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Keratoses
Kinds of Keratoses Selected AbstractsDermatoskopische Merkmale der aktinischen KeratoseJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 11 2007Ketty Peris First page of article [source] Comparison of Seborrheic Keratoses, Inflamed Seborrheic Keratoses, and Inverted Follicular Keratoses Using P53, BCL-1, and BCL-2JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005C. Ko While cell cycle markers have been used to differentiate benign versus malignant lesions and to classify malignant lesions, benign keratoses have not been well studied using such markers, and the relation of the cell cycle to inflammation or irritation of benign keratoses is unclear. We compared the immunohistochemical staining patterns of 10 seborrheic keratoses, 10 inflamed seborrheic keratoses, and 10 inverted follicular keratoses using antibodies to p53, bcl-1, and bcl-2. Staining with antibodies to p53 was increased in inverted follicular keratoses compared to inflamed or non-inflamed seborrheic keratoses. Bcl-1 staining was similar in all lesions. A population of bcl-2-positive dendritic cells was seen within the epidermal portion of inverted follicular keratoses. Keratinocyte bcl-2 staining was higher in seborrheic keratoses compared to the other two keratoses. Bcl-2 may be increased in seborrheic keratoses as an anti-apoptotic mechanism while increased p53 may trigger apoptosis in inverted follicular keratoses. [source] Waxy Keratoses of Childhood in a Segmental DistributionPEDIATRIC DERMATOLOGY, Issue 5 2001Don Mehrabi B.S. Waxy keratoses of childhood is a rare genodermatosis previously noted in both familial and isolated presentations. Three previous cases have been described in which the lesions appeared over the trunk and extremities. We report a case in which the waxy keratoses of childhood lesions appeared in a segmental distribution along a single lower extremity, differing from the more extensive patterns reported previously. We suggest a possible postzygotic mutation hypothesis for this unique segmental distribution, addressing both the possibility of a genomic mosaicism and loss of heterozygosity. [source] Enhanced Chondrogenic Responses of Human Articular Chondrocytes Onto Silk Fibroin/Wool Keratose Scaffolds Treated With Microwave-Induced Argon PlasmaARTIFICIAL ORGANS, Issue 5 2010Young Woo Cheon Abstract Silk fibroin (SF) is a natural, degradable, fibrous protein that is biocompatible, is easily processed, and possesses unique mechanical properties. Another natural material, wool keratose (WK), is a soluble derivative of wool keratin, containing amino acid sequences that induce cell adhesion. Here, we blended SF and WK to improve the poor electrospinability of WK and increase the adhesiveness of SF. We hypothesized that microwave-induced argon plasma treatment would improve chondrogenic cell growth and cartilage-specific extracellular matrix formation on a three-dimensional SF/WK scaffold. After argon plasma treatment, static water contact angle measurement revealed increased hydrophilicity of the SF/WK scaffold, and scanning electron microscopy showed that treated SF/WK scaffolds had deeper and more cylindrical pores than nontreated scaffolds. Attachment and proliferation of neonatal human knee articular chondrocytes on treated SF/WK scaffolds increased significantly, followed by increased glycosaminoglycan synthesis. Our results suggest that microwave-induced, plasma-treated SF/WK scaffolds have potential in cartilage tissue engineering. [source] Photoallergic contact dermatitis from topical diclofenac in Solaraze® gelCONTACT DERMATITIS, Issue 6 2006L. Kowalzick Solaraze® gel (Shire Deutschland GmbH & Co. KG, Cologne, Germany) containing 3% diclofenac has been licensed in 2001 as a topical treatment for actinic keratoses. It is commonly used in dermatological practice. Undesirable effects are believed to be rare but include pruritus, paresthesia and application-site reactions (dry skin, rash, erythema, contact dermatitis and vesicobullous eruptions). Recently, a few cases of contact dermatitis due to three different allergens including diclofenac have been reported (1,2). [source] Photodynamic Therapy for the Treatment of Cutaneous Neoplasia, Inflammatory Disorders, and PhotoagingDERMATOLOGIC SURGERY, Issue 5 2009EMILY TIERNEY MD BACKGROUND Photodynamic therapy (PDT) has demonstrated high efficacy, minimal side effects, and improved cosmetic outcome when used for the treatment of actinic keratoses (AK), basal cell carcinoma (BCC), squamous cell carcinoma, and photoaging. METHODS To review the literature on the use of PDT in dermatologic surgery using MEDLINE. RESULTS Published clinical studies using PDT in the treatment of AKs yield overall efficacy rates ranging from 50% to 71% with one treatment to as high as 88% to 90% with two or more treatments. For superficial BCC, initial clearance rates were 76% to 97%, and for Bowen's disease, initial clearance rates ranged from 72% to 94% overall. The use of PDT for photorejuvenation is a relatively new application of this technology, which has shown promise in improving the appearance of fine lines, pigmentary variation, and telangiectasias. CONCLUSIONS The advantages of photodynamic therapy include the capacity for noninvasive targeted therapy through topical application of aminolevulinic acid and methyl aminolevulinic acid, with outstanding cosmetic results. Although the theory behind the use of chemical photosensitizers and ultraviolet light to treat a wide variety of skin disorders is straightforward, the practical application of this technology is evolving. Additional research into the precise mechanisms of action for specific photosensitizers and optimal light sources will be highly beneficial to the advancement of this technology. [source] Does Imiquimod Histologically Rejuvenate