5-Aminolaevulinic acid patch photodynamic therapy for the treatment of actinic keratoses: preliminary results from an Italian study in the real-life setting.

BACKGROUND: Photodynamic therapy (PDT) is recommended for both lesion and field therapy of actinic keratoses (AKs). The 5-aminolaevulinic acid (5-ALA) patch PDT is indicated for the treatment of isolated mild AKs (≤1.8 cm) on the face and bald scalp. It was demonstrated to be effective and safe in clinical trials with a good tolerability profile. METHODS: In this retrospective multicenter real-life study, 33 patients with a total of 99 AKs of the scalp, face, ears, and/or hands and 2 actinic cheilitis were treated with one treatment session of 5-ALA patch PDT with a red light source (total dose of 37 J/cm2). RESULTS: Overall, 12 weeks after treatment, 68/99 (69%) lesions were completely cleared. Complete response was obtained in 82% of AKs on the ears, 78% on the face, 57% on the hands, and 56% on the scalp and in the two actinic cheilitis. The treatment was very effective on grade I AKs, cleared in 87% of the cases and less efficient on grade II-III lesions, cleared in 47% of the cases. 5-ALA patch PDT was well tolerated with a good to excellent cosmetic outcome in 97% of the patients and with 94% of the patients being satisfied or very satisfied with the treatment. CONCLUSIONS: Our results confirm that 5-ALA patch PDT is a good option for AK treatment in clinical practice, it is easy to use, effective and well tolerated even in difficult-to-treat-areas. Moreover, it has an excellent cosmetic outcome.

Biologics exposure during pregnancy and breastfeeding in a psoriasis patient.

Biologic agents have revolutionized the treatment of psoriasis, and the increasing use of these agents in women of childbearing age raises questions regarding pregnancy safety. We report a case of a woman affected with severe psoriasis, who underwent three pregnancies while exposed to biologic agents. Although immediately dismissed at first pregnancy awareness, first-trimester exposure occurred, and the course of the pregnancies was carefully monitored. The patient was under adalimumab treatment during her first pregnancy and ustekinumab at her second and third gestation. She had a premature birth at 35 weeks during the first two pregnancies and at 36 weeks during her last pregnancy. All babies were born healthy without congenital anomalies. Furthermore, due to the rapid worsening of her psoriasis, biologics treatment was reintroduced immediately after breastfeeding in the first two occasions, but immediately after delivery in the last pregnancy, with the explicit consent of the patients. There are few data available on biologics treatment safety during pregnancy and breastfeeding, especially regarding ustekinumab. We report our positive experience with the aim of increasing case notifications, facilitate meta-analysis, and eventual consensus recommendations regarding the use of biologics in special population.

Successful ustekinumab treatment of noninfectious uveitis and concomitant severe psoriatic arthritis and plaque psoriasis.

We report the first successful treatment of noninfectious uveitis with ustekinumab in a patient with severe concomitant psoriasis and psoriatic arthritis who failed to respond to conventional immune suppressants and with contraindications to tumor necrosis factor alpha inhibitors.