RESUMO
BACKGROUND High altitude increases sunlight exposure, resulting in actinic keratosis, which predisposes people to skin cancer. The dermoscopy procedure evaluates keratotic and pigmented skin changes. This study aimed to describe the clinical and dermoscopic actinic changes in the lips of 25 indigenous children living at high altitude in Ecuador. MATERIAL AND METHODS An observational study was conducted in a public school in the Andes region of Ecuador (August-November 2019). Twenty-five children, males and females, age 5-15 years were assessed by complete physical examination, digital dermoscopic photographs, and punch biopsies. Descriptive statistics and Fisher's exact test were used to summarize and analyze the data. RESULTS We included 17 (68%) boys and 8 (32%) girls with a mean age of 9.8±2.0 years. Clinical lips findings reported desquamation [52% Upper Lip (UL); 40% Lower Lip (LL)], fissuring (8% UL; 8% LL), scabs (8% UL; 8% LL), and discoloration (40% UL; 20% LL). Dermoscopic features included a white-yellow lip color (24% UL; p=0.02). The main morphologic pattern of blood vessels was monomorphic (88% UL; p<0.001), polymorphous (60% LL; p<0.001), dotted pattern (64% UL; 28% LL; p=0.02), and linear-irregular (32% UL; 72% LL; p=0.01). Girls had radiating white structures on UL (p=0.025), while boys presented white structureless areas (UL 63.6%; LL 77.8%; p=0.032). No differences in dermoscopic findings were observed according to Fitzpatrick scale score (FSS). Punch biopsies showed no indications of actinic cheilitis. CONCLUSIONS Dermoscopic features in indigenous children living in high altitudes were related to actinic damage, but histopathological findings were negative.
Assuntos
Ceratose Actínica , Neoplasias Cutâneas , Masculino , Feminino , Humanos , Criança , Pré-Escolar , Adolescente , Lábio , Altitude , Equador , Neoplasias Cutâneas/patologia , Ceratose Actínica/diagnóstico , Ceratose Actínica/patologiaRESUMO
The 5% 5-fluorouracil (5-FU) cream, considered the gold standard topical treatment, and peeling using 70% glycolic acid (GA) followed by 5% 5-FU are methods for the treatment of actinic keratoses (AKs). However, the comparison of these two treatments had not yet been described and therefore was the objective of this study. A randomized clinical trial, intrapatient study in which 17 patients received a type of treatment in the right and left upper limb with 5% 5-FU cream (twice daily) or a peeling application of 70% GA (every 15 days) followed by 5% 5-FU cream. There was a significant reduction of 75% and 85.71% in the mean number of AK lesions and of 74.5% and 85.71% in the size of lesions on the upper limbs of patients treated with peeling and 5% 5-FU cream (P-value ≤.001), respectively. Neither treatment was superior to the other since there was no significant difference (P-value ≥.05) between the treatments, both at the post-intervention period as well as when comparing the difference between the pre and post-intervention periods. The peeling with 70% GA followed by 5% 5-FU as well as 5% 5-FU cream are effective methods for the treatment of AKs on upper limbs.
Assuntos
Ceratose Actínica , Administração Tópica , Fluoruracila/efeitos adversos , Humanos , Ceratose Actínica/diagnóstico , Ceratose Actínica/tratamento farmacológico , Resultado do Tratamento , Extremidade SuperiorRESUMO
The differences in the biochemistry of normal and cancerous tissue could be better exploited by Raman spectroscopy when the spectral information from normal tissue is subtracted from the abnormal tissues. In this study, we evaluated the use of the normal-subtracted spectra to evidence the biochemical differences in the pre-cancerous and cancerous skin tissues compared with normal skin, and to discriminate the groups with altered tissues with respect to the normal sites. Raman spectra from skin tissues [normal (Normal), benign (dermatitis-BEN), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and actinic keratosis (KER)] were obtained in vivo (Silveira et al., 2015, doi: https://doi.org/10.1002/lsm.22318) and used to develop the spectral model. The mean spectrum of the normal sites (circumjacent to each lesion) from each subject was calculated and subtracted from each individual spectrum of that particular subject independently of the group (Normal, BEN, BCC, SCC, KERAT). The mean spectra of each altered group and the mean spectra of the differences were firstly evaluated in terms of biochemical contribution or differentiation comparing the normal site. Then, the normal-subtracted spectra were submitted to discriminant models based on partial least squares and principal components regression (PLS-DA and PCR-DA), and the discrimination were compared with the model using non-subtracted spectra. Results showed that the peaks of nucleic acids, lipids (triolein) and proteins (elastin and collagens I, III, and IV) were significantly different in the lesions, higher for the pre- and neoplastic lesions compared with normal and benign. The PLS-DA showed that the groups could be discriminated with 90.3% accuracy when the mean-subtracted spectra were used, contrasting with 75.1% accuracy when the non-subtracted spectra were used. Also, when discriminating non-neoplastic tissue (Normal + BEN) from pre- and neoplastic sites (BCC + SCC + KERAT), the accuracy increases to 92.5% for the normal-subtracted compared with 85.3% for the non-subtracted. The subtraction of the mean normal spectrum from the subject obtained circumjacent to each lesion could significantly increase the diagnostic capability of the Raman-based discrimination algorithm.