Ultraviolet Radiation,Damaged Skin?DERMATOLOGIC SURGERY, Issue 12 2007KATHLEEN SMITH MD BACKGROUND Imiquimod (IMI) 5% is believed by some to result in an improved cosmetic appearance of chronically ultraviolet radiation (UV)-damaged skin. OBJECTIVE The objective was to determine what histologic and immunohistologic changes were present in actinically damaged skin after treatment with IMI. METHODS AND MATERIALS Pre- and posttherapy biopsies of 12 patients with histories of actinic keratoses were evaluated with routine histology and immunohistochemical stains including p53, p63, proliferating cell nuclear antigen (PCNA), c-kit, and Factor XIIIa. RESULTS After IMI therapy there was less compact hyperkeratosis, a more uniform rete ridge pattern with a more ordered proliferation of the epidermis, and a decrease in sun-damaged melanocytes. The papillary dermis showed a more uniform cellularity, and there was increased cellularity within the area of solar elastosis. After therapy, staining for p53, p63, and PCNA was decreased within the epidermis; staining for c-kit was decreased but more uniform in the basal cell; and Factor XIIIa expression was increased within the papillary dermis with a more ordered pattern of staining. CONCLUSION These morphologic and immunohistochemical patterns may explain some of the improvement in overall skin appearance after IMI therapy and may be related to the spectrum of signaling pathways induced by the imidazoquinolines. [source] 5-Aminolevulinic Acid Photodynamic Therapy: Where We Have Been and Where We Are GoingDERMATOLOGIC SURGERY, Issue 8 2004Michael H. Gold MD Background. Photodynamic therapy, utilizing the topical administration of 20% 5-aminolevulinic acid, has generated a great deal of interest in the dermatology community over the past several years. Objective. The purpose of this article is to review the history of photodynamic therapy in dermatology and to review recent new advances with this technology that will increase its appeal to all dermatologists. Methods. A literature review and results of new clinical trials with regards to photorejuvenation and acne vulgaris treatments with 5-aminolevulinic acid photodynamic therapy are presented. Results. Short-contact, full-face 5-aminolevulinic acid photodynamic therapy treatments with a variety of lasers and light sources have shown to be successful in treating all facets of photorejuvenation and the associated actinic keratoses as well as disorders of sebaceous glands, including acne vulgaris. The treatments are relatively pain-free, efficacious, and safe. They are also making already available laser/light source therapies work better for acne vulgaris and photorejuvenation. Conclusions. The use of 5-aminolevulinic acid photodynamic therapy with short-contact, full-face broad-application therapy is now able to bridge the world of medical and cosmetic dermatologic surgery. This therapy is available for all dermatologists to utilize in the care of their patients. [source] Human Papillomavirus and Overexpression of P16INK4a in Nonmelanoma Skin CancerDERMATOLOGIC SURGERY, Issue 3 2004Ingo Nindl PhD Background. P16INK4a overexpression has been identified as a specific biomarker in high-risk human papillomavirus (HPV),infected cervical (pre)cancer lesions. Objective. To evaluate the overexpression of this cyclin-dependent kinase inhibitor in skin tumors depending on HPV infections, we analyzed normal skin, benign skin disease, and skin cancer specimens. Methods. Biopsies of 23 patients with normal histology (3), psoriasis (2), verrucae vulgaris (2), actinic keratoses (5), squamous cell carcinoma (SCC) in situ (3), Bowen's carcinoma (1), and SCC (7) were analyzed. Specimens of 23 patients were immunostained using the monoclonal antibody E6H4 specific for p16INK4a. HPV status was assessed by a polymerase chain reaction (PCR) system to detect all currently known HPV types. MY (MY09/MY11 and MYN9/MYN10)-, CP (CP65/CP70 and CP66/CP69)-nested PCR, and three single PCR methods CN1, CN3, and CN4 were used in a first step, and HPV typing was performed by restriction fragment length polymorphism analysis. Only ,-globin,positive patients were included in this study. Results. HPV DNA was detected in all actinic keratoses, SCC in situ, Bowen's carcinoma, and SCC, in 50% (one of two) of verrucae vulgaris, in 66% (two of three) of normal skin, and in none of two psoriasis. P16INK4a expression was not detected in normal skin, psoriasis, and verrucae vulgares. Overexpression of p16INK4a was detected in a subset of dysplastic cells (10% to 80%) of all skin (pre)cancer lesions such as actinic keratoses, SCC in situ, Bowen's carcinoma, and SCC infected with HPV independent of sun exposure. Conclusion. P16INK4a appears to be overexpressed in a portion of dysplastic cells from actinic keratoses and SCC. Further studies to examine the association of HPV infection and the overexpression of p16INK4a are warranted. [source] Frequency of Seborrheic Keratosis Biopsies in the United States: A Benchmark of Skin Lesion Care Quality and Cost EffectivenessDERMATOLOGIC SURGERY, Issue 8 2003Maria I. Duque MD Background. Most seborrheic keratoses may be readily clinically differentiated from skin cancer, but occasional lesions resemble atypical melanocytic neoplasms. Objective. To evaluate the frequency, cost, and intensity of procedures performed that result in the removal and histopathologic evaluation of seborrheic keratoses. Methods. Episodes of surgical removal of lesions that were identified as seborrheic keratoses by histologic identification were determined using Medicare Current Beneficiary Survey data from 1998 to 1999. These episodes were defined by a histopathology procedure code that is associated with a diagnosis code for seborrheic keratosis. We then identified what procedure(s) generated the histopathology specimen. Biopsy and shave procedures