Solar keratoses

A 0.1% ophthalmic preparation is recommended for prevention of postoperative ophthalmic inflammation and can be used after intraocular lens implantation and strabismus surgery. A topical gel containing 3% diclofenac is effective for solar keratoses. Diclofenac in rectal suppository form can be considered for preemptive analgesia and postoperative nausea. In Europe, diclofenac is also available as an oral mouthwash and for intramuscular administration. 

The hands of pre-menopausal patients do not show any signs of atrophic aging, but too much sun produces a whole range of spots, sessile tumors, flat warts and solar keratoses. Small flat warts can be treated success-... 

Photoaging solar keratoses, pigmentary lesions, epidermal atrophy and solar elastosis are indications for resorcinol if their histological origins are not too deep. 

Fluorouracil is a pyrimidine antimetabolite. The metabolism of fluorouracil in the anabolic pathway blocks the methylation reaction of deoxyuridylic acid to chymidylic acid. In this manner, fluorouracil interferes with the synthesis of DNA and to a lesser extent inhibits the formation of RNA. It is indicated in colon, rectum, breast, gastric, and pancreatic carcinoma (injection) multiple actinic or solar keratoses, and superficial basal-cell carcinoma (topical). 

Masoprocol, a dicatechol compound with antipsoriatic and antineoplastic properties (10% cream), is nsed in actinic (solar) keratoses. 

P. Welf, E. Rieger, H. Kerl (1993). Topical photodynamic therapy with endogenous porphyrins after application of 5-aminolevulinic acid. An alternative treatment modality for solar keratoses, superficial squamous cell carcinomas, and basal cell carcinomas J. Am. Acad. Dermatol., 28, 17-21. 

C. Fritsch, B. Homey, W. Stahl, P. Lehmann, T. Ruzicka, H. Sies (1998). Preferential relative porphyrin enrichment in solar keratoses upon topical application of delta-aminolevulinic acid methylester. Photochem. Photobiol., 68, 218-221. 

Photodynamic therapy (PDT) with various photosensitizers has been proven to be highly efficient in the treatment of skin tumors. However, most valid data are available for ALA only, which has been shown to effectively sensitize solar keratoses and superficial basal cell carcinomas with porphyrins. Initial squamous cell carcinomas also show good response to ALA-PDT. Treatment of psoriasis by PDT is a subject under investigation. During the last decade numerous studies on PDT for dermatological diseases have been published, the more important ones are reviewed here. 

A) Solar keratoses on the capillitium with thick hyperkeratoses or... 

In general, surgical excision is the most effective and preferential treatment epithelial skin tumors. However, alternative modalities are necessary for extensive or multiple disseminated lesions such as superficial BCC and solar keratoses to improve functional and cosmetic results. In general, the outcomes of clinical studies on PDT treatment of skin tumors are difficult to compare since different specifications of PDT were used. The following discussion will review mainly data on topical ALA-PDT. The trend of the effectiveness of PDT will be given for different dermatological disorders. Detailed information is summarized in Tables 3-8 below. 

Table 5. Clinical studies on PDT efficacy in squamous cell carcinomas, solar keratoses and Bowen s disease...

C. Fritsch, S. Stege, G. Saalmann, G. Goerz, T. Ruzicka, J. Krutmann (1997). Green light is effective and less painful than red light in photodynamic therapy of facial solar keratoses. Photodermatol. Photoimmunol. Photomed., 13, 181-185. 

The role of retinoids in differentiation and carcinogenesis was the subject of a review article.Results of a clinical trial of the oral retinoid Rol3-6298 (21a) in the treatment of solar keratoses and squamous... 

Skin cancer is caused by exposure to UV radiation and the sun is the main source of this radiation. Sunscreens were initially formulated to prevent sxmbums laboratory studies later revealed that in rodents they could reduce UV-induced skin cancer which resembles human squamous cell carcinoma. Three randomised trials in older adults showed the ability of sunscreens to moderately reduce the occurrence of solar keratoses and the squamous cell carcinoma. However, no effect was observed for basal cell carcinoma [81 ]. These higher risks were found when sun exposure appeared to be intentional, that is, with the desire to acquire a tan, a healthy look or simply to spend as long as possible in the sun with as much skin exposure as possible. 

Actinic keratoses and solar keratoses (number present) 2<5 4< 10 6< 15 8> 15 ... 

A number of trials have attempted to investigate the effect of yS-carotene supplementation on nonmelanoma skin cancer, the most common forms of which are basal cell and squamous cell carcinomas (these types of cells are both found in the top layer of the skin). However, none have shown any significant effect on skin cancer prevention. For example, the Physicians Health Study found no effect after 12 years of yS-carotene supplementation on the development of a first nomnelanoma skin cancer. The Nambour Skin Cancer Prevention Trial of 1621 men and women followed for nearly 5 years (most of whom had no history of skin cancer at baseline) showed that those supplemented with 30 mg yd-car-otene did not experience any reduction in risk of basal cell or squamous cell carcinoma or the occurrence of solar keratoses (precancerous skin growths that are a strong determinant of squamous cell... 

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