Single vs. fractionated photodynamic therapy for face and scalp actinic keratoses: a randomized, intraindividual comparison trial with 12-month follow-up.

OBJECTIVE: To compare the efficacy and tolerability of a single ALA-PDT illumination scheme with that of a fractionated ALA-PDT illumination scheme in face and scalp actinic keratoses (AKs). METHODS: Eligible patients received either a single ALA-PDT illumination or a fractionated illumination scheme randomly allocated to alternate sides of face/scalp. The side allocated to a single illumination received 75 J/cm(2). This side received 2 sessions performed 7 days apart. Lesions on the fractionated illumination scheme side received 20 and 80 J/cm(2), 4 and 6 hours after a single ALA application. Patients were evaluated at baseline, at 3 and 12 months after treatment. Efficacy end point included the individual AK lesion clearance rate. RESULTS: Thirty three patients with 266 lesions were enrolled in the study. Three months after treatment the overall lesion complete response rate was 89.05% for the single scheme and 96.12% for the fractionation scheme while at the 12-months follow-up response rate decreased to 85.4% for the single illumination and to 93.79% for the fractionated illumination group. Looking at lesion response based on lesion grade fractionated photodynamic therapy (PDT) resulted in larger rates of cured grade I as well as grade II lesions. Recorded adverse events were transient and did not demand additional therapy. CONCLUSIONS: Our results demonstrate that higher responses are achieved with fractionated PDT compared with single illumination PDT. The study data indicate that fewer treatment sessions may be needed with fractionated PDT increasing that way the comfort of the patient regarding number of visits, treatment cost and treatment-related downtime.

Dermoscopic features in the diagnosis of different types of basal cell carcinoma: a prospective analysis.

BACKGROUND: There is limited data on dermoscopic features of basal cell carcinomas (BCCs). We evaluated the presence of dermoscopic features in superficial (sBCCs), nodular (nBCCs), pigmented and non-pigmented BCCs in order to evaluate the role of dermoscopy in the diagnosis of different subtypes of BCCs. PATIENTS AND METHODS: We conducted a retrospective study to evaluate the presence of dermoscopic features in superficial, nodular, pigmented and non - pigmented BCCs. One hundred thirty eight lesions (42 superficial, 96 nodular, 102 pigmented and 36 non-pigmented) were assessed by dermoscopy. RESULTS: The most significant features in all categories, were a scattered vascular pattern, featureless areas, atypical red vessels, arborizing vessels, comma vessels, background of white-red structureless areas and telangiectasias. Haemorrhage-ulceration, hypopigmented areas and blue-grey ovoid nests were all more likely to be observed in sBCCs, than in nBCCs (p < 0.0001). Arborizing and atypical red vessels in addition to featureless areas, were more frequent in nodular than in sBCCs (p < 0.0001). Telangectasias, white-red structureless areas, red dots and red globules were more common in non- pigmented than in pigmented BCCs (p <0.0001). In addition, a significant difference of arborizing vessels was detected in pigmented lesions in comparison to non-pigmented (p<0.0001). CONCLUSIONS: There is limited data on dermoscopic features of basal cell carcinomas (BCCs). We evaluated the presence of dermoscopic features in superficial (sBCCs), nodular (nBCCs), pigmented and non-pigmented BCCs in order to evaluate the role of dermoscopy in the diagnosis of different subtypes of BCCs.

Sequential use of photodynamic therapy and imiquimod 5% cream for the treatment of actinic cheilitis: a 12-month follow-up study.

BACKGROUND: Actinic cheilitis (AC) may progress into fully developed squamous cell carcinoma with a relatively high risk of metastasizing and therefore requires early identification and treatment. OBJECTIVES: To assess the clinical and histological long-term outcome as well as the safety and tolerability of sequential use of photodynamic therapy (PDT) and imiquimod in AC. METHODS: Patients with histologically confirmed grade 1 and 2 AC received two methyl aminolaevulinate-PDT sessions 2weeks apart. After a 2-week rest period the patients started applying imiquimod 5% cream 3days per week for 4weeks. At the first follow-up visits at 3 and 6months, noncomplete clinical responders were biopsied and excluded from the study if histological alterations were indicative for AC. At the last 12-month follow-up all remaining patients were biopsied. Adverse events were noted at weeks 2, 4, 6 and 8 of the treatment phase and at every visit of the follow-up period. RESULTS: Of the 34 enrolled patients, 30 completed the study. Complete clinical response was achieved by 27 patients in 3months. At 6months, clinical and histological recurrence occurred in two patients, while at 12months the complete clinical cure rate obtained was 80% and the histological complete cure rate was 73%. Treatment was well tolerated and adverse events were as expected and transient. CONCLUSION: Sequential use of PDT and imiquimod cream is of significant benefit for the treatment of AC. Further studies are needed in order to confirm the improved outcome using the combination treatment, to clarify the involved mechanisms and to optimize the therapeutic protocol.

Erythema nodosum migrans in a male patient with hepatitis B infection.

Erythema nodosum migrans (ENM) is believed to represent a variant of chronic erythema nodosum; however, others consider it to be a separate clinical entity. It most commonly affects women in the third to sixth decade of life. Most cases are idiopathic, but some may be associated with streptococcal infection or thyroid disease. We present a case of ENM in a 33-year-old male patient with an erythematous, painful and infiltrated nodule on the lateral left lower leg. The lesion enlarged centrifugally, and a similar lesion appeared on the right lower leg. Both plaques exhibited a tendency to central clearing that made a peripheral ring evident. The patient was concurrently under treatment with antiviral drugs for hepatitis B infection and had an excellent response to treatment with potassium iodide. An association of ENM with the patient's viral hepatitis B could not be excluded.