were considered "low intensity," whereas excision and repair procedures were considered "high intensity." Results. Dermatologists managed 85% of all episodes of seborrheic keratoses. Dermatologists managed 89% of seborrheic keratosis episodes using low-intensity procedures compared with 51% by other specialties. For nondermatologists, 46% of the treatment cost ($9 million) to Medicare was generated from high-intensity management compared with 15% by dermatologists ($6 million). Conclusion. There is a significant difference in the management of suspicious pigmented lesions between dermatologists and other specialists. This affects both the cost and quality of care. [source] Rapid Development of Keratoacanthomas After a Body PeelDERMATOLOGIC SURGERY, Issue 2 2003SueEllen Cox MD Resurfacing techniques have been traditionally limited to the face because of a lack of predictability and standardization for peeling nonfacial skin. There is a need for medical and surgical intervention for treating nonfacial skin that is actinically damaged. Medium-depth chemical peels (Jessner +35% trichloroacetic acid) remove the photodamaged epidermis to stimulate the production of new collagen in the dermis and remove lesions associated with facial actinic damage, including lentigines and actinic keratoses. Widespread actinic damage is common on the arms and chest. A 70% glycolic acid gel plus 40% trichloroacetic acid peel (Cook Body Peel) is a controlled peel that predictably enables peeling of nonfacial skin in a uniform and safe fashion with specific clinical endpoints. An unusual complication of this body peel is reported. [source] Characteristics of skin aging in Korean men and womenINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 1 2005J. H. Chung Introduction Korea is located between Japan and Mainland China. The people of these three countries have similar appearances and it is difficult to differentiate between them. Although the population of Asia is more than half of the total population of the Earth, the inherent characteristics of Asian skin have not been well investigated. Commercial markets for cosmetics and drugs for photoaged skin are rapidly expanding in many Asian countries. Therefore, many investigators in the field of dermatology and cosmetology have become interested in brown Asian skin. Clinical characteristics of skin aging and photoaging in Asians Skin aging can be divided into two basic processes: intrinsic aging and photoaging [1]. Intrinsic aging is characterized by smooth, dry, pale, and finely wrinkled skin, whereas photoaging, which indicates premature skin aging in chronically photodamaged skin, is characterized by severe wrinkling and irregular pigmentation. The pattern of wrinkling in Asians seems to differ from that in Caucasians. Asians have coarser, thicker and deep wrinkles, particularly in the forehead, perioral and Crow's foot areas. In contrast, Caucasians usually have relatively fine cheek and Crow's foot wrinkles. The reasons for these differences are not known and need further investigation. There are racial, ethnic and genetic differences, and differences of skin structure and function, between the brown skin of Asians and the white skin of Caucasians. As Asian skin is more pigmented, acute and chronic cutaneous responses to UV irradiation differ from those in white skin. Many people believe, based on clinical impressions, that the main process of photoaging in Asians involves pigmentary changes, rather than wrinkling. However, no study has been performed to confirm this belief. Risk factors for skin wrinkles and their relative risks in Korean skin [2] Various factors such as age, sun-exposure, and smoking are known to be important risk factors for wrinkles. However, the relative risks of each factor on wrinkles in the brown skin of Asians have not been investigated, and they could differ from those in Caucasians. An evaluation system for skin wrinkling is necessary for Asian skin [3]. Thus, we developed an eight-point photographic scale for assessing wrinkles in both Korean genders [2]. This scale can probably be applied to the populations of other Asian countries, at least to the Japanese and Chinese. The pattern of wrinkles in both genders appears to be similar. Age Age is an important risk factor for wrinkling in Asians, as in Caucasians. Korean subjects in their 60s showed a 12-fold increased risk of wrinkling, while subjects in their 70s have a 56-fold increased risk compared with young age group. UV light It is well known that the UV component in sunlight can cause and accelerate photoaging. The pigmented skin of Asian may better protect skin from acute and chronic UV damage. However, we found a strong association between sun-exposure and the development of wrinkling in Koreans. It was found that sun exposure of more than 5 h per day was associated with a 4.8-fold increased risk in wrinkling versus less than 2 h of sun-exposure in Koreans. Estrogen deficiency Korean females have more wrinkles than men, after controlling for age, sun exposure, and smoking, it was found that they have a 3.6-fold increased risk of developing wrinkles than their male counterparts [2]. It has also been reported, that the relative risk for wrinkling in women is higher than in men as for in white Caucasians [4]. The reason why women show more wrinkles remains to be determined. It is possible that a reduction in skin collagen because of estrogen deficiency in postmenopausal woman may aggravate wrinkling severity. Korean women with more than 10 years since menopause showed a 3.9-fold higher risk of wrinkling than the women 5 years of beyond menopause [5]. We demonstrated that women with a history of HRT have a significantly lower risk, more specifically, one fifth of the risk of facial wrinkling relative to those who had no history of HRT. Interestingly, we found that wrinkle severity