Combined versus conventional photodynamic therapy with 5-aminolaevulinic acid nanoemulsion (BF-200 ALA) for actinic keratosis: A randomized, single-blind, prospective study.

BACKGROUND: Photodynamic therapy (PDT) has become one of the most effective therapies for the treatment of actinic keratosis, allowing the removal of more than one lesion in a single session. However, the pain sustained by the patient during treatment and local skin reactions can limit its use. OBJECTIVES: To determine the efficacy and safety of combined PDT (daylight PDT followed by conventional PDT) vs conventional PDT 12 weeks after treatment. METHODS: The study was performed as a randomized, single-center, non-inferiority clinical trial with two parallel groups. A total of 51 patients with grade I and II AKs on the scalp or face were randomized. Twenty-five patients received one session of combined PDT (combPDT), and 26 patients received one session of conventional PDT (cPDT). The primary endpoint was the reduction of AKs, 12 weeks after treatment. The secondary endpoint was the reduction in pain and local skin reaction. RESULTS: The reduction rate of grade I and II AKs was similar in combPDT and cPDT, showing no statistically significant differences between both groups, 76.67% vs 86.63% [P = .094] and 80.48% vs 83.08% [P = .679], respectively. However, pain was significantly lower in the combPDT group (2.56 vs 5, P < .01), as were local skin reactions. CONCLUSIONS: CombPDT has proven to be as effective as cPDT for the treatment of grade I and II AKs located on the scalp and face. Furthermore, combPDT has been shown to be considerably more tolerable than cPDT, causing only mild local skin reactions.

Chronic hand eczema and hepatogenic pruritus with good response to apremilast.

Hand eczema (HE) presents a high prevalence and severe impact on the quality of life of the patients. HE is a worldwide problem recognized for his high socio-occupational involvement. Treatment is mainly based on adequate recommendations for hand care together with topical anti-inflammatory treatments. Frequently, patients require systemic treatments such alitretinoin, among others. The comorbidities of the patients and the side effects of the treatments sometimes require prescribing other treatments off label on the technical data. This role in immunomodulation has led to the development of new studies that investigate what role does apremilast have in eczematous diseases, such as atopic dermatitis. We present this case for the quick and complete response of HE with apremilast, and the effective control of hepatogenic pruritus. These finding open a new possibility and alternative treatment of this complex and difficult of control with the treatments already described in the literature.