RESUMEN
Alopecia areata (AA) is a complex immune-mediated disorder, which is difficult to treat. The available treatment options seem to have limited benefit, help only some patients and have a high relapse rate. We evaluated a new therapeutic option for moderate to severe AA based on the combination of photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) and microneedling (MN). In total, 14 patients were enrolled, and these were randomly divided into 3 groups: Group A (MN alone; n = 9), Group B (ALA-PDT alone; n = 15) and Group C (combination of MN and ALA-PDT; n = 17). All patients were treated once every 3 weeks for a total of six treatments. The best clinical outcome was achieved in Group C, with complete hair regrowth observed in three patients, and an improvement of ≥ 50% and < 50% of the treated areas obtained in seven and six patients, respectively. Our report suggests that combination of ALA-PDT with MN could be an additional therapeutic option in moderate to severe AA, as MN allows better skin penetration of ALA and subsequent indirect immunosuppression.
Asunto(s)
Alopecia Areata/tratamiento farmacológico , Punción Seca , Ácidos Levulínicos/uso terapéutico , Fotoquimioterapia , Fármacos Fotosensibilizantes/uso terapéutico , Adulto , Alopecia Areata/terapia , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Ácido AminolevulínicoAsunto(s)
Asma , Dermatitis Atópica , Compuestos Heterocíclicos con 3 Anillos , Rinitis Alérgica , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asma/tratamiento farmacológico , Asma/complicaciones , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/complicaciones , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Estudios Retrospectivos , Rinitis Alérgica/tratamiento farmacológico , Rinitis Alérgica/complicaciones , Índice de Severidad de la EnfermedadAsunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Sarcoma de Kaposi/inducido químicamente , Neoplasias Cutáneas/inducido químicamente , Tetrahidroisoquinolinas/efectos adversos , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Quinapril , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/patología , Sarcoma de Kaposi/cirugía , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Tetrahidroisoquinolinas/uso terapéuticoAsunto(s)
Linfangioma/etiología , Linfedema/complicaciones , Neoplasias de los Tejidos Blandos/etiología , Diagnóstico Diferencial , Femenino , Humanos , Pierna/patología , Linfangioma/patología , Linfedema/patología , Persona de Mediana Edad , Neoplasias de los Tejidos Blandos/patología , Factores de TiempoRESUMEN
BACKGROUND: Cutaneous warts are an extremely common problem, whose eradication can be challenging. Topical PDT involves applying a porphyrin precursor, 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) to the affected area. ALA-PDT has been well documented to be successful in the treatment of recalcitrant warts. PDT has a limited role in the treatment of thicker lesions because the photosensitizer does not penetrate keratotic lesions well, though this is vehicle dependent. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of curettage + microneedling + ALA-PDT for the treatment of resistant acral warts. We hypothesized that microneedling may increase the efficacy of PDT, providing a channel to deliver the ALA to deeper areas of warts. METHODS: Our study was carried out between November 2017 and July 2018. Eligible participants had one or more resistant plantar or palmar warts. Thirteen patients were recruited. They underwent a thorough curettage, followed by the application of 5-ALA 10% cream on the wart, and by microneedling. Later, the pricked skin was covered for three hours by an occlusive polyurethane dressing, and finally irradiated with a red-light source. Patients performed one session every three weeks for a total of three cycles. RESULTS: After 3 treatments of curettage + microneedling + ALA-PDT, 11 patients (84.6%) showed complete remission (defined as complete disappearance of their warts). One patient (7.7%) showed partial remission (defined as greater than 50% decrease in the wart area) after 3 sessions; this patient needed other 2 sessions to achieve complete remission. The mean follow-up period after healing was 4.3 months. Adverse effects were recorded. CONCLUSION: We have demonstrated, for the first time to our knowledge, that the combination of curettage + microneedling + topical ALA-PDT may offer an effective and safe alternative for the treatment of acral resistant warts, even when PDT alone has already been insufficient.
Asunto(s)
Ácido Aminolevulínico/análogos & derivados , Legrado/métodos , Agujas , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Verrugas/terapia , Adolescente , Adulto , Ácido Aminolevulínico/administración & dosificación , Ácido Aminolevulínico/efectos adversos , Ácido Aminolevulínico/uso terapéutico , Terapia Combinada , Legrado/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fotoquimioterapia/efectos adversos , Fármacos Fotosensibilizantes/administración & dosificación , Fármacos Fotosensibilizantes/efectos adversos , Verrugas/tratamiento farmacológico , Adulto JovenAsunto(s)
Colorantes/efectos adversos , Dermatitis Alérgica por Contacto/tratamiento farmacológico , Dermatitis Alérgica por Contacto/etiología , Antebrazo , Naftoquinonas/efectos adversos , Fenilendiaminas/efectos adversos , Tatuaje , Adolescente , Antibacterianos/uso terapéutico , Dermatitis Alérgica por Contacto/patología , Quimioterapia Combinada , Antebrazo/patología , Glucocorticoides/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Masculino , Tatuaje/efectos adversos , Resultado del TratamientoRESUMEN
Some syndromes are of interest to both neurologists and dermatologists, because cutaneous involvement may harbinger symptoms of a neurological disease. The aim of this review is to clarify this aspect. The skin, because of its relationships with the peripheral sensory nervous system, autonomic nervous system and central nervous system, constitutes a neuroimmunoendocrine organ. The skin contains numerous neuropeptides released from sensory nerves. Neuropeptides play a precise role in cutaneous physiology and pathophysiology, and in certain skin diseases. A complex dysregulation of neuropeptides is a feature of some diseases of both dermatological and neurological interest (e.g. cutaneous and nerve lesions following herpes zoster infection, cutaneous manifestations of carpal tunnel syndrome, trigeminal trophic syndrome). Dermatologists need to know when a patient should be referred to a neurologist and should consider this option in those presenting with syndromes of unclear etiology.