Actinic keratoses therapy

Iyer S, Friedli A, Bowes L, Kricorian G, Fitzpatrick RE (2004) Full face laser resurfacing therapy and prophylaxis for actinic keratoses and non-melano-ma skin cancer. Lasers Surg Med 34 114-119... 

Imiquimod is an immune response modifier shown to be effective in the topical treatment of external genital and perianal warts (ie, condyloma acuminatum see Chapter 61). The 5% cream is applied three times weekly and washed off 6-10 hours after each application. Recurrences appear to be less common than after ablative therapies. Imiquimod is also effective against actinic keratoses, and possibly, molluscum contagiosum. Local skin reactions are the most common side effect these tend to resolve within weeks after therapy. However, pigmentary skin changes may persist. Systemic adverse effects such as fatigue and influenza-like syndrome have occasionally been reported. 

Imiquimod should be applied to the wart tissue three times per week and left on the skin for 6-10 hours prior to washing off with mild soap and water. Treatment should be continued until eradication of the warts is accomplished, but not for more than a total of 16 weeks. Recommended treatment of actinic keratoses consists of twice-weekly applications on the contiguous area of involvement. The cream is removed after approximately 8 hours with mild soap and water. Treatment of superficial basal cell carcinoma consists of five-times-per-week application to the tumor, including a 1-cm margin of surrounding skin, for a 6-week course of therapy. 

Chronic PUVA therapy accelerates photoaging and the development of actinic keratoses, nonmelanoma skin cancer, and melanoma. Squamous cell carcinomas occur at 10 times the expected frequency. In patients receiving 250 or more treatments, there is an increased risk of melanoma. Careful monitoring of patients for cutaneous carcinoma therefore is essential. 

Masoprocol, a dicatechol compound with an aliphatic spacer, is derived from the plant Larrea divaricata it is a potent 5-lipoxygenase inhibitor with antitumor activity. It is effective for the topical therapy of actinic keratoses. Masoprocol is available as a cream (actinex) and is apphed twice daily for approximately 1 month. Common side effects include redness, scaling, and pruritus. 

M. Stefanidou, A. Tosca, G. Themelis, E. Vazgiouraki, C. Balas (2000). In vivo fluorescence kinetics and photodynamic therapy efficacy of delta-aminolevulinic acid-induced porphyrins in basal cell carcinomas and actinic keratoses implications for optimization of photodynamic therapy. Eur. J. Dermatol., 10, 351-356. 

Y. Itoh, Y. Ninomiya, T. Henta, S. Tajima, A. Ishibashi (2000). Topical delta-aminolevulinic acid-based photodynamic therapy for Japanese actinic keratoses. J. Dermatol, 27, 513-518. 

R.M. Szeimies, S. Karrer, A. Sauerwald, M. Landthaler (1996). Photodynamic therapy with topical application of 5-aminolevulinic acid in the treatment of actinic keratoses an initial clinical study. Dermatology, 192, 246-251. 

Rivers JK. Topical 3% diclofenac in 2.5% hyaluronan gel for the treatment of actinic keratoses. Skin Therapy Lett 2004 9 1-3. 

The earliest trials were conducted in the 1960s using all-tra/w-retinoic acid. Activity was reported in the topical treatment of actinic keratoses (Stuttgen, 1962 Bollag and Ott, 1971), in the systemic therapy of oral leukoplakia (Ryssel et al., 1971 Koch and Schettler, 1973), and in the prevention of recurrent bladder papillomas (Evard and Bollag, 1972). However, marked hyper-vitaminosis A toxicity generally prohibited the use of effective doses. 

The therapeutic effectiveness of etretinate in the treatment of actinic keratoses was demonstrated in a placebo-controlled, double-blind cross-over study. Thirty-seven of 44 patients with multiple actinic keratoses had a complete or partial response when treated with etretinate at 75 mg/day for 2 months. Most responses occurred within the first month of therapy (Moriarty et al., 1982). 

Etretinate in doses of 0.5-1 mg/kg/day led to complete regression of three of three keratoacanthomas, 20 of 29 actinic keratoses, and two of 18 basal cell carcinomas (Berretti et al., 1981). Eight of 18 basal cell carcinomas underwent partial regression. Relapse of basal cell carcinomas was noted when therapy was either reduced or discontinued a large keratoacanthoma of the nose relapsed 27 months after discontinuation, again indicating that maintenance therapy is mandatory. 

Toll A, Parera ME, Velez M, Pujol RM. Photodynamic therapy with methyl amino-levulinate induces phototoxic reactions on areas of the nose adjacent to basal cell carcinomas and actinic keratoses. Dermatol Surg 2008 34(8) 1145-7. 

The most common areas for psoriasis in human are shown on the scalp[3, 4], Initially, a series of classical treatment is used to treat this disease but that attempt has been failed. Today, phototherapy and PDT have become a regular modality and effective way for psoriasis and actinic keratoses treatment[4]. In spite of the various by topical treatments available for the treatment of superficial skin disease in scalp skin, many patients not succeed to respond adequately or may develop side effects. The goal of PDT treatment of psoriasis and actinic keratoses is to cure or locally control the disease while minimizing complications in normal tissues and reducing pain regarding therapy by investigation the influence of optical properties of skin and hair. 

Taneja, A, A. Racette, Z. Gourgouliatos et al.,(2004) Broad-band UVB fiber-optic comb for the treatment of scalp psoriasis a pilot study. International journal of dermatology. 43(6) p. 462-467. Markham, T. and P. Collins,(200I) Topical 5 aminolaevulinic acid photodynamic therapy for extensive scalp actinic keratoses. British Journal of Dermatology. 145(3) p. 502-504. 

Photodynamic therapy refers to photodynamic action in vivo to destroy or modify tissue. Originally developed for treatment of various solid cancers, applications of it expanded to include treatment of precancerous conditions, e.g., actinic keratoses, high-grade dysplasia in Barrett s esophagus, and non-cancerous conditions, e.g., various eye diseases, including age-related macular degeneration (AMD). 

Jeffes, E., McCullogh, J., Weinstein, G., Kaplan, R., Glazer, S., and Taylor, R., Photodynamic therapy of actinic keratoses with topical aminolevulinic acid hydrochloride and fluorescent blue light, /. Am. Acad. Dermatol, 45, 96, 2001. 

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