Coherence Tomography

Background. Actinic keratosis (AK) is a common premalignant skin condition. Its diagnosis is based on a clinical and sometimes dermoscopic examination, but, in some situations, a skin biopsy may be necessary. Dynamic optical coherence tomography (D-OCT) can often bypass this need, by noninvasive evaluation of skin morphology. Early and effective treatment of AKs is important to prevent the progression to invasive squamous cell carcinoma (iSCC). Tirbanibulin 1% ointment, a new topical field therapy for AKs, has recently been introduced. Objectives. The aim of this study was to evaluate the efficacy and safety of tirbanibulin 1% ointment for the field treatment of nonhyperkeratotic, nonhypertrophic AKs (Olsen grade 1) on the face and/or scalp in adults, using D-OCT technology. Methods. Patients, presenting multiple, mild to moderate AKs on the face and scalp, in treatment with tirbanibulin 1% ointment for five consecutive days of an area measuring 25 cm2, were evaluated with videodermoscopy (V-track Vidix 4.0) and D-OCT (VivoSight Dx, Michelson Diagnostics Ltd., Kent, England, United Kingdom), as normal clinical practice. The lesions were staged according to the Olsen classification, excluding the most aggressive lesions. Results. We retrospectively evaluated 50 patients (27 males and 23 females, mean age 76 ± 7.9 years). At 57 days posttreatment, the complete clearance rate was 68% (n = 34) and partial clearance rate was 76% (n = 38). D-OCT showed markedly improved morphology, including a better recognizable dermal-epidermal junction (DEJ), associated with reduced inflammation. The most common adverse events reported were erythema and scaling, which were mostly mild and self-limiting. Conclusions. This study demonstrated that tirbanibulin may be considered an effective and well-tolerated treatment option for nonhyperkeratotic, nonhypertrophic AKs. It showed a favorable safety profile, with mostly mild adverse events. D-OCT can be considered a useful tool for personalizing AK treatment and monitoring.

Treatment and follow-up of melanoma in situ in a geriatric patient that is a nonsurgical candidate

Background: The standard of care for melanoma in situ is a wide excision with at least 0.5 cm margins. These melanomas can be large in size, and some elderly patients are not good surgical candidates so alternative treatment options have been explored. Topical imiquimod is currently approved by the Federal Drug Administration for the treatment of actinic keratosis, external anogenital warts, and superficial basal cell carcinoma. In some patients, treatment with topical imiquimod for malignant melanoma in situ has been shown to be successful. Case report: A 97-year-old male patient presented to a dermatology office with a 4.5×4.0 cm malignant melanoma in situ. The patient was given treatment options of excision and radiation therapy but refused due to his advanced age and desire to avoid extensive surgery. The patient agreed to topical treatment with imiquimod cream 5 times weekly for 5 months. A post-treatment repeat biopsy showed no evidence of residual malignant melanoma in situ. Continued post-treatment follow-up at 3-month internals with pigmented lesion assay(s) and repeat biopsies showed no evidence of recurrence at 1 year. Conclusions: In geriatric patients with a large-sized melanoma in situ that are not good surgical candidates, treatment with topical imiquimod should be considered. Long-term follow-up with pigmented lesion assay(s) should be considered in these patients to help avoid biopsy fatigue, wound management, and complications from comorbidities.

Pre-treatment with topical 5-fluorouracil increases the efficacy of daylight photodynamic therapy for actinic keratoses – A randomized controlled trial

BackgroundDaylight photodynamic therapy (dPDT) and topical 5-fluorouracil (5-FU) are each effective treatments for thin grade I actinic keratosis (AKs), but less so for thicker grade II-III AKs. Prolonged topical treatment regimens can be associated with severe skin reactions and low compliance.This study compares the efficacy of sequential 4 % 5-FU and dPDT with dPDT monotherapy for multiple actinic keratoses. MethodsSixty patients with a total of 1547 AKs (grade I: 1278; grade II: 246; grade III: 23) were treated in two symmetrical areas (mean size 75 cm2) of the face or scalp, which were randomized to (i) 4% 5-FU creme twice daily for 7 days before a single dPDT procedure and (ii) dPDT monotherapy. Daylight exposure was either outdoor or indoor daylight. ResultsTwelve weeks after treatment 87 % of all AKs cleared after 5-FU+dPDT compared to 74 % after dPDT alone (p<0.0001). For grade II AKs, the lesion response rate increased from 55 % with dPDT monotherapy to 79 % after 5-FU+dPDT (p<0.0056). Moderate/severe erythema was seen in 88 % 5-FU+dPDT areas compared to 41 % of dPDT areas two days after dPDT. Twelve weeks after treatment 75 % of the patients were very satisfied with both treatments. ConclusionsSequential 5-FU and dPDT was more effective than dPDT monotherapy in the treatment of AKs, especially for grade II AKs. Local skin reactions were more pronounced after combination treatment, but no patients discontinued the treatment. The combination of 5-FU and dPDT is an effective treatment of large treatment areas with high compliance and satisfaction.

