RESUMO
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the diagnosis and management of the full spectrum of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS-TEN overlap in adults during the acute phase of the disease. The document aims to.
Assuntos
Gerenciamento Clínico , Guias de Prática Clínica como Assunto , Síndrome de Stevens-Johnson , Adulto , Diagnóstico Diferencial , Prática Clínica Baseada em Evidências , Humanos , Gravidade do Paciente , Pele/patologia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/fisiopatologia , Síndrome de Stevens-Johnson/terapia , Reino UnidoAssuntos
Síndrome de Stevens-Johnson/terapia , Corticosteroides/uso terapêutico , Adulto , Assistência ao Convalescente , Analgesia/métodos , Curativos Biológicos , Procedimentos Clínicos , Ciclosporina/uso terapêutico , Oftalmopatias/terapia , Feminino , Doenças Urogenitais Femininas/terapia , Hidratação/métodos , Previsões , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Ativação Linfocitária , Masculino , Doenças Urogenitais Masculinas/terapia , Doenças da Boca/terapia , Apoio Nutricional/métodos , Prognóstico , Doenças Respiratórias/terapia , Higiene da Pele/métodos , Testes de Irritação da Pele/métodos , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/patologiaAssuntos
Lúpus Eritematoso Sistêmico/complicações , Porfirias/complicações , Anti-Inflamatórios/uso terapêutico , Clobetasol/uso terapêutico , Diagnóstico Diferencial , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Porfirias/diagnóstico , Porfirias/imunologia , Porfirias/cirurgiaRESUMO
BACKGROUND: Conventional treatment of basal cell carcinoma (BCC) causes morbidity and/or disfigurement in some patients because of the location (e.g. mid-face) and size of the lesion. OBJECTIVES: Following reports that such difficult-to-treat BCC lesions have been treated successfully with topical methyl aminolaevulinate (MAL) photodynamic therapy (PDT), a multicentre study was performed to determine the response of such BCC to MAL-PDT. METHODS: An open, uncontrolled, prospective, multicentre study was conducted comprising patients with superficial and/or nodular BCC who were at risk of complications, poor cosmetic outcome, disfigurement and/or recurrence using conventional therapy. Patients were given one or two cycles within 3 months of topical MAL-PDT, each consisting of two treatments 1 week apart. Tumour response was assessed clinically at 3 months after the last PDT, with histological confirmation of all lesions in clinical remission. The cosmetic outcome was rated. Patients with a BCC in remission will be followed up for 5 years for recurrence, of which the 24-month follow-up is reported here. Ninety-four patients with 123 lesions were enrolled and treated with MAL-PDT at nine European primary care and referral university hospitals. An independent blinded study review board (SRB) retrospectively excluded nine patients and a total of 15 lesions from the efficacy analysis, for not having a difficult-to-treat BCC according to the protocol. RESULTS: The lesion remission rate at 3 months was 92% (45 of 49) for superficial BCC, 87% (45 of 52) for nodular BCC, and 57% (four of seven) for mixed BCC, as assessed by clinical examination, and 85% (40 of 47), 75% (38 of 51), and 43% (three of seven), respectively, as assessed by histological examination and verified by the SRB. At 24 months after treatment, the overall lesion recurrence rate was 18% (12 of 66). The cosmetic outcome was graded as excellent or good by the investigators in 76% of the cases after 3 months follow-up, rising to 85% at 12 months follow-up, and 94% at 24 months follow-up. CONCLUSIONS: Topical MAL-PDT is effective in treating BCC at risk of complications and poor cosmetic outcome using conventional therapy. MAL-PDT preserves the skin and shows favourable cosmetic results.