significantly increased with an increasing number of full term pregnancies. The relative risk for severe wrinkling is increased by approximately 1.8-fold per full term pregnancy. Smoking It is known that smoking causes skin wrinkling in Caucasians, and that it plays no role in Blacks [6, 7]. Koreans with have a smoking history of more than 30 pack years showed a more than 2.8-fold increased risk of wrinkles [2]. The relative risks of wrinkles associated with a 30,50 pack-years history of smoking were 2.8- and 5.5-fold, respectively. Dyspigmentation in Asian skin To follow pigmentary changes, six photographic standards for both genders were developed for Korean skin, to produce a 6-point scale [2, 8]. Hyperpigmented spots, mostly lentigines, were prominent among women, while seborrheic keratosis tended to be more prominent in men. Seborrheic keratosis in Korean men Seborrheic keratoses (SKs) are benign cutaneous tumors. They have diverse clinical and histopathological appearances and are very common in the elderly (over 50 years old). The etiology of SKs is not well understood, although patients with a great number of lesionsshow a familial trait with an autosomal dominant pattern, and human papilloma virus has been suggested as possible cause because of verrucous appearance of the lesions. Exposure to sunlight has been suggested to be a risk factor for SKs. However, there is still some debate in terms of the role of sunlight. Recently, we have investigated the clinical characteristics of SKs and relationship between SKs and sunlight exposure in Korean males [9]. The prevalence of SKs in Koreans increases with age; it rose from 78.9% at 40 years, to 93.9% at 50 years and 98.7% in those over 60 years. Exposed areas, i.e. the face, neck and dorsum of the hands, demonstrate a significant increase in the prevalence of SKs by decade, whereas partly exposed areas, although SKs tended to increase in prevalence with age, this trend was not significant. When the estimated body surface area (BSA) is taken into account, the number of SKs on both the face and dorsum of the hands (0.51 ± 0.08 per 1% BSA) was over-represented compared with the trunk. SKs were also concentrated on the neck (0.38 ± 0.07 per 1% BSA) and in the V-area (0.47 ± 0.09 per 1% BSA). Outer forearms also showed 3-fold more SKs per unit area than neighboring arms and inner forearms, which are classified as partly exposed area (0.09 ± 0.02, 0.03 ± 0.01, respectively). The total area covered by SKs on exposed area also became significantly larger with aging than on intermittently exposed areas. These results indicate that exposure to sunlight might be related to SK growth. Our results indicated that excessive sun exposure is an independent risk factor of SKs. After controlling for age, smoking, and skin type, subjects with a sun exposure history of more than 6 hours per day showed a 2.28-fold increased risk of having severe SKs (n , 6) compared with those exposed for less that 3 h per day. These findings indicated that sun-exposure may play an important role in SK development. In summary, SKs are very common in Korean males and represent one of the major pigmentary problems. SKs concentrate on exposed skin, especially on the face and dorsum of the hands. Both age and lifetime cumulative sunlight exposure are important contributing factors and may work in a synergistic manner. Conclusion Many people tend to believe that wrinkles are not a prominent feature of Asian photoaged skin, and that dyspigmentation is a major manifestation in Asian skin. Contrary to this impression, wrinkling is also a major problem in the photoaged skin of Asians, and Korean people showing severe pigmentary changes usually tend to have severe wrinkles. In conclusion, the wrinkling patterns and pigmentary changes of photoaged skin in East Asians differ from those of Caucasians, and the relative risks of aggravating factors may be different from those of Caucasian skin. References 1.,Gilchrest, B.A. Skin aging and photoaging: an overview. J. Am. Acad. Dermatol. 21, 610,613 (1989). 2.,Chung, J.H. et al. Cutaneous photodamage in Koreans: influence of sex, sun exposure, smoking, and skin color. Arch. Dermatol. 137, 1043,1051 (2001). 3.,Griffiths, C.E. et al. A photonumeric scale for the assessment of cutaneous photodamage. Arch. Dermatol. 128, 347,351 (1992). 4.,Ernster, V.L. et al. Facial wrinkling in men and women, by smoking status. Am. J. Public Health. 85, 78,82 (1995). 5.,Youn, C.S. et al. Effect of pregnancy and menopause on facial wrinkling in women. Acta Derm. Venereol. 83, 419,424 (2003). 6.,Kadunce, D.P. et al. Cigarette smoking: risk factor for premature facial wrinkling. Ann. Intern. Med. 114, 840,844 (1991). 7.,Allen, H.B., Johnson, B.L. and Diamond, S.M. Smoker's wrinkles? JAMA. 225, 1067,1069 (1973). 8.,Chung, J.H. Photoaging in Asians. Photodermatol. Photoimmunol. Photomed. 19, 109,121 (2003). 9.,Kwon, O.S. et al. Seborrheic keratosis in the Korean males: causative role of sunlight. Photodermatol. Photoimmunol. Photomed. 