European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes).

A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC insitu and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.

The use of photodynamic therapy in actinic keratosis in comparison to cryotherapy and chemical peels

Photodynamic Therapy (PDT) is an effective treatment of actinic keratosis. 5-Aminolevulinic Acid (ALA) and Methyl Aminolevulinate (MAL) are commonly applied. However, there is a need to establish the quality of life after PDT treatment and potential conversion to squamous cell carcinomas. The objectives of the review were to compare the efficiency of PDT, the long-term reoccurrence, and cosmesis in actinic keratosis patients. Relevant studies from the year 2000 onwards involving PDT in comparison to Cryotherapy (CT) and chemical peels were collated using a combination of terms and keywords. Conflicting results were obtained when analysing PDT in comparison to CT. A conclusion could not be deducted as to whether PDT was more, less, or equivalently effective to CT However, results obtained indicated that PDT was of greater benefit in comparison to chemical peels. Additionally, in all the studies, a conclusion was made that PDT was far superior in cosmesis in comparison to conventional therapies.

Home- vs clinic-based daylight photodynamic therapy with 5-aminolevulinic acid nanoemulsion (BF-200 ALA) for actinic keratosis: A randomized, single-blind, prospective study

BackgroundDaylight photodynamic therapy (DL-PDT) has become one of the most effective treatments for the resolution of actinic keratosis (AK) of Olsen grade 1 and 2. Generally, PDT it is carried out in a clinic setting, which involves the patient's and their caregivers commuting to the hospital as well as a significant use of resources to carry it out within the clinic setting. ObjectivesTo determine the efficacy and safety of a home-based treatment of AK with DL-PDT with the BF-200 ALA gel compared to a clinic-based setting. MethodsThe study was performed as a randomized, single-center, non-inferiority clinical trial with two parallel groups. 9 patients received one clinic-based DL-PDT (group 1) and 11 patients received one session of home-based DL-PDT (group 2). The primary endpoints were the mean AK clearance per patient and the total AK lesion clearance rate 12 weeks after treatment. The secondary endpoints were the number of remaining AKs and new AKs appearing in the treatment field 12 weeks after one PDT session. The pain during and 24 h after PDT as well as the local skin reactions were also assessed. ResultsThe overall reduction of AK lesions per patient was similar in both groups with one PDT session. An overall AK clearance per patient of 10 ± 4.33 for group 1 versus 9.73 ± 2.9 for group 2 without statistically significant differences (p = 0.868). Regarding the clearance rate, although it was slightly higher in group 2 (71.58 ± 22.51 vs 82.1 ± 11.13), the analysis did not show statistically significant differences. The mild pain recorded during the treatment course and the mild local skin reactions were similar in both groups. Patient satisfaction was high for both groups without statistically significant differences. ConclusionSelf-performed home-based DL-PDT with BF-200 ALA gel is as effective as the one performed in a clinic-based setting, with a comparable safety profile, high levels of patient satisfaction and with advantages for the patients and their caregivers that can enhance patient´s adherence to the treatment

Prevention, diagnosis and treatment of actinic keratosis

Actinic keratoses are common in the UK, especially in lighter skinned individuals and those with high lifetime UV exposure. As they are considered premalignant and can progress to squamous cell carcinoma, early identification and treatment are important. This article provides a guide to the prevention, recognition and management of actinic keratosis.

Field Cancerization Therapies for the Management of Actinic Keratosis: An Updated Review.