Assuntos
Algoritmos , Ceratose Actínica/diagnóstico , Neoplasias Cutâneas/diagnóstico , Pele/diagnóstico por imagem , Pele/patologia , Análise Espectral Raman , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagem , Análise Discriminante , Humanos , Análise dos Mínimos Quadrados , Análise de Componente PrincipalRESUMO
Actinic keratosis (AK) is a lesion that arises as a result of excessive exposure to solar radiation and appearing predominantly on Fitzpatrick phototype I and II skin. Given that some AKs evolve into squamous cell carcinoma, these lesions are considered premalignant in nature, occurring mostly in elderly men and immunosuppressed individuals chronically exposed to ultraviolet (UV) radiation. There are several mechanisms for the formation of AKs; among them are oxidative stress, immunosuppression, inflammation, altered proliferation and dysregulation of cell growth, impaired apoptosis, mutagenesis, and human papillomavirus (HPV). Through the understanding of these mechanisms, several treatments have emerged. Among the options for AK treatment, the most commonly used include 5-fluorouracil (5-FU), cryotherapy, diclofenac, photodynamic therapy (PDT), imiquimod (IQ), retinoids, and ingenol mebutate (IM). There have been recent advances in the treatment options that have seen the emergent use of newer agents such as resiquimod, betulinic acid, piroxicam, and dobesilate. The combination between therapies has presented relevant results with intention to reduce duration of therapy and side effects. All AK cases must be treated because of their propensity to transform into malignancy and further complicate treatment. In addition to medical or surgical care, education about sun exposure prevention remains the best and most cost-effective method for AK prevention. The objective of this article is to conduct a literature review of the clinical presentation of AK including advances in treatment options available.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Fluoruracila/uso terapêutico , Ceratose Actínica/terapia , Fotoquimioterapia , Retinoides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antineoplásicos/uso terapêutico , Crioterapia , Diclofenaco/uso terapêutico , Diterpenos/uso terapêutico , Humanos , Imiquimode/uso terapêutico , Ceratose Actínica/diagnósticoRESUMO
BACKGROUND: Five per cent 5-fluorouracil (5-FU) cream is a well-established treatment for actinic keratosis (AK), and ingenol mebutate gel (IMB) is a novel topical field-directed therapy. OBJECTIVE: To compare the tolerability and safety of IMB with that of 5-FU for the treatment of facial AK. METHODS: An open-label, prospective, randomized, controlled clinical trial with 100 patients with AKs within a 25-cm(2) contiguous field on the face was conducted. IMB was applied daily for three consecutive days. 5-FU was applied twice a day for 4 weeks. The treatment effect and the adverse events were evaluated at baseline and on days 2, 3, 4, 8, 15, 22, 29, 36 and 43 for intent-to-treat populations. RESULTS: The mean (± SD) maximum local skin reactions (LSR) for patients treated with IMB was 10.85 (± 3.12), compared with 10.86 (± 3.55) for those who received 5-FU. Patients in the IMB group presented LSR that peaked at day 4 and almost completely regressed after 15 days. Differently, in the 5-FU group, the LSR peaked at day 29 and lasted until visit 36. Additionally, the area under the curve (LSR × visit) was significantly smaller for IMB. No differences between the treatments for pruritus, pain, tearing, conjunctival hyperaemia or headaches were noted, but the eyelid oedema rate was higher for IMB group. No significant difference in the proportion of dropouts was observed between groups. Both treatments demonstrated a suitable safety profile. CONCLUSION: For treating AKs, the local skin reactions in the IMB group were more short-lived compared with those of 5-FU, but both treatments seemed to be safe and tolerable.
