Navegando por Palavras-chave "Actinic keratosis"

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    Estudo clínico-laboratorial para verificar e comparar eficácia e segurança do ácido retinoico a 0,05% em creme e a 5% em peelings superficiais no fotoenvelhecimento e carcinogênese do antebraço
    (Universidade Federal de São Paulo (UNIFESP), 2017-10-26) Sumita, Juliana Mayumi [UNIFESP]; Bagatin, Edileia [UNIFESP]; Miot, Hélio Amante [UNIFESP]; http://lattes.cnpq.br/2543633050941005; Universidade Federal de São Paulo (UNIFESP)
    Background: Topical use of retinoic acid in cream is the gold standard treatment for skin aging, particularly photoaging. To obtain the same results in less time, the peeling of retinoic acid was created, but there are few controlled studies on its effectiveness, limited to the improvement of the signs of photoaging and cutaneous hyperpigmentation. Objectives: Evaluate and compare efficacy and safety of retinoic acid at 0.05% and 5% (as a peeling agent) for photoaging and carcinogenesis of the forearm. Methods: Prospective clinical study of therapeutic intervention, randomized, comparative and evaluator blinded. Efficacy and safety evaluated by the participant's opinion, severity of photoaging, measurement of the viscoelastic properties of the skin, corneometry, profilometry, high frequency ultrasound, histological exams (Hematoxylin-Eosin and Verhoeff stainings) and immunohistochemistry (p53, bcl-2 , Ki67 and collagen I). Results: The two forearms of 24 participants were evaluated. Three efficacy parameters showed opposite effects of the two treatments. 1) The thickness of the stratum corneum decreased with 0.05% retinoic acid and increased with 5%. 2) The echogenicity of the dermis by ultrasonography increased with 0.05% and decreased with 5%. 3) Ki67 expression increased with 0.05% and decreased with 5%. The favorable opinion of the participant, improvement of the photoaging score, corneometry, profilometry, recovery of viscoelasticity, increase of papillary dermis thickness, reduction of solar elastosis, decrease of p53, increase of bcl-2 and collagen I were not different between them. There was good tolerability in both treatments. Conclusion: The results confirmed the safety and benefits of retinoic acid at 0.05% and 5%, but at different scopes. 0.05% retinoic acid reversed the signs of photoaging in the long term (elevation of the echogenicity of the dermis), reaffirming itself as a gold standard for the treatment of photoaging. Peeling of 5% retinoic acid reduced the risk of skin cancer in the short term (reduction of Ki67), and was shown as a promising method for adjuvant treatment of actinic keratoses and cancerization field.
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    Isotretinoína oral em dose baixa versus tretinoína tópica na prevenção de queratoses actínicas em pacientes imunocompetentes: estudo clínico randomizado e comparativo
    (Universidade Federal de São Paulo (UNIFESP), 2016-05-31) Ianhez, Mayra [UNIFESP]; Bagatin, Edileia [UNIFESP]; http://lattes.cnpq.br/6478900066830476; http://lattes.cnpq.br/2315002761719798; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Chronic photoexposure can generate actinic keratosis and damage to the surrounding normal skin (field cancerization), which can evolve to skin cancer. Currently, the treatment of actinic keratosis addresses not only the destruction of individual lesions (using methods such as liquid nitrogen cryosurgery, electrocoagulation, trichloroacetic acid, and shaving), but also the treatment of field cancerization (using drugs such as 5-fluorouracil, imiquimod, ingenol mebutate, oral and topical retinoids, chemical peelings, and photodynamic therapy). Most studies involving retinoids have as purpose and primary outcome the prevention of nonmelanoma skin cancer. Therefore, few data are available about their use for the treatment of actinic keratosis. Oral and topical retinoids can be used for prevention and treatment of multiple actinic keratoses and field cancerization, especially in association with sunscreen and liquid nitrogen cryosurgery. Objectives: The primary objective of this research was to evaluate the clinical, histopathological, and immunohistochemical effects on the epidermis and dermis of the studied drugs for the treatment of multiple actinic keratoses of the face and forearms in immunocompetent patients. The secondary objectives were: 1) to evaluate the tolerability and safety of the medications; 2) to demonstrate the impact of the treatments on quality of life; 3) to investigate the reproducibility of lesion count as a parameter of efficacy; 4) to verify the role of cryosurgey associated to daily use of sunscreen in the control of actinic