Field cancerization theory highlights that the skin surrounding actinic keratoses (AK) is also at increased risk for possible malignant transformation; thus, field-directed treatments may both reduce the risk of AK recurrence and potentially reduce the risk of development of cutaneous squamous cell carcinoma (cSCC). Photodynamic therapy (PDT) with either aminolevulinic acid (ALA) or methylaminolevulinate (MAL), as well as topical treatments such as 5-fluorouracil (5-FU), diclofenac gel, piroxicam, imiquimod, and ingenol mebutate, have all shown higher efficacy than vehicle treatments. PDT is widely recognized for its high efficacy; however, concerns for associated pain have driven new studies to begin using alternative illumination and pretreatment techniques, including lasers. Among topical treatments, a combination of 5-FU and salicylic acid (5-FU-SA) has shown to be the most effective but also causes the most adverse reactions. Tirbanibulin, a new topical agent approved for use in 2020, boasts a favorable safety profile in comparison with imiquimod, 5-FU, and diclofenac. Meanwhile, ingenol mebutate is no longer recommended for the treatment of AKs due to concerns for increased risk of cSCC development. Moving forward, an increasing number of studies push for standardization of outcome measures to better predict risk of future cSCC and use of more effective measures of cost to better guide patients. Here, we present an updated and comprehensive narrative review both confirming the efficacy of previously mentioned therapies as well as highlighting new approaches to PDT and discussing the use of lasers and novel topical treatments for treatment of AK.

Blue light aminolevulinic acid photodynamic therapy downregulates cell division and proliferation pathways in cutaneous squamous cell carcinoma.

5-Aminolevulinic acid (5-ALA) photodynamic therapy (PDT) is a treatment for actinic keratosis (AK) and has been studied as a treatment for noninvasive cutaneous squamous cell carcinoma (cSCC). PDT induces apoptosis and necrosis in AKs and cSCC. 5-ALA blue light PDT may modulate gene expression and pathways in surviving cells. In this study, differential gene expression and pathway analysis of cSCC and human dermal fibroblasts were compared before and after 5-ALA blue light PDT using RNA sequencing. No genes were differentially expressed after correcting for multiple testing (false discovery rate < 0.05). As a result, transcription factor, gene enrichment, and pathway analysis were performed with genes identified before multiple testing (p < 0.05). Pathways associated with proliferation and carcinogenesis were downregulated. These findings using 5-ALA blue light PDT are similar to previously published studies using methyl-aminolevulinic and red light protocols, indicating that surviving residual cells may undergo changes consistent with a less aggressive cancerous phenotype.

Application of diglycidyl methylphosphonate ointment for the treatment of actinic keratosis, Bowen’s disease and basal cell carcinoma under the control of dermatoscopy

Application of diglycidyl methylphosphonate ointment for the treatment of actinic keratosis, Bowen’s disease and basal cell carcinoma under the control of dermatoscopy

Simultaneous Skin Rejuvenation in Patients Undergoing Medical Treatment for Actinic Keratosis and Non-Melanoma Skin Cancer: A Case Series Analysis

This original article presents the findings of a comprehensive case series, shedding light on the efficacy of diverse treatment modalities for managing precancerous and cancerous skin lesions and their remarkable rejuvenation effects on the skin. A particular focus is placed on the promising outcomes achieved through the application of a combination treatment involving 5-Fluorouracil (5-FU) and salicylic acid, which demonstrates enduring and noteworthy results. Furthermore, alternative therapeutic approaches, including 5-FU monotherapy, Methyl aminolevulinate–photodynamic therapy (MAL-PDT), and the combination of Imiquimod therapy with MAL-PDT, exhibit substantial potential for patients seeking non-surgical solutions. These treatments manifest as valuable tools in improving skin texture and mitigating the effects of photodamage. Nevertheless, the intricate interplay between the chosen treatment, the extent of photodamage, and individual patient characteristics, with a particular emphasis on age, necessitates long-term follow-up to gauge treatment outcomes and the likelihood of lesion recurrence. Notably, these treatments are associated with a significant degree of inflammation, igniting curiosity regarding enhanced skin cellular turnover and the potential for a more youthful skin appearance. Our findings accentuate the promise of topical fluorouracil (5-FU) and photodynamic therapy (PDT) in combating photoaging among patients with actinic keratoses. However, a need for further in-depth research is evident to unravel the nuanced relationships between these treatments, the severity of photodamage, and the influence of patient-specific factors. Such comprehensive investigations are instrumental in optimizing patient care and outcomes, offering a holistic approach to managing photodamage within the context of actinic keratoses. This work, when combined with existing literature, provides valuable insights and serves as a catalyst for future research to fully unlock the potential of these treatments, ultimately enhancing the quality of patient care.

Assessment of reflectance confocal microscopy for monitoring treatment of actinic keratosis and field cancerization with daylight photodynamic therapy.

