Modes of action of diclofenac 3%/hyaluronic acid 2.5% in the treatment of actinic keratosis

Maltusch, Adrienne; Röwert‐Huber, Joachim; Matthies, C.; Lange‐Asschenfeldt, Susanne; Stockfleth, Eggert

doi:10.1111/j.1610-0387.2011.07700.x

Cited by 23 publications

(26 citation statements)

References 30 publications

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“…Another relevant immunohistochemical result was the significant change in CD31 expression (a marker of angiogenesis) in subclinical AK at the end of treatment. This finding is consistent with previous results from other authors (24,39) and likely related to the effects of the drug on COX-2 inhibition.…”

Section: Resultssupporting

confidence: 94%

“…Treatment options for AKs include a wide range of ablative modalities and topical treatments such as diclofenac sodium gel, imiquimod, ingenol mebutate gel or 5-fluorouracil with salicylic acid. Diclofenac sodium 3% gel is a non-steroidal anti-inflammatory topical agent that demonstrates preferential inhibition of cyclo-oxygenase-2 (COX-2), an enzyme implicated in ultraviolet (UV)-induced skin carcinogenesis (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The treatment of AKs with topical 3% diclofenac in 2.5% hyaluronic acid (Solaraze ® , Almirall, S.A., Barcelona, Spain) has been extensively documented in the last decade (17).…”

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confidence: 99%

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Monitoring Treatment of Field Cancerisation with 3% Diclofenac Sodium 2.5% Hyaluronic Acid by Reflectance Confocal Microscopy: A Histologic Correlation

Malvehy¹,

Roldán–Marín²,

Iglesias-García³

et al. 2015

Acta Derm Venerol

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Visual inspection may fail to accurately evaluate field cancerisation (subclinical actinic keratoses [AKs]). We aimed to describe field cancerisation by confocal reflectance microscopy and changes induced by the application of 3% diclofenac sodium gel in 2.5% hyaluronic acid. Fourteen male patients, > 50 years old, with AKs on the bald scalp were included. Clinical examination, confocal microscopy and histological study of clinically visible lesions and "normal appearing" adjacent skin before and after treatment was completed. Reflectance confocal microscopy showed a decrease in scaling (p = 0.001) and atypia of the honeycomb pattern (p = 0.001) at 2 weeks of treatment. Changes in parakeratosis, inflammation and dermal collagen remodelling were also observed. Histology correlated with confocal features in AK and subclinical AK. Reflectance confocal microscopy was useful in the evaluation of field cancerisation and monitoring of treatment response. A rapid improvement in epidermal atypia was observed.

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Section: Resultssupporting

confidence: 94%

mentioning

confidence: 99%

Monitoring Treatment of Field Cancerisation with 3% Diclofenac Sodium 2.5% Hyaluronic Acid by Reflectance Confocal Microscopy: A Histologic Correlation

Malvehy¹,

Roldán–Marín²,

Iglesias-García³

et al. 2015

Acta Derm Venerol

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“…This effect may be mediated via inhibition of angiogenesis and induction of apoptosis. There is evidence that diclofenac induces regression of AKs [90, 91]. …”

Section: Discussionmentioning

confidence: 99%

Actinic Keratosis: Rationale and Management

Dodds

Chia

Shumack

2014

Dermatol Ther (Heidelb)