keratosis. Methods: This is an open, randomized, propective, and comparative clinical trial, including 61 participants, from 50 to 75 years of age, from both genders, with 5 to 60 visible and/or palpable actinic keratoses on the face and forearms. At the beginning (T0) and after 120 days (T120), all participants underwent liquid nitrogen cryosurgery to treat their actinic keratoses. Posteriorly, they were randomized in two treatment groups: 30 took oral isotretinoin, at the dose of 10 mg/day (ISO group), and 31 used 0.05% topical tretinoin cream every other night (TRE group), for 6 months (T300). All the subjects used SPF 60 sunscreen during the whole study period. At the beginning of the randomization (T120) and at the end of the study (T300), two biopsies were performed in the left forearm. The efficacy was evaluated using clinical (number of actinic keratoses) and histopathological parameters (hematoxilin-eosin and Weigert-Van Gieson staining, the latter for elastic fibers), as well as immunohistochemical markers of carcinogenesis (proteins p53, Bcl-2, and Bax) before and after the treatments. The safety evaluation included the report and observation of side effects and biochemical laboratory tests for the participants of the ISO group. Results: A decrease in the number of actinic keratoses related to liquid nitrogen cryosurgery and the use of SPF 60 sunscreen was observed between T0 and T120 (-39%) and to the treatments for field cancerization with oral isotretinoin (-33%) and topical tretinoin (-23%), cryosurgery and SPF 60 sunscreen between T120 and T300. The histopathological and immunohistochemical findings demonstrated: thinning of the stratum corneum and reduction of p53 and Bax expression between T120 and T300. Thickening of the basal to the granular layer and increased expression of Bcl-2 protein were observed in both groups. No modifications were found in the elastic tissue. In general, the treatment groups did not differ (p > 0.1). Only slight side effects were observed in both groups, except severe xerophthalmia in one patient of the ISO group. Between T120 and T180, the levels of total cholesterol and triglycerides increased in 76% and 61% of the participants, respectively, and this increase was around 30% of the initial value, returning to normal in T300 without the need to change or interrupt the treatment. Conclusion: Both low-dose oral isotretinoin and 0.05% topical tretinoin cream improved clinical, histopathological, and immunohistochemical parameters in patients with multiple actinic keratoses and field cancerization, without differences between them. The therapeutic choice of retinoids for field cancerization should take into consideration the patient?s profile, particularly in relation to the risk of side effects.
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    Liquid nitrogen for the treatment of actinic keratosis: A longitudinal assessment
    (Elsevier B.V., 2014-08-01) Ianhez, Mayra; Miot, Hello Amante; Bagatin, Edileia [UNIFESP]; Universidade Federal de Goiás (UFG); Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Cryosurgery with liquid nitrogen is one of the most used treatments for actinic keratosis. We aimed to study the effectiveness of two consecutive sessions of cryosurgery for actinic keratosis and investigate factors associated with its therapeutic success. Hence, we conducted a longitudinal study including 92 patients of both sexes, aged 50-75 years with 5-50 actinic keratosis on the face and forearms, who underwent cryosurgery and treatment with sunscreen SPF 30, at baseline and after 120 days. the lesions were counted in duplicate by the same examiner before the start of treatment and after 120 (N = 92) and 300 days (N = 33), represented by their medians and quartiles and compared using the generalized linear mixed effects model (negative binomial). Treatment behavior was investigated in relation to sex, age, education, skin type, smoking, sun exposure at work and the use of aspirin, anti-inflammatory and angiotensin-converting enzyme inhibitors. There was a significant reduction in the actinic keratosis count on the face and forearms (p < 0.05). Our results confirmed the effectiveness of cryosurgery for actinic keratosis, with a 57% reduction in the number, and size of the lesions. Higher education levels (p = 0.02) and less sun exposure at work (p = 0.02) independently promoted a significant reduction in the actinic keratosis count. Different population groups showed characteristic responses to the treatment, which may be explained by the degree of adherence to the use of photoprotection. in two sessions, cryosurgery with liquid nitrogen reduced the actinic keratosis count. (C) 2014 Elsevier Inc. All rights reserved.
