Association between the clinical and histopathological classifications of actinic keratosis and the efficacy of topical imiquimod treatment.

We investigated the association between the clinical and histopathological classifications of actinic keratosis (AK) and the efficacy of topical imiquimod treatment. Forty patients (55 lesions) with AK were treated with topical 5% imiquimod and the efficacy of imiquimod for AK was evaluated based on the clinical/histopathological changes. The complete remission (CR) rates in patients with the different clinical classifications of AK were 85.4% (erythematous type) and 46.2% (hyperkeratotic type). The CR rates in the different histopathological classifications of AK were 80% (hypertrophic type), 81.8% (atrophic type) and 42.9% (bowenoid type). The results revealed that determining the clinical and histopathological type of AK was important for selecting a therapeutic method. The topical imiquimod treatment could be expected to be more effective for AK clinically classified as the erythematous type, or histopathologically classified as the atrophic or hypertrophic type. However, it would be expected to be less effective for the treatment of AK clinically classified as the hyperkeratotic type or histopathologically classified as the bowenoid type. Our observations suggest that we can predict the efficacy of topical imiquimod therapy in AK by determining its clinical and histopathological type.

[Psoriasis-like eruption induced by adalimumab in a patient with rheumatoid arthritis : a case report and review of literature].

A 72-year-old man developed arthritis of the bilateral shoulders and fingers. X-ray examination of the fingers showed periarticular osteoporosis, joint space narrowing, and cystic changes at the bone ends. Because contrast-enhanced MRI revealed synovial membrane proliferation and osteolysis, a diagnosis of rheumatoid arthritis (RA) was made. Treatment for RA with methotrexate (4 mg/week) was initiated in December 2008. In February 2009, adalimumab administration (40 mg/2 weeks) was initiated. The RA markedly improved, and clinical remission was maintained thereafter. However, in April 2010, relatively well-delineated erythematous plaques accompanied by bullae and scales developed on the bilateral palms, toes, limbs, and the inguinal region. A diagnosis of psoriasis-like eruptions was made by skin biopsy, and adalimumab administration was discontinued. After 4 months, the eruptions improved. Psoriasis-like eruptions due to anti-TNF drugs are rarely observed, but adverse effects require caution. This case is reported along with a review of the literature.

5-Aminolevulinic acid-mediated photodynamic therapy to superficial malignant skin tumors using Super Lizer.

Photodynamic therapy (PDT) using topically applied 5-aminolevulinic acid (ALA) has become a generally accepted treatment modality for superficial malignant skin tumors. However, the costly excimer-dye laser, diode laser and light-emitting diode (LED) frequently used to administrate PDT are impractical to use in most dermatology clinics. This study evaluated the effectiveness of ALA-mediated PDT using a Super Lizer (Tokyo Iken, Tokyo, Japan) equipped with band-pass filters in 38 patients with superficial malignant skin tumors (33 cases of actinic keratosis and five cases of Bowen's disease). Twenty-one cases (18 cases of actinic keratosis and three cases of Bowen's disease) were successfully treated, and the other 17 cases (15 cases of actinic keratosis and two cases of Bowen's disease) showed partial remission after single or repeated administration of PDT. PDT repeated three times at weekly intervals was more effective against actinic keratosis than randomly repeated procedures. The Super Lizer is easy to handle and move, and is less expensive than other known machinery and is useful for PDT in dermatology, especially under the protocol of three times at weekly intervals for the treatment of actinic keratosis.