Actinic keratosis (AK) is the most common pre-malignant cutaneous lesion of the skin, often associated with field cancerization. Daylight photodynamic therapy (DL-PDT) is used as treatment, showing good histological results. Reflectance confocal microscopy (RCM) may be useful as a non-invasive, real-time approach to monitor treatment, however, there is a lack of data on the correlation between RCM and histopathological findings in AK patients treated with DL-PDT. To correlate histological and RCM findings and evaluate the efficacy of DL-PDT in patients with AK and field cancerization treated with DL-PDT. Patients with field cancerization and a minimum of six AK lesions on the face were included in the study. A single session combining methyl aminolevulinate followed by two-hour daylight exposure of the face was performed. RCM and biopsy were performed before and after three months of the intervention to compare efficacy between patients using the Wilcoxon test, and concordance of the findings based on the different methods was analysed using the Kappa test. Twenty-four patients completed the study. An improvement in photodamage and a decrease in the number of AK lesions (45.3% reduction) was observed. Regression in atypia and dysplasia was observed via histopathology and RCM, however, there was poor agreement between the methods. No changes were observed after treatment for inflammation, fibroplasia and acantholysis. Concordance between histological and RCM findings was poor, suggesting that RCM cannot replace the histopathological examination, however, it may be used as an adjuvant test for follow-up of patients. Despite this, DL-PDT proved to be an effective method for treating AK.

Nem termikus atmoszférikus plazma használata a bőr in situ laphámsejtes karcinómájának kezelésére: esetismertetés

Despite its high incidence, cutaneous squamous cell carcinoma (SCC) remains a treatment challenge. Non-thermal, atmospheric pressure plasma (NTAP) is an emerging modality with a broad range of potential applications in dermatology, including the treatment of actinic keratosis. Given the close relationship between actinic keratosis and SCC, we treated three patients with biopsy-proven in-situ SCC, using NTAP. All three patients have tolerated the treatment very well, and they all reached full clinical resolution of their lesion after 2-5 treatment sessions. This case series highlights the potential role of NTAP in the treatment of SCC.

Patient- and Clinician-Reported Outcomes of Tirbanibulin 1% in the Treatment of Actinic Keratosis on the Face and Scalp (PROAK Study)

Introduction: Actinic Keratosis (AK) has been shown to negatively affect emotional and social functioning and skin-related quality of life [1]. The objective was to evaluate clinician- and patient-reported outcomes (ClinRO; PRO) for tirbanibulin treatment satisfaction and effectiveness among patients administered tirbanibulin in routine clinical practice across the U.S.&#x0D; Methods: A single-arm, prospective cohort study (PROAK: NCT05260073) was conducted in adults with AKs on the face or scalp as part of usual care. Patients and clinicians completed surveys and clinical assessments at baseline, Week-8, and Week-24. ClinRO and PRO comprised Treatment Satisfaction Questionnaire for Medication (TSQM-9) (with 3 domains: treatment effectiveness, convenience of use, and global satisfaction with treatment) and Expert Panel Questionnaire (EPQ) (assessing overall skin appearance, satisfaction with improvement in “skin texture” and “how skin looks”, and likelihood to consider tirbanibulin again). Clinicians assessed AK responses using Investigator's Global Assessment (IGA) and patient’s skin photodamage severity scale. IGA success was defined as achieving IGA score of 0-1 (≥75% AK lesions clearance). Data at Week-8 was already published [1]. Here we present the results obtained at Week-24.&#x0D; Results: A total of 278 patients completed study assessments at Week-24 (mean age: 66.3 years; 68.6% males; Fitzpatrick skin type II: 71.4%). Mean (standard deviations [SD]) TSQM-9 score in effectiveness, convenience and global satisfaction was 74.3 (21.2), 84.5 (15.6) and 74.9 (23.9) for clinicians and 73.4 (21.4), 85.0 (14.7) and 71.9 (24.7) for patients. 77.3% of clinicians and 78.4% of patients reported a high likelihood for considering tirbanibulin treatment in the future. At Week-24, 83.6% of clinicians and 78.5% of patients rated overall skin appearance after tirbanibulin treatment to be mostly somewhat/much improved. At Week-24, the proportion of patients with completely/partially cleared AK (IGA 0/1) was 71.9%, similar to that obtained at Week-8 (73.8%) [1].&#x0D; Conclusions: Effectiveness ≥75% clearance was achieved by 71.9% of patients, consistent with the results of the Phase III trials [2]. ClinRO and PRO demonstrated high satisfaction with once-daily tirbanibulin treatment for 5 consecutive days at Week-24, and both clinicians and patients reported a desire to consider tirbanibulin treatment in the future.&#x0D; [1] Schlesinger T et al. Skin. 2023;7(3):771-787.&#x0D; [2] Blauvelt A et al. N Engl J Med. 2021;384(6):512–20.