19, 73,80 (2003). [source] Topical diclofenac in the treatment of actinic keratosesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2007Hans F. Merk Prof. Dr. Med. First page of article [source] The search for topical treatments for seborrheic keratoses continuesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2006Craig G. Burkhart MPH No abstract is available for this article. [source] Xeroderma pigmentosum with limited involvement of the UV-exposed areas: a case reportINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2003Mostafa Mirshams-Shahshahani MD A 21-year-old woman with skin type IV, who had developed photophobia and brown, spotty, hyperpigmented lesions on her face from early childhood, presented to our center for treatment of her facial lesions. Examination on admission revealed numerous, freckle-like, hyperpigmented macules and actinic keratoses over the central part of the face, with sparing of the forehead, chin, and peripheral area (Fig. 1). The area involved was approximated to be around 2% of the total body surface. The dorsal parts of the hands showed no lesions (Fig. 2), but guttate hypomelanotic lesions were apparent on both forearms. Figure 1. Limitation of xeroderma pigmentosum lesions to the center of the face Figure 2. Hands are devoid of any lesions Histologic examination of biopsies from four different facial lesions revealed them to be keratoacanthoma (1.5 × 2.5 cm ulcerative nodule on the right cheek), sclerosing basal cell epithelioma (nasal lesion), lentigo simplex, and hypertrophic actinic keratosis. Corneal clouding, conjunctival injection, loss of lashes, and atrophy of the lids were apparent on ophthalmologic examination. Other parts of the physical examination, including examination of the oral cavity, were nonsignificant. In addition, except for the presence of mild eczema in a sibling, the patient's family history regarding the presence of any similar problem and also any other important dermatologic or general disorder was negative. [source] Topical 3.0% diclofenac in 2.5% hyaluronan gel in the treatment of actinic keratosesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2001John E. Wolf Jr MD Background Actinic keratoses (AKs) are epidermal skin lesions with the potential to develop into invasive squamous cell carcinoma (SCC). Treatment at an early stage may prevent development of SCC. Current treatment options are highly destructive and associated with significant side-effects. Early studies with topical diclofenac were encouraging and led to its evaluation for the treatment of actininic keratosis. Previous studies have demonstrated that 3% diclofenac in 2.5% hyaluronan gel is effective and well tolerated in the treatment of AK. The present study was designed to further explore the therapeutic potential of this gel. Methods This randomized, double-blind, placebo-controlled trial involved outpatients with a diagnosis of five or more AK lesions contained in one to three 5 cm2 blocks. Patients received either active treatment (3% diclofenac gel in 2.5% hyaluronan gel) or inactive gel vehicle (hyaluronan) as placebo (0.5 g b.i.d. in each 5 cm2 treatment area for 90 days). Assessments included the Target Lesion Number Score (TLNS), Cumulative Lesion Number Score (CLNS), and Global Improvement Indices rated separately by both the investigator (IGII) and patient (PGII). Results Results obtained from 96 patients at follow up (30 days after end of treatment) indicated that a significantly higher proportion of patients who received active treatment had a TLNS = 0 compared to the placebo group (50% vs. 20%; P < 0.001). There was also a significant difference between the two groups in CLNS, with 47% of patients in the active treatment group having a CLNS = 0 compared with only 19% in the placebo group (P < 0.001). The proportion of patients with an IGII score of 4 (completely improved) at follow-up was 47% in the active treatment group compared with only 19% in the placebo group (P < 0.001); for PGII these values were 41% vs. 17%, P < 0.001. Both treatments were well tolerated, with most adverse events related to the skin. Conclusions Topical 3% diclofenac in 2.5% hyaluronan gel was effective and well tolerated for the treatment of AK. [source] Treatment of actinic keratoses with birch bark extract: a pilot studyJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 2 2006Constance Huyke aktinische Keratosen; Betulinsäure; Betulin; Oleanolsäure Summary Background: Birch bark contains a variety of apoptosis-inducing and anti-inflammatory substances such as betulinic acid, betulin, oleanolic acid and lupeol. Therefore, birch bark extract may be effective in the treatment of actinic keratoses. To address this issue, a pilot study using a standardized birch bark ointment was performed. Methods: Twenty-eight patients with actinic keratoses were enrolled in this prospective, non-randomized pilot study. Fourteen patients were treated with birch bark ointment only; fourteen patients received a combination therapy with cryotherapy and birch bark ointment. Treatment response was assessed clinically after two months. Results: Clearing of more than 75 % of the lesions was seen in 79 % of the patients treated with birch bark ointment monotherapy. The response rate of the combined treatment modality was 93 %. Therapy with birch bark ointment was well tolerated. Conclusion: In this pilot study, a standardized birch bark extract was effective in the treatment of actinic keratoses. This therapy is easy to perform and it has no side effects. Birch bark ointment may be a new therapeutic option for actinic keratoses. Zusammenfassung Hintergrund: Birkenkork ist reich an Triterpenen (Betulin, Betulinsäure, Oleanolsäure, Lupeol, Erythrodiol), für die Apoptose induzierende und antientzündliche Wirkungen beschrieben sind. Deshalb könnte sich ein Extrakt aus Birkenkork für die Therapie von aktinischen Keratosen eignen. Mit der hier untersuchten Birkenkork-Creme liegt erstmals eine galenische Formulierung vor (Birkenkorkextrakt, pflanzliche Öle, Wasser), in der die Wirkstoffe des Birkenkorks in therapeutisch ausreichender Menge vorhanden sind. Methoden: Im Rahmen der prospektiven, nicht randomisierten Pilotstudie wurden 28 Patienten mit aktinischen Keratosen behandelt. 