Ane Beatriz Mautari Niwa

A Pilot Split‐Face Study Comparing Conventional Methyl Aminolevulinate‐Photodynamic Therapy (PDT) With Microneedling‐Assisted PDT on Actinically Damaged Skin

Background Topical photodynamic therapy (PDT) is an approved treatment for superficial nonmelanoma skin cancers. To enhance photosensitizer penetration into the epidermis, microneedling (MN) devices or ablative carbon dioxide lasers are combined with PDT. Objectives To compare the efficacy and safety of MN‐assisted PDT with that of conventional PDT in human skin field cancerization. Materials and methods Ten patients with multiple actinic keratoses (AKs) and photodamage were randomized to receive conventional methyl aminolevulinate (MAL) with previous gentle curettage on one side of the face and MAL‐PDT combined with 1.5‐mm‐length MN on the other side after MAL application. After a 90‐minute incubation, patients were illuminated with a red light‐emitting diode and evaluated for improvement of photodamage, clearance of AKs, and side effects before and after 30 and 90 days. Results At day 30, global scores for photodamage, mottled pigmentation, roughness, and sallowness improved on both sides (p < .05), but fine lines improved only on the MN‐PDT side (p = .004). At day 90, facial erythema (p = .04) and coarse wrinkles (p = .002) also improved on the MN‐PDT side, in addition to fine lines for conventional MAL‐PDT (p = .01). Erythema (p = .009), edema (p = .01), crusting (p = .01), and pain (p = .004) were more common and intense on the MN‐PDT side. One patient developed a secondary bacterial infection at day 7 on the MN‐PDT side. Average AK clearance was 88.3%, with no difference between the sides. Conclusion Microneedling‐assisted PDT is a safe and effective method and can produce superior cosmetic results to conventional MAL‐PDT for improving photodamaged skin. Further larger prospective studies are needed to determine whether the addition of MN decreases actinic keratosis.

Fractional Photothermolysis for the Treatment of Hypertrophic Scars: Clinical Experience of Eight Cases

BACKGROUND Hypertrophic scars are common problems and represent a challenging condition to treat. Fractional photothermolysis has been effective at resurfacing photodamaged skin, acne scars, and atrophic scars, but there are few reports on its use for hypertrophic scars. OBJECTIVE To evaluate the safety and efficacy of 1,550‐nm erbium‐doped fiber laser treatment of hypertrophic scars in eight patients. METHODS Eight patients (skin phototypes II‐IV) with hypertrophic scars received monthly treatments with a 1,550‐nm erbium‐doped fiber laser. Energy settings ranged from 35 to 50 mJ, and eight to 10 passes were applied with treatment levels 6 to 8. An independent physician evaluator assessed the treatment response by comparing pre‐ and posttreatment clinical photographs using a quartile grading scale (grade 1, ≤25%=minimal to no improvement; grade 2, 26‐50%=moderate improvement; grade 3, 51‐75%=marked improvement; grade 4, >75%=near total improvement. RESULTS At four weeks after the last treatment session, a mean grade of 2.4 was achieved based on an independent physicians clinical assessment. Improvement in pigmentation occurred in all hyperpigmented scars. CONCLUSION Hypertrophic scars can be effectively and safely improved with 1,550‐nm erbium‐doped fiber laser treatment. The authors have indicated no significant interest with commercial supporters.

Terapia fotodinâmica em dermatologia: princípios básicos e aplicações

Photodynamic therapy involves the administration of a photosensitizing drug and its subsequent activation by light at wavelengths matching the absorption spectrum of the photosensitizer. Currently, topical photodynamic therapy has received approval for the treatment of cutaneous oncologic conditions such as actinic keratoses, Bowens disease and superficial basal cell carcinoma in many countries in the world. Multicenter randomized controlled studies have demonstrated high efficacy and superior cosmetic outcome over standard therapies. For many non-oncologic dermatological diseases such as acne vulgaris, viral warts and localized scleroderma, case reports and small series have confirmed the potential of photodynamic therapy. After the development of topical photosensitizers 5-aminolevulinic acid (ALA) or its methyl ester (MAL), photodynamic therapy has gained worldwide popularity in dermatology, as these drugs do not induce prolonged phototoxicity as the systemic photosensitizing hematoporphyrin derivatives do. The production of reactive oxygen intermediates such as singlet oxygen depends on the concentration and localization of the photosensitizer in the diseased tissue as well as the applied light dose. Either incoherent lamps or LED arrays are suitable for the cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving inflammatory condition.

Pain in photodynamic therapy: mechanism of action and management strategies

Photodynamic therapy involves administration of a photosensitizing drug and its subsequent activation by irradiation with a light source at wavelengths matching the absorption spectrum of the photosensitizer. In many countries around the world, topical photodynamic therapy has been approved for treatment of cutaneous oncologic conditions such as actinic keratosis, Bowens disease, and superficial basal cell carcinoma. Multicenter, randomized, controlled studies have confirmed its efficacy and superior cosmetic outcomes compared to conventional therapies. Nevertheless, this therapeutic method presents some adverse effects, such as erythema, edema, pigmentation, pustules, and pain. There is no doubt that pain is the most severe of the adverse effects, being sometimes responsible for definitive treatment interruption. The pain mechanism has not yet been fully understood, which makes complete pain control a challenge to be conquered. In spite of that, this literature review presents some useful pain management strategies as well as the most important pain-related factors in photodynamic therapy.

Síndrome carcinóide: relato de caso

Carcinoid tumors are rare neoplasms with an estimated incidence of 1 to 2 cases per 100,000 inhabitants. The malignant carcinoid syndrome, characterized by flushing, diarrhea, abdominal pain and, less frequently, pellagra, bronchospasm and valvular disease, occurs in less than 10% of patients. Nevertheless, in advanced stages of the disease, the incidence is about 40 to 50%. Retrospective studies and descriptive case series have shown that cutaneous involvement is relatively common but has rarely been reported. We present a case of carcinoid syndrome diagnosed with basis on skin findings on clinical examination.

Carcinoma basocelular em localizações incomuns

The authors present five patients who develop basal cell carcinomas in sites this tumor rarely occurs. The aim is to report the rare location of this frequent cutaneous malignancy and to briefly discuss the concept of unusual location of basal cell carcinoma.