Photodynamic therapy reduces the histological features of actinic damage and the expression of early oncogenic markers.

BACKGROUND: Photodynamic therapy (PDT) has been shown to be effective in treating nonmelanoma skin cancer (NMSC), especially actinic keratosis (AK). Moreover, there is sufficient evidence of its effectiveness in preventing the appearance of premalignant and malignant lesions in organ transplant recipients. OBJECTIVES: To describe the molecular and genetic changes underlying this preventive effect. METHODS: Twenty-two patients with AK were treated with methyl aminolaevulinate and red light. Biopsies were performed before and 6 weeks after the treatment. Conventional histopathology and immunohistochemistry were carried out. RESULTS: Not only was a reduction in the dysplasia and elastosis observed, but also a decreased expression of Ki-67 and p53. The abnormal findings did not disappear completely in all cases. The expression of cyclin D1 remained stable. CONCLUSIONS: These findings show that PDT has the potential to reduce the histological signs of photoageing. Moreover, the reduction of Ki-67, a marker of proliferation and of p53, a marker of early skin carcinogenesis, indicates a reversal of the carcinogenic process. On the other hand, the fact that one treatment does not clear dysplasia and expression of p53 completely, and the persistence of cyclin D1, indicate that one single treatment, despite showing good clinical results, is not sufficient to clear completely the signs of chronic actinic damage, and thus the risk of NMSC.

Expression of p53 and p16 in actinic keratosis, bowenoid actinic keratosis and Bowen's disease.

INTRODUCTION: Bowen's disease (BD) and bowenoid actinic keratosis (bAK) have traditionally been differentiated according to the presence or absence of dysplasia in the follicular epithelium. p16 has been suggested to be a useful tool to make the differential diagnosis between BD and AK and as a marker of bad prognosis. MATERIALS: Five biopsies of BD, five of AK and five of bAK where stained for p53 and p16. RESULTS: All lesions showed positive immunostaining of p53, affecting to the lower two thirds of the epidermis in BD and bAK, and only the basal layer in non-bAK. All the BD and bAK cases were positive for p16, showing a similar immunostaining pattern, whereas no staining was observed in non-bAK. DISCUSSION AND CONCLUSION: These findings suggest a common pathogenic mechanism for BD and bAK. bAK might have worse prognosis than AK. p16 might not be useful as a tool for differential diagnosis between AK and BD because bAK and BD show an extremely similar immunohistochemical pattern.

[Recent advances in laser therapy and other technologies]. / Recientes avances en láser y otras tecnologías.

Laser technology and other energy sources are rapidly finding a place in dermatology clinics. In the field of skin rejuvenation by fractional photothermolysis, although few controlled studies have been undertaken, several devices have emerged in recent years that appear less effective than laser ablation techniques but that are safer. The aim of this short article is to provide an introduction, though not treat in depth, the different emerging technologies in dermatology. We will focus particularly on lasers and light sources in improving applications such as the treatment of vascular lesions, acne, and encapsulated ink tattoos; light-emitting diodes; developments in the treatment of cellulitis; photodynamic therapy; suction methods; scarring; and finally the recent and doubtlessly future introduction of home devices for use in a range of dermatologic applications (depilation, rejuvenation, treatment of acne, etc).

Aspectos epidemiológicos, patogénicos, clínicos y diagnósticos de la dermatitis atópica. ¿Es posible la prevención? / No disponible

