A 12-month follow-up split-scalp study comparing calcipotriol-assisted MAL-PDT with conventional MAL-PDT for the treatment of actinic keratosis: a randomized controlled trial.

To enhance the efficacy of photodynamic therapy (PDT) for actinic keratosis (AKs), physical and chemical pre-treatments, such as calcipotriol (CAL) have been suggested. To compare the long-term 12-month efficacy and safety between methylaminolevulinate (MAL)-PDT and prior application of topical CAL versus conventional MAL-PDT for AKs of the scalp. Twenty patients with multiple AKs on the scalp were randomized to receive conventional PDT on one side of the scalp and CAL-assisted PDT, in which CAL was applied daily for 15 days beforehand, on the other side. Patients were evaluated for AK clearance at three, six and 12 months thereafter. All 20 patients completed the study. At three months, overall AK clearance was 92.07% and 82.04% for CAL-PDT and conventional PDT, respectively (p < 0.001). Similar results were found at six and 12 months: 92.07% and 81.69% (p < 0.001), and 90.69% and 77.46% (p < 0.001) for CAL-PDT and conventional PDT, respectively. Grade I AKs showed a similar response rate for both sides (p = 0.055) at three months and significant differences were obtained at six (p = 0.001) and 12 months (p < 0.001) for CAL-PDT and conventional PDT. Grade II AKs showed greater improvement on the CAL-PDT side (89.55% vs 62.90%) (p < 0.001) at three months. No difference was found at six and 12 months. CAL-PDT proved to be safe and more effective than conventional PDT for the treatment of AKs on the scalp after 12 months. CAL pre-treatment may have enhanced the efficacy of PDT for AK treatment, however, larger trials are needed to corroborate our findings.

Feasibility of daylight-mediated photodynamic therapy for actinic keratosis throughout the year in Central and South America: a meteorological study.

BACKGROUND: Daylight-mediated photodynamic therapy (DL-PDT) is an efficacious treatment option for thin actinic keratosis (AK) that offers advantages over conventional PDT in terms of tolerability, treatment duration, and cost. A clinical study conducted in Australia determined the mean irradiance during a 2-hour exposure to be 305.8 W/m(2) (range: 40-585 W/m(2) ). The protoporphyrin IX light dose is influenced by latitude, weather conditions, and time of year. A recent study of meteorological data concluded that DL-PDT can be performed effectively throughout the year in Australia. OBJECTIVES: Based on the same hypothesis and applying the same methodology, the present study investigated the suitability of daylight to perform DL-PDT in Central and South America. METHODS: Solar radiation and weather data were gathered and analyzed to assess daylight irradiance (light intensity) throughout a full year across 32 geographical locations in Central and South America. RESULTS: The minimum average daily solar irradiance reported was above 305.8 W/m(2) in all locations investigated throughout the year. Annual averages of daily irradiance ranged from 578 W/m(2) in Chihuahua, Mexico, to 321 W/m(2) in Puerto Montt, Chile. CONCLUSIONS: Daylight-mediated PDT for AK can be performed effectively throughout the year in Central and South America given that weather conditions permit a comfortable 2-hour direct exposure to daylight.

Daylight-mediated photodynamic therapy for actinic damage in Latin America: consensus recommendations.

Although conventional photodynamic therapy (c-PDT) using methyl aminolevulinate cream (MAL) is effective for the treatment of grade I-II facial and scalp actinic keratosis (AK), it is associated with treatment-related pain for some patients. Daylight-mediated PDT (DL-PDT) has shown similar efficacy to c-PDT, was nearly painless, and was well tolerated. Overall, DL-PDT effectively treats AK and offers a simpler and better tolerated treatment option than c-PDT. This consensus panel provided recommendations on the use of DL-PDT in Latin America (LATAM) for the treatment of actinic damage associated with few or multiple AKs. The panel was comprised of eight dermatologists from different LATAM countries who have experience using PDT for the treatment of actinic damage. The panel reviewed the relevant literature and provided personal expertise with regard to using DL-PDT for the treatment of photodamage with or without AK. The recommendations formulated by the expert panel provide evidence-based guidelines on all aspects of DL-PDT for the treatment of actinic damage associated with AK in different regions of LATAM. These recommendations provide guidance for dermatologists to ensure maintenance of efficacy and safety of DL-PDT when treating actinic damage, associated with few or multiple AKs in sun-exposed skin.

The development of erythema elevatum diutinum in a patient with juvenile idiopathic arthritis under treatment with abatacept.

In this case report, we present the first report of erythema elevatum diutinum after treatment of juvenile idiopathic arthritis with abatacept. Although it could also be coincidental, in our case, the appearance of vasculitis was not blocked by the simultaneous administration of a stimulation inhibitor, and alerts to the fact that as effective as a abatacept may be to control of the inflammatory articular symptoms, this might not translate into control of the disease.

The enigmatic development of psoriasis and psoriasiform lesions during anti-TNF therapy: a review.

OBJECTIVES: The paradoxical observation that antitumor necrosis factor (anti-TNF) agents are capable of inducing psoriasis and psoriasiform skin lesions while also being therapy for psoriasis gained substantial support following the description of this condition by several authors. Our aim was to review the literature of this subject. METHODS: A retrospective review of the literature was performed using the Medline database between 2005 and February 2007. RESULTS: Since the first publication by our group in April 2005 to the present, 50 cases of this type of dermatitis have been described. More than half of the cases were associated with the use of infliximab. Different presentations of psoriasis were reported, plaque form being the most prevalent. A number of clinical and immunological observations suggest a cytokine disequilibrium in patients receiving chronic anti-TNF therapy leading to this condition. Treatment for the skin disease includes changing the anti-TNF agent or discontinuing the medication. CONCLUSIONS: The appearance of psoriasis and psoriasiform lesions during chronic anti-TNF therapy is dependent on the presence of known and unknown interrelated factors. Enhanced clinician awareness of this drug complication and further investigation of its mechanisms are warranted.