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    Luz intensa pulsada e ácido 5 aminolevulínico no tratamento de queratoses actínicas e fotoenvelhecimento facial
    (Universidade Federal de São Paulo (UNIFESP), 2010-04-28) Haddad, Alessandra [UNIFESP]; Santos, Ivan Dunshee de Abranches Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: Photodynamic rejuvenation is the term used to the treatment of actinic keratosis and photodamage with photodynamic therapy. OBJECTIVE: Evaluate the efficacy of photodynamic therapy with aminolevulinic acid and intense pulsed light in the treatment of actinic keratosis and photodamage. METHODS: Fourty three patients mean age 71,3 years, were randomized in three groups: Control (IPL 18J); Treatment I (ALA+ IPL 16J); and Treatment II ( ALA+ IPL 18J) and evaluated clinically an photographically by two observers in Pre, 48hs, 8 weeks and 12 weeks Post-Treatment using Griffth’s Photonumeric Scale. Five actinic keratosis were marked as target in Pre-Treatment and biopsies Pre and Post-Treatment were done in one lesion to evaluate atypias and loss of cellular polarity. RESULTS: Non parametric tests showed marked improvement in mottled pigmentation, texture fine wrinkles in Groups Treatment I and II. In Control Group improvement only in mottled pigmentation. Actinic Keratosis clearance in Groups Treatment I and II were 51,2% and 68,4% respectively, whereas in Group Control it was 5%. In relation to Control Group, Groups Treatment I and II showed significant reduction of atypias and improvement in loss of cellular polarity. CONCLUSIONS: Photodynamic therapy with aminolevulinic acid and intense pulsed light is effective in the treatment of photodamage and actinic keratosis. The resolution of actinic keratosis was better with higher levels of energy.
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    Microscopia confocal reflectante a laser na avaliação da resposta terapêutica da ceratose actínica com 5-fluorouracila tópica a 5%: estudo comparativo com o exame anatomopatológico
    (Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Ishioka, Priscila [UNIFESP]; Hirata, Sergio Henrique [UNIFESP]; Ferreira, Marcus Antonio Maia de Olivas; http://lattes.cnpq.br/2145986062185182; http://lattes.cnpq.br/2040826097718565; http://lattes.cnpq.br/4667837268289413; Universidade Federal de São Paulo (UNIFESP)
    Background: Histological examination is the gold standard for actinic keratosis diagnosis; however, it is not always a feasible approach. Reflectance confocal microscopy (RCM) is a noninvasive technique that may be an alternative for monitoring actinic keratoses treatment response. Topical 5fluorouracil is indicated for actinic keratosis multiple lesions and for field cancerization treatment. Objectives: To assess the RCM accuracy, sensibility and specificity for actinic keratosis, considering as a goldstandard the histopathological examination; as well as to evaluate the efficacy of 5% 5fluorouracil treatment. Methods: This is a prospective study in actinic keratosis patients between August, 2014 and November, 2015. RCM analyses were performed in one randomly selected actinic keratosis lesion of the upper limbs by two independent observers before and after 5% 5fluorouracil treatment. At the end of treatment and with clinical bleaching of treated lesions, histological examination was performed by two pathologists. Results: A total of 50 lesions were enrolled, and 40 lesions presented complete clinical bleaching after treatment and were included in the final analysis. Accuracy, sensibility and specificity means among observers were 83.8%, 84.6% and 83.3%, respectively. After 5fluorouracil treatment, actinic keratosis was diagnosed in 45.0% (observer 1) and 32.5% (observer 2) of subjects according to RCM and in 32.5% of subjects according to histological examination. Considering RCM observers diagnosis, the concordance was substantial (k 0,637, p<0,001). 5fluorouracil led to a reduction in 55.0%67.5% of actinic keratoses according to RCM analysis. Conclusion: This study allows to validate of RCM as a noninvasive method capable of monitoring actinic keratosis therapeutic response to 5fluorouracil, presenting efficacy comparable to histological examination. Additionally, the results suggest that 5fluorouracil may be a satisfactory option for therapeutic control of this condition.
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    The reliability of counting actinic keratosis
    (Springer, 2013-11-01) Ianhez, M.; Fleury Junior, L. F. F.; Bagatin, Edileia [UNIFESP]; Miot, H. A.; Universidade Federal de Goiás (UFG); Universidade Federal de São Paulo (UNIFESP); Univ Paulista State
    Many epidemiological studies and clinical trials have been performed concerning actinic keratoses. the most eligible endpoint in the majority of articles is counting of actinic keratoses before and after treatments, nevertheless some authors support that this is not a reliable form of evaluation. the aim of this study was to evaluate the actinic keratoses counting by various raters and suggest approaches to increase the reliability. Cross-sectional study: forty-three patients were evaluated by four raters (inter- and intra-rater assessment) on the face and forearms. the mean actinic keratoses counts on the face and forearms were 7.7 and 9.1. the overall agreement among the raters for the facial and forearm actinic keratoses was 0.74 and 0.77. the intra-rater assessment showed high rates of agreement for the face (ICC = 0.93) and forearms (ICC = 0.83). Higher agreement occurred when counting up to five lesions. Four raters led to increased measurement variability and loss of reliability. Higher rates of agreement may be achieved with small number of lesions, limitation and/or segmentation of body areas to reduce their number, in AK prevention designs, are strategies that may lead to a greater reliability of these measurements.