La prevalencia de la dermatitis atópica (DA) se ha triplicado en los últimos 30 años enlos países industrializados. A menudo existen datos de agregación familiar, lo que indicauna marcada predisposición genética en estos pacientes. La incidencia es similar en ambossexos, pero existen diferencias étnicas y geográficas muy significativas que sugieren la participaciónde factores ambientales en la aparición de la enfermedad. Para entender la fisiopatologíade la DA hay que tener en cuenta simultáneamente las anomalías genéticas, la debilidadde la barrera cutánea, la alteración del sistema inmune y la susceptibilidad a padecersobreinfecciones microbianas de los individuos afectados.Dado que los mecanismos fisiopatológicos no están bien esclarecidos, de momento noes posible modificarlos para cambiar el curso de la enfermedad. Así, el retraso de la lactanciaartificial, la introducción de los alimentos sólidos en el lactante, o las restricciones dietariasen las gestantes afectas de la enfermedad, no han demostrado ser eficaces en la prevenciónde la DA. Sin embargo, sí parece importante realizar un tratamiento adecuado de laslesiones cutáneas para prevenir la sensibilización alérgica percutánea y evitar la apariciónde asma o rinoconjuntivitis.El picor y la recurrencia de las lesiones son los datos clínicos esenciales. El diagnósticode la enfermedad suele ser sencillo, pero en algunas ocasiones el pediatra puede requerirayuda especializada para confirmar el diagnóstico o tratar los casos más severos(AU)

The prevalence of atopic dermatitis (AD) has doubled or three-folded in industrializedcountries. There are often data of family history of atopic diathesis, suggesting that thereis a genetic predisposition in these patients. The incidence is similar in both sexes, but thesignificant ethnic background and geographic differences point out the importance of environmentalfactors in the development of the disease.To understand the physiopathology, it is necessary to take into account genetic abnormalities,dermal barrier impairment, immune system disturbances and the increased susceptibility of DA patients to suffer from microbial infections. Given that the immunopathologicalmechanisms of AD are not yet well understood, it is impossible to modify them to changethe course of the disease. For example, delaying artificial lactation or the timing of introductionof solid food, as well as performing dietary restrictions in pregnant women, havenot shown to have a protective effect in AD. However, it seems to be important to treat cutaneouslesions to prevent allergic sensitization through the skin, which might lead to asthmaor rhinoconjuntivitis in these patients.Pruritus and recurrences are the clinical hallmark of the disease. The diagnosis is usuallymade straightforward based on clinical features, but the pediatrician may need specializedhelp occasionally, either to confirm the diagnosis or to manage severe cases(AU)

Recientes avances en láser y otras tecnologías / Recent advances in laser therapy and other technologies

La tecnología láser y otros tipos de fuentes energéticas se están incorporando rápidamente a la consulta del dermatólogo. En el campo del rejuvenecimiento fraccional han aparecido en los últimos años varios equipos, aun habiéndose realizado escasos estudios controlados, inferiores en eficacia a los láseres ablativos pero con mayor grado de seguridad. Este breve artículo sólo pretende introducir, pero no desarrollar de forma exhaustiva, las diferentes tecnologías emergentes en Dermatología, especialmente láseres y fuentes de luz para el tratamiento de lesiones vasculares, acné y tatuajes con tintas encapsuladas y cicatrices; las aplicaciones de los diodos emisores de luz (LED), las novedades en el tratamiento de la «celulitis», terapia fotodinámica, métodos de succión, y por último la reciente y sin duda futura introducción de los dispositivos caseros para el tratamiento de diversos problemas dermatológicos (depilación, rejuvenecimiento, acné, etc.) (AU)

Laser technology and other energy sources are rapidly finding a place in dermatology clinics. In the field of skin rejuvenation by fractional photothermolysis, although few controlled studies have been undertaken, several devices have emerged in recent years that appear less effective than laser ablation techniques but that are safer. The aim of this short article is to provide an introduction, though not treat in depth, the different emerging technologies in dermatology. We will focus particularly on lasers and light sources in improving applications such as the treatment of vascular lesions, acne, and encapsulated ink tattoos; light-emitting diodes; developments in the treatment of cellulitis; photodynamic therapy; suction methods; scarring; and finally the recent and doubtlessly future introduction of home devices for use in a range of dermatologic applications (depilation, rejuvenation, treatment of acne, etc) (AU)

Enfermedad de injerto contra huésped crónica tratada con fotoféresis: a propósito de un caso / A case of chronic graft vs host disease treated with photopheresis

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