Keratoses

Actinic keratoses were the first skin lesions to be treated topically with all-frans-retinoic acid. In various clinical trials, retinoids have been shown to be active in chemoprevention and treatment or prevention skin malignancies [2]. 

Vitamin D3 (VD3) and retinoids synergistically inhibit the growth and progression of squamous cell carcinomas and actinic keratoses in chronically sun exposed skin. One reason for this synergism may be the direct influence of VD3 on the isomerization and the metabolism of RA. Here, VD3 inhibits the isomerization of 13-cis-RA to the more receptor active all-trans and 9-cis-isomers. Moreover, the VD3 derivative secocholestra-trien-l,3,24-triol (tacalcitol), used for the treatment of severe keratinizing disorders inhibits 4-hydroxylation of all-ri ans-RA. 

Actinic keratoses Dark skin Melasma Photoaging... 

Griffin TD, Van Scott EJ (1991) Use of pyruvic acid in the treatment of actinic keratoses a clinical and histopathologic study. Cutis 47 325-329 Halasz CL (1998) Treatment of warts with topical pyruvic acid with and without added 5-fluoruracil. Cutis 62(6) 283-285... 

Epidermal growths including actinic keratoses and thin seborrheic keratoses... 

Epidermal growths such as actinic keratosis, lentigines or thin seborrheic keratoses can all be treated effectively with 25-35% TCA peels. Thicker epidermal growths or growths involving the dermis will be more resistant to treatment such as hypertrophic actinic keratoses and thicker seborrheic keratoses and may even be resistant to a medium-depth peel. Resistant lesions many times are best treated with a combination of a medium-depth chemical peel and other modalities such as manual dermasanding or CO, laser. 

Excellent to Good Response Actinic keratoses Superficial melasma Superficial hyperpigmentation Ephelides Lentigines... 

Seborrheic keratoses Hypertrophic keratoses Mixed melasma Mixed hyperpigmentation... 

Actinic keratoses are the most common epithelial precancerous lesions which occur primarily on sun-exposed skin of middle-aged and elderly people as multiple erythematous macules or papules with a dry adherent scale (Figs. 12.1, 12.2 and 12.3). 

Actinic keratoses are persistent, easily palpable, rough, usually erythematous patches that range in size between pinpoint to over 2 cm in diameter (Fig. 12.4a, b) ... 

Chiarello SE (2000) Cryopeeling (extensive cryosurgery) for treatment of actinic keratoses an update and comparison. Dermatol Surg 26 728-732... 

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... 

Ages 20S-30S Early photoaging Mild dyschromia No keratoses Minimal wrinkling Minimal, no makeup Minimal,or no scarring... 

Late 30S-40S Early senile lentigines Dyschromia Early actinic keratoses Parallel smile lines Early wrinkling Some foundation worn Mild acne scarring... 

Usually aged 50-65 Dyschromia, telangiectasias Visible keratoses Wrinkling at rest Always wears makeup Moderate acne scarring... 

Patient age 60-75 Actinic keratoses Prior skin cancers Wrinkling throughout Makeup cakes cracks Severe acne scarring... 

Lawrence et al. [66] in a split face study, compared the efficacy and safety of Jessner s solution and 35% TCA with 5% fluorouracil in the treatment of widespread facial actinic keratoses. Fifteen patients were treated. Both treatments reduced the number of visible actinic keratoses by 75%. Similarly, both caused equivalent reductions in keratinocyte atypia, hyperkeratosis, and parakeratosis. Compared to fluorouracil, only one application of the peel was necessary. 

Spencer JM (2004) Premalignant manifestations of photoaging actinic keratoses and atypical nevi. In Goldberg DJ (ed) Photodamaged skin. Marcel Dekker, Inc., New York, pp 1-16... 

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