14 Patienten erhielten eine Creme mit Birkenkorkextrakt als Monotherapie, 14 Patienten wurden zusätzlich kryotherapeutisch behandelt. Die Birkenkork-Creme wurde von den Patienten zweimal täglich aufgetragen. Das klinische Ansprechen wurde nach zwei Monaten erfasst. Ergebnisse: Bei Behandlung mit Birkenkorkextrakt als Monotherapie zeigten 79 % der Patienten nach einem Beobachtungszeitraum von zwei Monaten eine klinische Abheilung von über 75 % der Läsionen. Bei der Kombinationsbehandlung mit Kryotherapie kam es bei 93 % der Patienten zu einem Ansprechen auf die Behandlung. Die Verträglichkeit der Birkenkork-Creme war in allen Fällen sehr gut. Schlussfolgerung: Im Rahmen dieser Pilotstudie zeigte die lokale Anwendung eines standardisierten Birkenkorkextraktes eine gute Wirksamkeit bei der Behandlung aktinischer Keratosen. Die Anwendung ist einfach und die Verträglichkeit sehr gut. Deshalb stellt Birkenkorkextrakt eine interessante neue Therapieoption für aktinische Keratosen dar. [source] Behandlung aktinischer Keratosen mit Birkenkorkextrakt: Eine PilotstudieJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 2 2006Constance Huyke aktinische Keratosen; Betulinsäure; Betulin; Oleanolsäure Summary Background: Birch bark contains a variety of apoptosis-inducing and anti-inflammatory substances such as betulinic acid, betulin, oleanolic acid and lupeol. Therefore, birch bark extract may be effective in the treatment of actinic keratoses. To address this issue, a pilot study using a standardized birch bark ointment was performed. Methods: Twenty-eight patients with actinic keratoses were enrolled in this prospective, non-randomized pilot study. Fourteen patients were treated with birch bark ointment only; fourteen patients received a combination therapy with cryotherapy and birch bark ointment. Treatment response was assessed clinically after two months. Results: Clearing of more than 75 % of the lesions was seen in 79 % of the patients treated with birch bark ointment monotherapy. The response rate of the combined treatment modality was 93 %. Therapy with birch bark ointment was well tolerated. Conclusion: In this pilot study, a standardized birch bark extract was effective in the treatment of actinic keratoses. This therapy is easy to perform and it has no side effects. Birch bark ointment may be a new therapeutic option for actinic keratoses. Zusammenfassung Hintergrund: Birkenkork ist reich an Triterpenen (Betulin, Betulinsäure, Oleanolsäure, Lupeol, Erythrodiol), für die Apoptose induzierende und antientzündliche Wirkungen beschrieben sind. Deshalb könnte sich ein Extrakt aus Birkenkork für die Therapie von aktinischen Keratosen eignen. Mit der hier untersuchten Birkenkork-Creme liegt erstmals eine galenische Formulierung vor (Birkenkorkextrakt, pflanzliche Öle, Wasser), in der die Wirkstoffe des Birkenkorks in therapeutisch ausreichender Menge vorhanden sind. Methoden: Im Rahmen der prospektiven, nicht randomisierten Pilotstudie wurden 28 Patienten mit aktinischen Keratosen behandelt. 14 Patienten erhielten eine Creme mit Birkenkorkextrakt als Monotherapie, 14 Patienten wurden zusätzlich kryotherapeutisch behandelt. Die Birkenkork-Creme wurde von den Patienten zweimal täglich aufgetragen. Das klinische Ansprechen wurde nach zwei Monaten erfasst. Ergebnisse: Bei Behandlung mit Birkenkorkextrakt als Monotherapie zeigten 79 % der Patienten nach einem Beobachtungszeitraum von zwei Monaten eine klinische Abheilung von über 75 % der Läsionen. Bei der Kombinationsbehandlung mit Kryotherapie kam es bei 93 % der Patienten zu einem Ansprechen auf die Behandlung. Die Verträglichkeit der Birkenkork-Creme war in allen Fällen sehr gut. Schlussfolgerung: Im Rahmen dieser Pilotstudie zeigte die lokale Anwendung eines standardisierten Birkenkorkextraktes eine gute Wirksamkeit bei der Behandlung aktinischer Keratosen. Die Anwendung ist einfach und die Verträglichkeit sehr gut. Deshalb stellt Birkenkorkextrakt eine interessante neue Therapieoption für aktinische Keratosen dar. [source] Actinic keratoses: a cosmetic nuisance or a mortal risk?JOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2004R Cerio [source] Decreased Srcasm expression in hyperproliferative cutaneous lesionsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 3 2009Marc C. Meulener Background:, Src-family tyrosine kinases (SFKs) are signaling proteins that regulate keratinocyte proliferation and differentiation. Src-activating and signaling molecule (Srcasm) is a recently identified molecule that downregulates SFK activity and promotes keratinocyte differentiation. To determine if Srcasm expression correlates with keratinocyte differentiation, we characterized the level of Srcasm expression in some cutaneous lesions that exhibit increased keratinocyte proliferation. Methods:, Formalin-fixed sections of randomly selected seborrheic keratoses (SKs) and basal cell carcinomas (BCCs) were analyzed for Srcasm and Ki-67 immunohistochemical staining. Anti-Srcasm and anti-Ki-67 stainings were performed in parallel. Results:, All SKs displayed decreased Srcasm staining in areas comprised of basaloid keratinocytes that exhibited an increased Ki-67 index. Higher Srcasm staining levels were detected near pseudohorn cysts where keratinocytes exhibited a lower Ki-67 index. All multicentric and nodular BCCs displayed a prominent loss of Srcasm staining in association with a marked increase in Ki-67 staining. Conclusions:, Our results support the hypothesis that Srcasm protein levels are decreased in the hyperproliferative keratinocytes found in SKs and BCCs. Increased Srcasm protein levels are detected in keratinocytes undergoing differentiation. Decreased Srcasm levels may be part of the pathophysiologic mechanism in cutaneous lesions, exhibiting keratinocyte hyperproliferation. [source] Activation of Src-family tyrosine kinases in hyperproliferative epidermal disordersJOURNAL OF CUTANEOUS PATHOLOGY, Issue 3 2008Elias E. Ayli Background:, Src-family tyrosine kinases (SFKs) are important regulators of keratinocyte growth and differentiation. In a broad range of cell types, persistent activation of SFKs correlates with increased cell proliferation. In this study, we determined if SFK activity is increased in cutaneous neoplasia and psoriasis, common hyperproliferative epidermal disorders. Methods:, Formalin-fixed