Reflectance confocal microscopy: a crucial role for actinic keratosis treatment monitoring

Pellacani, Giovanni; Longo, Caterina

doi:10.1111/jdv.15091

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…RCM enables repeated imaging of the same lesion over time, which can be used for monitoring efficacy of non-invasive treatments. It has demonstrated to be helpful not only in identifying and grading AK lesions, but also in monitoring AK treatment outcomes [35][36][37][38]. In this regard, several studies have been performed with RCM to evaluate the efficacy of field-directed treatments such as 5-fluorouracil [39], ingenol mebutate [40], PDT [41], diclofenac [42], imiquimod [43], and surgery [44].…”

Section: De Junctionmentioning

confidence: 99%

Long-Term Efficacy of a New Medical Device Containing Fernblock® and DNA Repair Enzyme Complex in the Treatment and Prevention of Cancerization Field in Patients with Actinic Keratosis

Bustos¹,

Aguilera²,

García³

et al. 2019

J Clin Exp Dermatol Res

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subclinical and histologically abnormal epidermal tissue due to Ultraviolet (UV)-induced DNA damage. The photoproducts, "as consequence of DNA damage induced by UV", are mainly cyclobutane pyrimidine dimers (CPDs). Fernblock® demonstrated in previous studies significant reduction of the number of CPDs induced by UV radiation. Photolyases are a specific group of enzymes that remove the major UV-induced DNA lesions by a mechanism called photo-reactivation. the effect of a new medical device (NMD) containing a DNA-repair enzyme complex (photolyases, endonucleases and glycosilases), a combination of UV-filters, and Fernblock® in the treatment of the cancerization field in 30 AK patients after photodynamic therapy (PDT). Patients were randomized into two groups: patients receiving a standard sunscreen (SS) and patients receiving the NMD. Clinical, dermoscopic, reflectance confocal microscopy (RCM) and histological evaluations were performed. between them (p=0.476). A significant increase in the number of AKs was observed in SS group after six (p=0.026) and twelve months of PDT (p=0.038); however, this increase did not reach statistical significance in the NMD group. Regarding RCM evaluation, honeycomb pattern assessment after twelve months of PDT showed significant differences in the extension and grade of the atypia in the NMD group compared to SS group (p=0.030 and p=0.026, respectively). Concerning histopathological evaluation, keratinocyte atypia grade improved from baseline to six months after PDT in all the groups, with no statistically significant differences between the groups. Twelve months after PDT, p53 expression was significantly lower in the NMD group compared to SS group (p=0.028). The product was well-tolerated, with no serious adverse events reported.

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Section: De Junctionmentioning

confidence: 99%

Long-Term Efficacy of a New Medical Device Containing Fernblock® and DNA Repair Enzyme Complex in the Treatment and Prevention of Cancerization Field in Patients with Actinic Keratosis

Bustos¹,

Aguilera²,

García³

et al. 2019

J Clin Exp Dermatol Res

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“…AKs are diagnosed by the dermatologist through a clinical exam and the support of portable dermatoscopes, but often this method is not sufficient to ensure that the treatment has been effective or to discriminate between AK and SCC. Non-invasive imaging techniques, such as in vivo confocal laser microscopy [ 12 ] and optical coherence tomography (OCT), can provide complementary information [ 13 ] but require expensive instrumentation and long scanning times. Clinically, dermatologists currently rely on biopsy or excision with histological examination.…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Analysis of Actinic Keratosis before and after Topical Treatment Using a Cold Stimulation and Near-Infrared Spectroscopy

et al. 2020

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Background and objectives: The possible evolution of actinic keratoses (AKs) into invasive squamous cell carcinomas (SCC) makes their treatment and monitoring essential. AKs are typically monitored before and after treatment only through a visual analysis, lacking a quantitative measure to determine treatment effectiveness. Near-infrared spectroscopy (NIRS) is a non-invasive measure of the relative change of oxy-hemoglobin and deoxy-hemoglobin (O2Hb and HHb) in tissues. The aim of our study is to determine if a time and frequency analysis of the NIRS signals acquired from the skin lesion before and after a topical treatment can highlight quantitative differences between the AK skin lesion area. Materials and Methods: The NIRS signals were acquired from the skin lesions of twenty-two patients, with the same acquisition protocol: baseline signals, application of an ice pack near the lesion, removal of ice pack and acquisition of vascular recovery. We calculated 18 features from the NIRS signals, and we applied multivariate analysis of variance (MANOVA) to compare differences between the NIRS signals acquired before and after the therapy. Results: The MANOVA showed that the features computed on the NIRS signals before and after treatment could be considered as two statistically separate groups, after the ice pack removal. Conclusions: Overall, the NIRS technique with the cold stimulation may be useful to support non-invasive and quantitative lesion analysis and regression after a treatment. The results provide a baseline from which to further study skin lesions and the effects of various treatments.

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“…Here, we postulate that systemic (oral) photoprotection administered in a controlled, systematic manner, increases the efficiency of topical treatment in subjects with severe actinic damage. To address this, we follow up on a combination of clinical parameters, that constitute the basis of easy‐to‐use “photo score”, and microscopic examination of the skin carried out by means of non‐invasive technique (in vivo reflectance confocal microscopy (RCM)), for determining intensity of damage and efficacy of the intervention 11 . The hypothesis is that this photo score will improve in subjects receiving protocol‐determined doses of a specific topical sunscreen containing a non‐filtering botanical extract compared to control subjects that use sunscreen ad libitum; and that the addition of a regime of a systemic (oral) photoprotector in addition to the topical regime would improve the photo score even further.…”

Section: Introductionmentioning

confidence: 99%

The combination of oral and topical photoprotection with a standardized Polypodium leucotomos extract is beneficial against actinic keratosis

Pellacani

Peris

Ciardo

et al. 2023

Photoderm Photoimm Photomed

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Excessive exposure to sunlight or UV radiation causes acute and chronic skin damage. Actinic damage can be acute, i.e. sunburn; chronic damage causes photoaging and cancer, including melanoma and non-melanoma skin cancer. Photoprotection helps prevent these damages. The most common strategy is the use of topical sunscreens. Sunscreens are primarily composed of chemical (also known as organic) and/or physical (also known as inorganic) filters, although some of them contain additional components such as photon quenchers and antioxidant substances, often of natural origin, which reduce UV-induced oxidative damage. The main limitation of

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Reflectance confocal microscopy: a crucial role for actinic keratosis treatment monitoring

Abstract: Linked article: This is a commentary on P. Ishioka et al., pp. 1155–1163 in this issue. To view this article visit https://doi.org/10.1111/jdv.14716

Cited by 6 publications

References 5 publications

Long-Term Efficacy of a New Medical Device Containing Fernblock® and DNA Repair Enzyme Complex in the Treatment and Prevention of Cancerization Field in Patients with Actinic Keratosis

Long-Term Efficacy of a New Medical Device Containing Fernblock® and DNA Repair Enzyme Complex in the Treatment and Prevention of Cancerization Field in Patients with Actinic Keratosis

Non-Invasive Analysis of Actinic Keratosis before and after Topical Treatment Using a Cold Stimulation and Near-Infrared Spectroscopy

The combination of oral and topical photoprotection with a standardized Polypodium leucotomos extract is beneficial against actinic keratosis

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