Assuntos
Diterpenos/administração & dosagem , Tolerância a Medicamentos , Dermatoses Faciais/tratamento farmacológico , Fluoruracila/administração & dosagem , Ceratose Actínica/tratamento farmacológico , Administração Tópica , Dermatoses Faciais/diagnóstico , Seguimentos , Géis , Humanos , Imunossupressores/administração & dosagem , Ceratose Actínica/diagnóstico , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
La guía está dirigida al personal clínico asistencial que brinda cuidados a pacientes con queratosis actínicas en los temas de prevención, diagnóstico, tratamiento y seguimiento, en los diferentes grados de complejidad de los servicios de la atención en salud en el marco del SGSSS (médicos familiares, médicos generales, médicos especialistas en dermatología, oncólogos, cirujanos plásticos, patólogos, radioterapeutas, cirujanos de cabeza y cuello, profesionales de enfermería y otros profesionales de la salud relacionados con el manejo de las queratosis actínicas). Los manejos de condiciones específicas por parte de los subespecialistas ameritan recomendaciones que exceden el alcance del presente documento. Esta GPC también, se dirige a tomadores de decisiones, generadores de políticas de salud, pagadores del gasto y todo el personal relacionado, que se desempeñe en el ámbito hospitalario o de las aseguradoras en salud. Esta GPC ofrece recomendaciones específicas para las preguntas definidas, y excede el alcance de la misma, definir las competencias profesionales del equipo involucrado en el manejo de esta patología
Assuntos
Humanos , Adulto , Ceratose Actínica/diagnóstico , Ceratose Actínica/tratamento farmacológico , NeoplasiasRESUMO
La guía está dirigida al personal clínico asistencial que brinda cuidados a pacientes con queratosis actínicas en los temas de prevención, diagnóstico, tratamiento y seguimiento, en los diferentes grados de complejidad de los servicios de la atención en salud en el marco del SGSSS (médicos familiares, médicos generales, médicos especialistas en dermatología, oncólogos, cirujanos plásticos, patólogos, radioterapeutas, cirujanos de cabeza y cuello, profesionales de enfermería y otros profesionales de la salud relacionados con el manejo de las queratosis actínicas). Los manejos de condiciones específicas por parte de los subespecialistas ameritan recomendaciones que exceden el alcance del presente documento. Esta GPC también, se dirige a tomadores de decisiones, generadores de políticas de salud, pagadores del gasto y todo el personal relacionado, que se desempeñe en el ámbito hospitalario o de las aseguradoras en salud. Esta GPC ofrece recomendaciones específicas para las preguntas definidas, y excede el alcance de la misma, definir las competencias profesionales del equipo involucrado en el manejo de esta patología.
Assuntos
Humanos , Adulto , Ceratose Actínica/diagnóstico , Ceratose Actínica/tratamento farmacológico , NeoplasiasRESUMO
BACKGROUND: Pigmented actinic keratosis (PAK) is a frequent simulator of lentigo maligna (LM) on the face upon clinical and dermoscopic examination, leading to misdiagnosis and unnecessary excisions. LM and PAK share dermoscopic features, making it difficult to have a confident diagnosis of PAK only with current dermoscopic knowledge. OBJECTIVE: We sought to evaluate sensitivity, specificity, and interobserver reproducibility of a novel dermoscopic feature, inner gray halo (IGH), and establish its histopathological and confocal correlations. METHODS: Dermoscopists blinded to histopathological diagnosis evaluated 58 PAK and 21 LM for the presence of IGH and dermoscopy parameters. Areas exhibiting IGH were marked and imaged with reflectance confocal microscopy before sampling for histopathologic correlation. Reflectance confocal microscopy and transverse histologic sectioning were performed in 14 of 79 cases. RESULTS: IGH was present in 53 of 58 (94.1%) PAK and in 5 of 21 (23.8%) LM in our series (sensitivity 91.4%; specificity 71.4%; positive predictive value 89.8%). Interobserver agreement was excellent (Kappa 0.846). Through transverse and perpendicular histologic sections, a dermoscopic-histologic-confocal correlation of IGH was established. LIMITATIONS: A larger test set is needed to further validate the use of IGH in the differential diagnosis of PAK and facial pigmented lesions. CONCLUSION: IGH is a novel dermoscopic parameter useful for the differentiation of PAK from LM on the face.
Assuntos
Sarda Melanótica de Hutchinson/diagnóstico , Hiperpigmentação/diagnóstico , Ceratose Actínica/diagnóstico , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Brasil , Estudos de Coortes , Intervalos de Confiança , Dermoscopia/métodos , Diagnóstico Diferencial , Face , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Sarda Melanótica de Hutchinson/ultraestrutura , Hiperpigmentação/patologia , Imuno-Histoquímica , Ceratose Actínica/patologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/ultraestruturaRESUMO
BACKGROUND: Tumor cells show alterations in their glycosylation patterns when compared to normal cells. Lectins can be used to evaluate these glycocode changes. Chemiluminescence assay is an effective technique for quantitative analysis of proteins, nucleic acids, and carbohydrates due to its high sensitivity, specificity, and rapid testing. OBJECTIVE: To use histochemiluminescence based on lectin conjugated to acridinium ester (AE) for the investigation of glycophenotype changes in cutaneous tumors. METHODS: Concanavalin A (Con A), Peanut agglutinin (PNA), Ulex europaeus agglutinin-I (UEA-I), and Maackia amurensis agglutinin (MAA) were conjugated to acridinium ester. Biopsies of cutaneous tumors and normal skin were incubated with the lectins-AE, and chemiluminescence was quantified and expressed as Relative Light Units (RLU). Results. Actinic keratosis (AK), keratoacanthoma (KA), squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) showed lower expression of α -D-glucose/mannose and α -L-fucose residues compared to normal tissue. Cutaneous tumors displayed higher expression of Gal- ß (1-3)-GalNAc residues than normal tissue. AK and SCC exhibited higher expression of Neu5Ac- α (2,3)Gal residues than normal epidermis. KA and BCC showed equivalent RLU values compared to normal tissue. CONCLUSIONS: Lectin histochemiluminescence allowed quantitative assessment of the carbohydrate expression in cutaneous tissues, contributing to eliminate the subjectivity of conventional techniques used in the histopathological diagnosis.