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Premalignant Neoplasms
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Management: AKs may be managed medically with topical or destructive approaches. Topical therapies include 5-fluorouracil (5-FU), imiquimod, ingenol mebutate, and photodynamic therapy. Destructive therapies include cryotherapy, curettage, and ablative laser resurfacing. Transplant patients given low-dose acitretin or isotretinoin can have significant reductions in the number of lesions. Oral nicotinamide may be effective for prevention in high-risk groups.
Retinoids in Keratinization Disorders
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
Therapy includes topical sunscreens, topical diclofenac, topical 5-fluorouracil, topical steroids, cryotherapy, CO2, Q-switched ruby, neodymium:yttrium-aluminum-garnet (Yag), Er-Yag, pulsed dye, fractional photothermolysis lasers, intensed pulsed light and Grenz ray, photodynamic therapy, vitamin D analogs (tacalcitol, calcipotriol), keratolytics, topical tacrolimus, cantharidin plaster, dermabrasion, topical ingenol mebutate, and imiquimod. Topical and oral retinoids are the first choice of treatment. Relapse is common. Patients should be monitored for skin cancers (98,99).
Skin and soft tissue
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Ingenol mebutate cream (A, 1+) contains a plant-derived ester. It works well in about half of early AKs with one-half relapsing after a year. A 2015 FDA update described complications such as allergies and zoster.
Contemporary management of actinic keratosis
Published in Journal of Dermatological Treatment, 2021
Cristian Navarrete-Dechent, Ashfaq A. Marghoob, Michael A. Marchetti
Jansen et al. (7) performed a randomized, single-blind, and controlled trial in 624 patients (89% male, median age 73 years, 93% skin type I/II), with ≥5 AKs and found that topical 5% 5-fluorouracil cream (5-FU) was significantly more effective in reducing AK counts at 1-year than 5%-imiquimod cream, methyl aminolevulinate photodynamic therapy, or 0.015%-ingenol mebutate gel. Weinstock et al. (8). conducted a randomized, double-blinded, and placebo-controlled trial of a single 2–4-week course of 5-FU for chemoprevention of keratinocyte carcinoma (KC) on the face/ears. These 932 high-risk participants (98% male, median age 70 years, 99% white) had a history of at least 2 KC in the previous 5 years and a median baseline AK count of 6 on the face/ears. They found no difference between treatment groups in time to first KC, basal cell carcinoma (BCC), or SCC, or any differences in the incidence of these cancers at the study end (year 4). In a secondary analysis, the authors found a 75% 1-year relative risk reduction in participant in-field SCC among the 5-FU group. This treatment effect was associated with a 3% absolute risk reduction and a number needed to treat (NNT) of 33. Excluding SCC in-situ and keratoacanthoma, we calculated the 1-year absolute risk reduction to be 2% and the NNT to be 50 (9).
Patient-centered management of actinic keratosis. Results of a multi-center clinical consensus analyzing non-melanoma skin cancer patient profiles and field-treatment strategies
Published in Journal of Dermatological Treatment, 2020
Wolfgang G. Philipp-Dormston, Maxime Battistella, Lise Boussemart, Alessandro Di Stefani, Paolo Broganelli, Kai-Martin Thoms
Ingenol mebutate was one of the treatment options proposed for many of the profiles and this was driven by its association with good cosmetic outcomes (17,18); the predictable nature of the treatment and related short-term local skin reactions (19–22); and the fact that the administration regimen of ingenol mebutate allows for flexible use, as patients are able to decide how and when it is used according to their needs and individual condition. In a randomized, evaluator-blinded trial of ingenol mebutate 0.015% gel and diclofenac sodium 3% gel, patients experienced a shorter duration of skin reactions, with a peak after one week, with ingenol mebutate compared with diclofenac sodium, who experienced reactions throughout the 90-day treatment (3). These attributes support ingenol mebutate, in the panel’s opinion, as a viable option for many of the patient profiles; assuming its use is complemented by treatment-focused education delivered at treatment initiation (23). Despite the presence of local skin reactions, a study of 274 patients using ingenol mebutate reported that 98.2% of patients were adherent to the 3-day administration regimen (24). Collectively, this evidence supports the panel’s recommendation that ingenol mebutate therapy in patients that are well-educated by their dermatologist can lead to consistent, standardized and effective outcomes, with predictable, short-term local skin reactions.
Laser ablation and topical drug delivery: a review of recent advances
Published in Expert Opinion on Drug Delivery, 2019
Chien-Yu Hsiao, Shih-Chun Yang, Ahmed Alalaiwe, Jia-You Fang
Irradiation of the Er:YAG laser with a wavelength of 2940 nm is highly absorbed by water in the skin. The laser beam generates a minimal thermal effect and coagulation zone. Because of the characteristics of superficial ablation of SC and epidermis, this technique is practical for improving drug permeation, especially the hydrophilic and macromolecular permeants. Ingenol mebutate is a topically applied drug approved for actinic keratosis management. The limited penetration to deeper skin strata has restrained the therapeutic outcome [47]. Erlendsson et al. [48] investigated the usefulness of the fractional Er:YAG laser for improving ingenol permeation. The Er:YAG laser generated intraepidermal (66 μm depth) and intradermal (570 μm depth) MTZs in pigskin. Ingenol transport to receptor compartment of in vitro Franz cell was increased from 0 ng in intact skin to 547 and 677 ng after intraepidermal and intradermal ablation, respectively. The MTZ densities of 0.5%, 1%, 2.5%, 5%, and 10.5% elevated dermal uptake by 1.6-, 2.1-, 3.1-, 3.4-, and 3.9-fold, respectively, as compared to untreated control.