105

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Actinic keratoses (AKs) are common skin lesions heralding an increased risk of developing squamous cell carcinoma (SCC) and other skin malignancies, arising principally due to excessive ultraviolet (UV) exposure. They are predominantly found in fair-skinned individuals, and increasingly, are a problem of the immunosuppressed. AKs may regress spontaneously, remain stable or transform to invasive SCC. The risk of SCC increases for those with more than 5 AKs, and the majority of SCCs arise from AKs. The main mechanisms of AK formation are inflammation, oxidative stress, immunosuppression, impaired apoptosis, mutagenesis, dysregulation of cell growth and proliferation, and tissue remodeling. Human papilloma virus has also been implicated in the formation of some AKs. Understanding these mechanisms guides the rationale behind the current available treatments for AKs. One of the main principles underpinning the management of AKs is that of field cancerization. Wide areas of skin are exposed to increasing amounts of UV light and other environmental insults as we age. This is especially true for the head, neck and forearms. These insults do not target only the skin where individual lesions develop, but also large areas where crops of AKs may appear. The skin between lesions is exposed to the same insults and is likely to contain as-yet undetectable preclinical lesions or areas of dysplastic cells. The whole affected area is known as the ‘field’. Management is therefore divided into lesion-directed and field-directed therapies. Current therapies include lesion-directed cryotherapy and/or excision, and topical field-directed creams: 5-fluorouracil, imiquimod, diclofenac, photodynamic therapy and ingenol mebutate. Combining lesion- and field-directed therapies has yielded good results and several novel therapies are under investigation. Treatment is variable and tailored to the individual making a gold standard management algorithm difficult to design. This literature review article aims to describe the rationale behind the best available therapies for AKs in light of current understanding of pathophysiology and epidemiology. A PubMed and MEDLINE search of literature was performed between January 1, 2000 and September 18, 2013. Where appropriate, articles published prior to this have been referenced. This is not a systematic review or meta-analysis, but aims to highlight the most up to date understanding of AK disease and its management.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0049-y) contains supplementary material, which is available to authorized users.

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“…migration: in order to start the reconstruction of the tissues, the surviving cell populations and the neighboring ones must recruit leukocytes from blood vessels (10,11,12,13,14). colonization: once migrated in the affected area, it is essential to induce apoptosis in cells with irreversible damage, to remove the debris produced as a result of surgical trauma, provide the information in order to enable the tissue differentiation (15,16,17,18) . angiogenesis: it is essential to construct a support microcirculatory system that ensures both a flow of metabolites and a flow of growth factors within the injured area (19,20,21) .…”

Section: Discussionmentioning

confidence: 99%

“…2 We decided to conduct a pilot study to test the hypothesis that exogenous administration of high molecular weight SH, at the dosage of 9 mg three times a day for a period of 30 days, could determine positive effects on symptoms on the basis of tissue repair claimed by SH and on quality of life and cytology of patients suffering from chronic pharyngitis. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] …”

Section: Introductionmentioning

confidence: 99%

Pilot study on the effects of high molecular weight sodium hyaluronate in the treatment of chronic pharyngitis

Leone

Caruso

Allocca

et al. 2015

Int J Immunopathol Pharmacol

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Although several therapeutic approaches are available at present for the treatment of chronic pharyngitis, new therapeutic strategies acting on pharyngeal mucous function should be investigated in order to improve symptoms and quality of life. High-molecular weight hyaluronate performs important functions on mucociliary clearance, tissues hydration, defense against micro-organisms, and on tissue repair as well, but at present there is no clinical evidence of its exogenous use in patients with chronic pharyngitis. Our open, randomized controlled study was carried out to investigate efficacy, and tolerability of exogenous high molecular weight sodium hyaluronate (SH) at the dosage of 9 mg three times a day for a period of 30 days, in patients with chronic pharyngitis. Results show significant improvements of symptoms and cytology in active group (A, n = 10) vs. control group (B, n = 10). Good compliance and no adverse events were reported in group A. In conclusion, SH was effective and safe in patients with chronic pharyngitis.

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Modes of action of diclofenac 3%/hyaluronic acid 2.5% in the treatment of actinic keratosis

Abstract: The efficacy of diclofenac 3 %/hyaluronic acid 2.5 % in the treatment of AKs is probably due to anti-inflammatory and anti-angiogenic effects, potentially associated with anti-proliferative and apoptosis-inducing underlying mechanisms.

Cited by 23 publications

References 30 publications

Monitoring Treatment of Field Cancerisation with 3% Diclofenac Sodium 2.5% Hyaluronic Acid by Reflectance Confocal Microscopy: A Histologic Correlation

Monitoring Treatment of Field Cancerisation with 3% Diclofenac Sodium 2.5% Hyaluronic Acid by Reflectance Confocal Microscopy: A Histologic Correlation

Actinic Keratosis: Rationale and Management

Pilot study on the effects of high molecular weight sodium hyaluronate in the treatment of chronic pharyngitis

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