Safety and Tolerability of Tirbanibulin 1% Treatment of Actinic Keratosis on Face and Scalp in Routine Clinical Practice Across the U.S. (PROAK Study)

Introduction: Actinic Keratosis (AK) has been shown to negatively affect emotional and social functioning and skin-related quality of life of patients [1]. The objective of this analysis was to evaluate safety and tolerability of tirbanibulin in AK treatment, among patients administered tirbanibulin in routine clinical practice across the U.S.&#x0D; Methods: A single-arm, multicenter, prospective cohort study (PROAK: NCT05260073) was conducted in adult patients with AKs on 25 cm2 on the face or scalp who were newly initiated with once-daily tirbanibulin 1% ointment treatment (5 consecutive days course) as part of usual care. Safety and tolerability endpoints were assessed at Week-8 and Week-24 and included adverse events (AEs), serious AEs (SAE), adverse drug reactions (ADRs), serious ADRs, local skin reactions (LSR), skin scarring and pigmentation (hypo/hyperpigmentation). Number of patients discontinuing treatment because of AEs, ADRs and for any other reasons were also reported. LSR (erythema, flaking/scaling, crusting, swelling, vesiculation/pustulation, and erosion/ulceration) were scored 0-3 (absent-severe) and summed to a composite score (0-18).&#x0D; Results: A total of 300 patients were included in the safety analysis population (males: 68%; mean age: 67 years; Fitzpatrick skin type II: 89%; AK on the face: 78%). A total of 98% of patients completed the 5-day treatment course. During the study, 5% of patients reported at least one AE, 4% of patients at least 1 SAE, and no patients reported serious ADR. Basal Cell Carcinoma was reported in 1% of patients and Squamous Cell Carcinoma in 2% of patients; all cases were considered not related to treatment. No patients discontinued the study due to AEs or ADRs. At Week-8, the most reported LSR were erythema (48% mild-moderate, 5% severe) and flaking/scaling (50% mild-moderate, 3% severe). The rest of LSR were reported in 2-8% of patients (8% crusting, 5% swelling, 2% vesiculation/pustulation, and 2% erosion/ulceration) and all were mild-moderate in severity. Mean (min-max) LSR composite score was 0.94 (0-11). At Week-8, scarring or hypo/hyperpigmentation was observed in 1%, 5% and 3% of patients, respectively. &#x0D; Conclusions: Once-daily tirbanibulin 1% ointment for 5 consecutive days showed a favorable safety and tolerability profile in the treatment of AK of the face or scalp.&#x0D; [1] Schlesinger T et al. Skin. 2023;7(3):771-787.

Nanoformulations for dermal delivery of imiquimod: The race of “soft” against “hard”

Imiquimod (IMQ) is an immunostimulating agent used in the treatment of basal cell carcinoma and actinic keratosis. Due to its low solubility and poor skin bioavailability, the dermal formulation of IMQ remains challenging. In analogy to tyre compounds used in Formula 1 racing, we compare four types of nanosystems belonging to three groups: (i) “hard” nanoparticles in the form of IMQ nanocrystals, (ii) “intermediate” nanoparticles in the form of liposomes and lipid nanocapsules, and (iii) “soft” nanoparticles in the form of a nanoemulsion based on oleic acid. The nanoemulsion and nanocrystals were able to incorporate the highest amount of IMQ (at least 2 wt%) compared to liposomes (0.03 wt%) and lipid nanocapsules (0.08 wt%). Regarding size, liposomes, and lipid nanocapsules were rather small (around 40 nm) whereas nanocrystals and nanoemulsion were larger (around 200 nm).All developed nanoformulations showed high efficiency to deliver IMQ into the skin tissue without undesirable subsequent permeation through the skin to acceptor. Especially, the 2 wt% IMQ nanoemulsion accumulated 129 μg/g IMQ in the skin, compared to 34 μg/g of a 5 wt% commercial cream. The effects of the respective nanoparticulate systems were discussed with respect to their possible diffusion kinetics (Brownian motion vs. settling) in the aqueous phase.

Photodynamic Therapy for Treatment of Actinic Keratosis in a Patient With Graft Versus Host Disease

ABSTRACT Photodynamic therapy, consisting of aminolevulinic acid and blue light in combination, is a treatment option for diffuse actinic keratosis in patients with cutaneous manifestations of graft-versus-host disease resulting from an allogenic stem cell transplantation for lymphoma. Different treatment options, such as imiquimod and 5-fluorouracil, are effective treatment options in the general population, but risk flaring graft-versus-host disease in patients with this condition. We present a case where photodynamic therapy was successfully used in the treatment of actinic keratosis for a patient with chronic graft-versus-host disease without flaring the cutaneous manifestations of graft-versus-host disease.