tissue sections of unremarkable epidermis, psoriasis, actinic keratoses (AKs), squamous cell carcinoma in situ (SCIS) and squamous cell carcinoma (SCC) were subjected to immunohistochemical staining for activated SFKs. Results:, All psoriasis specimens displayed significantly greater staining for activated SFKs than sections of unremarkable skin. In the psoriasis biopsies, the degree of epidermal hyperplasia was proportional to the level of activated SFK staining. All AKs, SCISs and SCCs exhibited more prominent staining than sections of unremarkable epidermis. No discernable difference in activated SFK staining was seen between AKs, SCIS and SCC specimens. Conclusions:, This study shows increased staining of activated SFKs in human biopsy specimens of psoriasis and cutaneous neoplasia. These data provide direct evidence for increased activation of SFKs in the pathogenesis of hyperproliferative epidermal disorders. [source] Primary cutaneous osteosarcoma of the scalp: a case report and review of the literatureJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2007Daniela Massi The patient had been previously submitted to electrodessications of the scalp due to multiple solar keratoses. Histopathologically, the lesion showed features of a high-grade conventional osteoblastic osteosarcoma involving the dermis. Computed tomography showed no involvement of the underlying bone tissues. Clinical examination and extensive total body radiologic workup revealed absence of bone lesions in any body site, thus suggesting a final diagnosis of primary cutaneous extraskeletal osteosarcoma. The clinico-pathological features of the case are discussed in light of the rare cases previously described in the literature. [source] Tenascin expression in actinic keratosisJOURNAL OF CUTANEOUS PATHOLOGY, Issue 11 2006Maria Lentini Background:, Tenascin is an extracellular matrix protein frequently expressed around neoplastic and non-neoplastic lesions of the skin. Actinic keratoses (AKs) are intraepidermal neoplastic lesions of the sun-exposed skin. They are classified according to the extension of dysplasia in four stages; they also present different histological varieties. Methods:, We performed an immunohistochemical study using tenascin monoclonal antibody diluted 1 : 50 on 150 cases of AKs classified, respectively, in histotypes (38 hypertrophic, 18 atrophic, 21 bowenoid, 19 acantolytic, and 40 mixed) and in stages (27 stage I, 46 stage II, 42 stage III, and 35 stage IV; 14 in tumoral progression). Results:, Tenascin positivity was observed in all cases at the dermal level close to the epithelial lesion. The intensity of reaction increased from stage I to stage IV and, of course, also in tumoral progression. Its expression was not related to the histotypes. In very few cases, the atypical keratinocytes were positive. Conclusions:, Tenascin expression in AKs is related to the stages of dysplasia. In fact, the immunostaining intensity corresponds to the degree of the dysplasia rather than the thickness of the involved epidermis. Tenascin plays a role in neoplastic progression working as an anti-adhesive factor. [source] Molecular diagnosis of basal cell carcinoma and other basaloid cell neoplasms of the skin by the quantification of Gli1 transcript levelsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 2 2005Naohito Hatta Background:, Distinguishing basal cell carcinoma (BCC) from other benign and malignant skin tumors is sometimes a difficult task for the pathologists. Because the activation of hedgehog signals and the up-regulation of its critical transcriptional factor Gli1 are well documented in BCC, a molecular technique measuring Gli1 transcripts may aide the diagnosis. Methods:,Gli1 transcript levels were measured by real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR) using RNA extracted from formalin-fixed, paraffin-embedded tissues of 68 cases of various skin tumors. Hematoxylin and eosin-stained pathology slides were independently reviewed by three expert dermatopathologists. Results:, The histological diagnoses were unambiguous in 53 tumors. The tumors included BCC (21), squamous cell carcinoma (13), seborrheic keratoses (8), trichoepithelioma (5), eccrine poroma/porocarcinoma (4), and sebaceous epithelioma/carcinoma (2). In these unambiguous cases, all BCC and trichoepithelioma tumors showed high expression of Gli1mRNA, while the expression was virtually absent in other tumors. The diagnosis was discordant among three pathologists in the remaining 15 tumors. Histological diagnoses included BCC, BCC with sebaceous differentiation, sebaceoma/sebaceous epithelioma, trichoblastoma, trichoepithelioma, basaloid follicular harmartoma, basosquamous carcinoma, etc. Six of them showed high Gli1 transcript levels. Conclusions:, Quantification of Gli1 transcripts by RT-PCR is helpful in discriminating BCC and trichoepithelioma from other skin tumors. [source] Atypical Response of Xeroderma Pigmentosum to 5-Fluorouracil: A Histopathological Image Analysis Study Reveals New Insight into EtiopathogenesisJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005S.A. Centurion Xeroderma pigmentosum (XP) is a recessively inherited genodermatosis associated with extreme sun sensitivity, defective repair of several types of sunlight induced adducts in cellular DNA, and numerous, early-onset skin cancers. The dry, rough skin corresponds to progressive cytologic atypia and loss of polarity in the underlying epidermis. Associated with these changes are immune deficiencies against ultraviolet radiation-induced skin cancer. 