Actualités sur la prise en charge des kératoses actiniques chez les patients transplantés d'organes: Management of actinic keratoses in organ transplant recipients: an update.

Transplant recipients are at high risk of developing actinic keratosis (AK) and skin cancer. For this reason, initiating treatment at an early stage is crucial. Topical and systemic therapeutic options for AK have widely been described in studies of immunocompetent patients. However, little is known about AK management in organ transplant recipients (OTR). Photodynamic therapy (PDT), along with imiquimod, topical NSAIDs and topical 5-fluorouracil have been used on ORT patients in small non randomized studies. Although these studies seem to suggest that PDT offers best results, solid evidence is lacking. Nicotinamide and oral retinoids have also been described as reasonably effective preventive treatments in ORT patients. Management of immunosuppressive drugs is also considered as a key point for reducing the number of AK in ORT patients; an early switch for m-tor inhibitors has been shown to be protective while azathioprine, ciclosporin and tacrolimus have been shown to heighten the risk of developing AKs and skin cancer in this population. © 2019 Elsevier Masson SAS. All rights reserved. Cet article fait partie du numéro supplément Kératoses actiniques : comprendre et traiter réalisé avec le soutien institutionnel de Galderma International.

[Procedure for daylight methyl aminolevulinate photodynamic therapy to treat actinic keratoses]. / Modalités pratiques de traitement des kératoses actiniques par photothérapie dynamique topique en lumière du jour avec l'aminolévulinate de méthyle.

Actinic keratosis (AK), also known as solar keratosis or pre-cancerous keratosis, is frequently observed in areas of skin exposed to sunlight, particularly in light-skinned patients. In France, photodynamic therapy using red light (conventional PDT) and methylamino 5-levulinate (MAL) is indicated in the treatment of thin or non-hyperkeratotic and non-pigmented multiple AK lesions or large zones covered with AK lesions. It is well-known for its efficacy but also for its side effects, especially pain during illumination, which can limit its use. An alternative to PDT using natural daylight has recently been proposed to treat actinic keratosis lesions, and results in greater flexibility as well as significant reduction in pain. The lesions are prepared as for conventional PDT, with MAL cream being applied by the physician or the patient, after which they are exposed to natural daylight for 2hours. The lesions are then gently cleansed and protected from natural light for 24hours. This paper seeks to provide a precise description of the daylight PDT procedure for the treatment of AK.

[PDT panoramic view. Principle, photosensitizers, light sources and validated indications in dermatology]. / Revue Panoramique de la PDT. Principe, photo-sensibilisateurs, sources de lumières et indications validées en dermatologie.

INTRODUCTION: Photodynamic therapy (PDT) combines the use of a topical sensitizer and its excitation with a light of appropriate wavelength. Its use in dermatooncology has been possible in France in 2006 when the methyl ester ALA or Metvixia® got approved. OBJECTIVE: To provide a panoramic view of validated indications of PDT in oncodermatology. METHOD: This work is based on the review of the literature as well as available guidelines or recommendation on PDT in dermatology. RESULTS: Standardized protocols and results of the main clinical trials are given for the three major indications in dermatology: actinic keratosis, basal cell carcinoma and Bowen disease. CONCLUSION: PDT has its role to play in the treatment of multiple superficial carcinomas and cutaneous precancerous lesions and its main advantage resides in its optimal healing.