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Multiple Actinic Keratoses (multiple + actinic_keratose)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Aggressive Cutaneous Squamous Cell Carcinoma Associated with Prolonged Voriconazole Therapy in a Renal Transplant Patient

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2008
A. Vanacker
A 69-year-old man, with a history of end-stage renal disease due to polyarteritis nodosa, followed by invasive pulmonary aspergillosis secondary to cyclophosphamide and corticosteroids, received a renal transplant 2 years ago under prophylactic treatment with voriconazole. Because of the severity of the aspergillosis, it was decided to continue voriconazole for a prolonged period. Eighteen months after transplantation, the patient developed a severe facial phototoxic reaction. A few months later, he developed multiple actinic keratoses and a large, rapidly expanding, poorly differentiated squamous cell carcinoma (SCC) with perineural invasion and metastatic lymph nodes, necessitating radical surgery and radiotherapy. Voriconazole therapy has been suggested to be involved in the development of multi-focal invasive SCC when complicated by a phototoxic reaction. Therefore, an alternative antifungal prophylaxis regimen (for instance with posaconazole) should be considered when evaluating patients for solid organ transplantation who are at high risk for the development of cutaneous malignancies. [source]

Photodynamic therapy of multiple actinic keratoses: reduced pain through use of visible light plus water-filtered infrared A compared with light from light-emitting diodes

BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2010
V. Von Felbert
Summary Background, Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is an effective treatment for multiple actinic keratoses (AKs). Pain, however, is a major side-effect. Objectives, To compare pain intensity, efficacy, safety and cosmetic outcome of MAL PDT with two different light sources in an investigator-initiated, randomized, double-blind study. Methods, Eighty patients with multiple AKs grade I,II were assigned to two groups: group 1, MAL PDT with visible light and water-filtered infrared A (VIS + wIRA); group 2, MAL PDT with light from light-emitting diodes (LEDs), with a further division into two subgroups: A, no spray cooling; B, spray cooling on demand. MAL was applied 3 h before light treatment. Pain was assessed before, during and after PDT. Efficacy, side-effects, cosmetic outcome and patient satisfaction were documented after 2 weeks and 3, 6 and 12 months. Where necessary, treatment was repeated after 3 months. Results, Seventy-six of the 80 patients receiving MAL PDT completed the study. Patient assessment showed high efficacy, very good cosmetic outcome and high patient satisfaction. The efficacy of treatment was better in the group of patients without spray cooling (P = 0·00022 at 3 months, P = 0·0068 at 6 months) and showed no significant differences between VIS + wIRA and LED. VIS + wIRA was significantly less painful than LED: the median of maximum pain was lower in the VIS + wIRA group than in the LED group for PDT without spray cooling. Pain duration and severity assessed retrospectively were less with VIS + wIRA than with LED, irrespective of cooling. Conclusions, All treatments showed high efficacy with good cosmetic outcome and high patient satisfaction. Efficacy of treatment was better without spray cooling. VIS + wIRA PDT was less painful than LED PDT for PDT without spray cooling. [source]

Successful treatment of multiple actinic keratoses in organ transplant patients with topical 5% imiquimod: a report of six cases

BRITISH JOURNAL OF DERMATOLOGY, Issue 2 2006
C. Ulrich
Summary Background, Nonmelanoma skin cancer represents a significant cause of morbidity in organ transplant recipients (OTRs). Cutaneous malignancies, mainly invasive squamous cell carcinoma and its precursor actinic keratosis (AK), appear approximately 5,10 years after organ transplantation. Impaired wound healing and high recurrence rates in immunocompromised patients treated with destructive therapies such as cryosurgery or topical 5-fluorouracil represent frequently known complications. Objectives, To evaluate the safety and efficacy of imiqimod 5% in the treatment of AKs in OTRs. Methods, Six OTRs (two kidney, two heart, one lung and one liver) with extensive AKs were treated with imiquimod 5% cream two to three times weekly in an open-label uncontrolled, nonrandomized pilot study. Results, In five of six patients treated with imiquimod 5% cream all AK lesions were cleared after 12,16 weeks. One patient showed partial response. Local adverse events at the site of application included erythema, oedema and mild erosion. No wound infection or scarring was observed in any of these patients. All graft-related laboratory parameters were stable during and after treatment. Immunosuppressive therapy remained unchanged throughout the treatment. Conclusions, These results suggest that imiquimod 5% cream may be useful for the local treatment of precancerous AK lesions in OTRs. [source]