5-Fluorouracil (5-FU) is a DNA synthesis antimetabolite used against several types of cancers. Applied topically in normal subjects it is associated with moderate to severe inflammation in areas where actinic keratoses have arisen followed by ablation of the actinic keratoses which is dependent on the inflammation. We applied 5-FU to the sun-exposed skin of two patients with XP, a 14 year-old light complected black male and a 14 year-old Caucasian female. No inflammation was observed, but marked improvement in the clinical presentation of the skin was seen, as well as an absence of new malignancies. This change was confirmed histopathologically and correlated with normalization of polarity and cytologic changes in the epidermal cells. These histologic findings were quantitated using computerized image analysis. These results may be due to activation of alternative DNA repair pathways in these nucleotide excision repair deficient cells. [source] Activation of P44/42 Map Kinases within Human Epidermal Neoplasia.JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005Bryon Jackson Squamous cell carcinoma (SCC) arises from a series of genetic changes that form a clone of keratinocytes with enhanced growth characteristics. The p44/42 Map kinase pathway is a highly conserved growth regulatory pathway that helps relay critical signals from the cell membrane to the nucleus. Evidence demonstrating activation of the p44/42 pathway in the human cutaneous SCC has not been established. This study examined if p44/42 MAP kinase is activated in lesions of keratinocytic neoplasia. Lesions from the defined stages of keratinocytic neoplasia, normal skin, actinic keratoses, squamous cell carcinoma in situ, and squamous cell carcinoma, were randomly selected from archived material and studied. Antibodies that detect human p44/42 (phosphorylated and unphosphorylated) and only phosphorylated, activated, human p44/42 were used. The intensity and prevalence of cytoplasmic and nuclear staining was evaluated in the lesional cells. The results suggest that there is a not a simple linear relationship between the amount of nuclear staining and the type of lesion. The results show that there was a significant increase in the level of nuclear phosphorylated p44/42 staining progressing from an actinic keratoses to a sqaumous cell carcinoma in situ. These findings suggest that p44/42 MAP kinases are activated in keratinocytic neoplasia. [source] Comparison of Seborrheic Keratoses, Inflamed Seborrheic Keratoses, and Inverted Follicular Keratoses Using P53, BCL-1, and BCL-2JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005C. Ko While cell cycle markers have been used to differentiate benign versus malignant lesions and to classify malignant lesions, benign keratoses have not been well studied using such markers, and the relation of the cell cycle to inflammation or irritation of benign keratoses is unclear. We compared the immunohistochemical staining patterns of 10 seborrheic keratoses, 10 inflamed seborrheic keratoses, and 10 inverted follicular keratoses using antibodies to p53, bcl-1, and bcl-2. Staining with antibodies to p53 was increased in inverted follicular keratoses compared to inflamed or non-inflamed seborrheic keratoses. Bcl-1 staining was similar in all lesions. A population of bcl-2-positive dendritic cells was seen within the epidermal portion of inverted follicular keratoses. Keratinocyte bcl-2 staining was higher in seborrheic keratoses compared to the other two keratoses. Bcl-2 may be increased in seborrheic keratoses as an anti-apoptotic mechanism while increased p53 may trigger apoptosis in inverted follicular keratoses. [source] T-lymphocyte clonality in benign lichenoid keratosesJOURNAL OF CUTANEOUS PATHOLOGY, Issue 10 2002David I. Smith BA [source] Gene expression of differentiation-specific keratins (K4, K13, K1 and K10) in oral non-dysplastic keratoses and lichen planusJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 8 2000Balvinder K. Bloor Abstract: Gene expression for the differentiation-specific keratins (K4, K13, K1 and K10) was analyzed in oral non-dysplastic keratoses, oral lichen planus (OLP) and lichenoid reactions (LR) by comparative in situ hybridization (ISH) and immunohistochemistry (IHC) to investigate molecular changes in the altered differentiation pattern from non- to para- or orthokeratinization. At the protein level, K4 and K13 were detected homogeneously in the suprabasal compartment of parakeratotic epithelium but showed reduced expression in orthokeratoses, particularly in the presence of lymphocytes. Corresponding transcripts were restricted to basal and lower prickle cells. Synthesis of K1 and K10 was upregulated and more pronounced in orthokeratotic epithelia. The study showed an alteration in the pattern of differentiation-specific keratins, although involvement of the lymphocytic infiltrate in OLP and LR resulted in further gene modulation. In both diseases, K1 and K10 showed transcriptional control, proteins having the same distribution as their transcripts. This represented a change from post-transcriptional regulation in normal buccal epithelium, in which mRNAs for K1 and K10 are more widely expressed than their proteins. Thus, the pattern of keratin gene expression may be altered in response to frictional/smoking stimuli or immune-mediated mechanisms. [source] Guidelines for practical use of MAL-PDT in non-melanoma skin cancerJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2010E Christensen Abstract Methyl aminolaevulinate photodynamic therapy is increasingly practiced in the treatment of actinic keratoses, Bowen's disease and basal cell carcinomas. This method is particularly suitable for treating multiple lesions, field cancerization and lesions in areas where a good cosmetic outcome is of importance. Good treatment routines will contribute to a favourable result. The Norwegian photodynamic therapy (PDT) group consists of medical specialists with long and extensive PDT experience. With support in the literature, this group presents guidelines for the practical use of topical PDT in non-melanoma skin cancer. [source] | |||||||||||||