Topical tacalcitol as neoadjuvant for photodynamic therapy of acral actinic keratoses: An intra-patient randomized study.

BACKGROUND: photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) is a well described and widely practiced treatment for actinic keratoses (AKs) on the head and face. Less is known about its use for AKs on upper extremities, which can be challenging for the dermatologist. The aim of our study was to compare the combination of topical tacalcitol before 5-ALA-PDT vs conventional 5-ALA-PDT for acral AKs in a prospective, randomized, intra-individual clinical study. METHODS: patients with AKs of both upper extremities underwent keratolytic pretreatment with topical tacalcitol on the back of one hand and/or forearm (right vs left), randomly selected, for fifteen consecutive days before PDT. All patients underwent one session of 5-ALA-PDT. Visual analog scale for pain was assessed immediately after PDT session and any side effects were recorded after 3 days. Efficacy was evaluated with lesion count (LC) prior to treatment (V0) and 90 days (V1) after PDT. RESULTS: twenty-one patients with multiple acral AKs were enrolled and completed the study. At V1, neoadjuvant combination of topical tacalcitol plus PDT was significantly more effective than PDT alone (percentage reduction in total lesion count was 44.4 %. There was no significant difference in VAS pain score between the two treatment modalities. Mild erythema was the only local side effect reported for both treatment regimens (52.4 %, tacalcitol plus PDT vs 42.9 %, PDT alone). CONCLUSIONS: neoadjuvant use of topical tacalcitol might be useful to improve PDT efficacy, especially in hard-to-treat AKs on extremities.

Oxidative stress involvement in psoriasis: a systematic review.

Psoriasis is a skin chronic inflammatory disease with a complex aetiology. It is characterised by the imbalance of environmental, genetic, and immunologic factors. Reactive oxygen species (ROS) could damage the cell components. The antioxidant system defends the body against ROS; a malfunction of the antioxidant system, together with an increased production of ROS, is involved in the pathogenesis of several diseases such as psoriasis. The purpose of this systematic review is to give an updated scenario about oxidative stress involvement in the psoriatic disease to identify useful biomarkers and to propose innovative therapies. A total of 28 studies were identified. Although several molecules were demonstrated being associated with psoriasis, only a little group resulted being eligible as disease biomarker [malonyldialdehyde (MDA), total oxidative stress, and oxidative stress index]. However, only MDA seems to be the best candidate for a clinical screening of psoriasis patients since it is intimately linked to Psoriasis Area Severity Index. Data suggest that current therapies with drugs, a healthy lifestyle, and the integration of a diet rich in antioxidants help to reduce the damage of oxidative stress caused by psoriasis, especially at the level of the skin. As much as we know, this is the first systematic review evaluating the oxidative stress role in psoriasis.

Combination of tacalcitol ointment and photodynamic therapy for the treatment of follicular mucinosis of the scalp.

Follicular mucinosis (FM) is a rare inflammatory disorder histologically characterized by mucin deposition in the follicular epithelium. There is no standard therapy for FM and several treatments have been described in the literature. We present the case of a 59 year-old female affected by a recalcitrant FM with diffuse scalp alopecia, in which complete clinical remission was achieved after a combination of topical tacalcitol and photodynamic therapy.