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Introduction to dermatological treatment
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
This utilises natural sunlight instead of light from a medical lamp. It has the advantage of the treatment being performed outdoors at the patient's convenience. It is best for widespread sun damaged skin on the face, since it produces less reaction and pain than conventional PDT. The actinic keratoses should be thin with minimal thickness of the keratin surface. Caution should be exercised if there is high UV exposure (low latitudes in summer). A single treatment is sufficient for actinic keratoses. Bowen's disease should be treated twice, a week apart.
Case 31
Published in Edward Schwarz, Tomos Richards, Cases of a Hollywood Doctor, 2019
Edward Schwarz, Tomos Richards
They show actinic keratosis lesions, also known as solar keratosis. This is a precancerous form of squamous cell carcinoma, more common in the elderly. Risk factors for developing actinic keratosis include chronic sun exposure, fair skin and immunosuppression. It is important to ask about travel occupation, as patients who have had spent large amounts of time in the sun, such as gardeners or those who grew up in hot climates, are particularly at risk.
Radiation Toxicity
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Table 33.2 summarizes the chronic effects of sunlight and photosensitivity reactions. For instance, general dermatologic reactions, such as dermatoheliosis and elastosis, occur with greater frequency with chronic sunlight exposure (Table 33.2). Actinic keratoses, described as precancerous keratotic lesions, result from years of sun exposure, especially in fair-skinned individuals. The lesions present as pink, poorly marginated, scaly or crusted superficial growths on skin. Depending on the number of lesions present, they are usually treated with cryotherapy (freezing), curettage (surgical scraping), or topical application of 5-fluorouracil (5-FU).
Comparing efficacy and safety of potassium hydroxide 5% solution with 5-fluorouracil cream in patients with actinic keratoses: a randomized controlled trial
Published in Journal of Dermatological Treatment, 2022
Ali Salehi Farid, Somayeh Niknam, Kheirollah Gholami, Soheil Tavakolpour, Amir Teimourpour, Maryam Daneshpazhooh, Ali Nili, Arghavan Azizpour, Maryam Nasimi, Hamidreza Mahmoudi
Major treatments for actinic keratosis (AK) include two types: destructive modalities such as curettage, and cryotherapy; and nondestructive agents including topical creams such as 5-fluorouracil (5-FU) cream 5% (1–5). Destructive modalities can be associated with different adverse effects such as dyspigmentation, bulla formation, infection, and scarring (6–11). 5-FU is approved by the U.S. Food and Drug Administration (FDA) for the treatment of AK (12,13). However, 5-FU is associated with erythema, crust formation, and bleeding; its effectiveness decreasing in the long run (14,15). Potassium hydroxide (KOH) is a keratolytic agent that is used in the treatment of skin lesions such as warts, molluscum contagiosum, and plantar callus (16–19). KOH is an effective, safe, and inexpensive drug that can easily dissolve keratin and penetrate skin due to its alkaline nature (20).
Reducing unpleasant side effects of topical 5-Fluorouracil treatment for actinic keratosis: a randomized controlled trial
Published in Journal of Dermatological Treatment, 2020
Melody Maarouf, Bryan W. Kromenacker, Eric S. Brucks, Aleksi Hendricks, Vivian Y. Shi
Actinic keratosis (AK) carries a 0.25–16% risk of progression to squamous cell carcinoma, warranting prophylactic treatment (1). Topical therapy for ‘field cancerization,’ or diffuse AK burden (2), treats clinical and occult lesions (2,3). 5-Fluorouracil (5-FU) inhibits thymidylate synthetase, a DNA precursor enzyme. Inhibition of DNA synthesis in dysplastic cells causes apoptosis (1), resulting in an inflammatory response characterized by erythema, blistering, necrosis with erosion, and subsequent reepithelialization (2). Complete clearance with topical 5-FU treatment can be seen in up to 90% of patients without extensive hyperkeratotic AKs who can tolerate the side effects (4,5). Unfortunately, nearly all patients experience some degree of pain, itching, burning, irritation, inflammation, dryness, swelling, and tenderness, which may take several weeks to subside. These unpleasant yet unavoidable side effects are the primary reason for patient noncompliance (6) and dissatisfaction (7).
Effects of topical piroxicam and sun filters in actinic keratosis evolution and field cancerization: a two-center, assessor-blinded, clinical, confocal microscopy and dermoscopy evaluation trial
Published in Current Medical Research and Opinion, 2019
Marina Agozzino, Teresa Russo, Chiara Franceschini, Sara Mazzilli, Virginia Garofalo, Elena Campione, Luca Bianchi, Massimo Milani, Giuseppe Argenziano
Actinic keratosis (AK) is considered an “in situ” non-melanoma skin cancer induced by ultraviolet chronic exposure1. In general, several lesions are present in the same subject2, increasing the risk of malignant transformation3. The concept of field cancerization refers to the development of multiple lesions which derive from preneoplastic changes due to a cumulative exposure to carcinogenic agents4. The combined treatment of AK lesions and field cancerization is considered the gold standard in this clinical setting5. In the pathogenesis of AK, an increased activity of cyclooxygenase (COX) enzymes (both COX-2 and COX-1), at the keratinocyte level, plays a relevant role6,7. Topical anti-inflammatory agents, like diclofenac, could improve the evolution of this kind of lesion8. A topical product containing piroxicam 0.8% and sun filters (50 SPF) (ACTX) has been shown to be very effective in reducing AK lesions9–12. Non-invasive tools like dermoscopy and reflectance confocal microscopy (RCM) are considered effective alternatives to biopsy for the characterization of actinic damage and field cancerization13. So far, no data are available regarding the effects of this product on skin modifications evaluated by RCM and dermoscopy at the target lesion sites and on field cancerization.