Daylight Photodynamic Therapy Versus 5-Fluorouracil for the Treatment of Actinic Keratosis: A Case Series

Abstract

Introduction

The incidence of actinic keratosis (AK) continues to increase worldwide. Currently available options for the treatment of AK include topical 5-fluorouracil (5-FU) and daylight-mediated photodynamic therapy (DL-PDT). This split-face pilot study compared DL-PDT using 16% methyl aminolevulinate (MAL) cream versus 5-FU cream in patients with AK on the face/scalp.

Methods

Five male subjects (mean age 70 years) with grade I–III AK on the face/scalp were enrolled. Subjects received a single session of DL-PDT with 16% MAL on one side and topical 5% 5-FU for 21 days on the other side. Evaluations of efficacy, safety, and subject satisfaction were conducted 48 h, 7 days, 14 days, 1 month, and 3 months after treatment.

Results

At 3 months, the lesion complete response rate was 80% and 93% for DL-PDT and 5-FU, respectively. Lesion partial response was 20% and 7%, respectively. Fewer treatment-related adverse events (AEs) were reported with DL-PDT than with 5-FU, and they resolved spontaneously in 5–7 and 27–30 days, respectively. Subjects preferred DL-PDT because of the lower incidence of AEs and rapid recovery compared with 5-FU.

Conclusion

DL-PDT is a convenient alternative to 5-FU with good efficacy and a favorable safety profile, allowing patients to effectively treat their AK without compromising their social life.

Funding

Galderma.

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Malignancy-associated generalized perforating granuloma annulare

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Human CD4+ CD25+ CD127hi cells and the Th1/Th2 phenotype

Publication date: Available online 10 January 2018
Source:Clinical Immunology
Author(s): Aditi Narsale, Rosita Moya, Joanna Davida Davies
CD4⁺ T cells that co-express CD25 and CD127 (CD25⁺CD127⁺) make up around 20% of all circulating CD4⁺ memory T cells in healthy people. The clinical significance of these cells is that in children with type 1 diabetes their relative frequency at diagnosis is significantly and directly correlated with rate of disease progression. The purpose of this study was to further characterize the CD25⁺CD127^hi cells. We show that they are a mix of Th1 and Th2 cells however, they have a significantly higher relative frequency of pre-committed and committed Th2 cells, and secrete significantly higher levels of Th2-type cytokines than CD25⁻ memory T cells. Further, these cells are neither exhausted nor senescent and proliferate to the same extent as CD25⁻ memory cells. Thus, CD25⁺CD127^hi cells are a highly active subset of memory T cells that might play a role in controlling inflammation via anti-inflammatory Th2-type deviation.



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Pediatric-onset Evans syndrome: Heterogeneous presentation and high frequency of monogenic disorders including LRBA and CTLA4 mutations

Publication date: Available online 10 January 2018
Source:Clinical Immunology
Author(s): Caroline Besnard, Eva Levy, Nathalie Aladjidi, Marie-Claude Stolzenberg, Aude Magerus-Chatinet, Olivier Alibeu, Patrick Nitschke, Stéphane Blanche, Olivier Hermine, Eric Jeziorski, Judith Landman-Parker, Guy Leverger, Nizar Mahlaoui, Gérard Michel, Isabelle Pellier, Felipe Suarez, Isabelle Thuret, Geneviève de Saint-Basile, Capucine Picard, Alain Fischer, Bénédicte Neven, Frédéric Rieux-Laucat, Pierre Quartier
Evans syndrome (ES) is defined by the combination of autoimmune hemolytic anemia and immune thrombocytopenia. Clinical presentation includes manifestations of immune dysregulation, found in primary immune deficiencies, autoimmune lymphoproliferative syndrome with FAS (ALPS-FAS), Cytotoxic T Lymphocyte Antigen-4 (CTLA-4) and Lipopolysaccharide-Responsive vesicle trafficking Beige-like and Anchor protein (LRBA) defects. We report the clinical history and genetic results of 18 children with ES after excluding ALPS-FAS. Thirteen had organomegaly, five lymphocytic infiltration of non-lymphoid organs, nine hypogammaglobulinemia and fifteen anomalies in lymphocyte phenotyping. Seven patients had genetic defects: three CTLA4 mutations (c.151C>T; c.109+1092_568-512del; c.110-2A>G) identified by Sanger sequencing and four revealed by Next Generation Sequencing: LRBA (c.2450+1C>T), STAT3 gain-of-function (c.2147C>T; c.2144C>T) and KRAS (c.37G>T). No feature emerged to distinguish patients with or without genetic diagnosis. Our data on pediatric-onset ES should prompt physicians to perform extensive screening for mutations in the growing pool of genes involved in primary immune deficiencies with autoimmunity.



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Guidelines of care for the management of cutaneous squamous cell carcinoma

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human cancer and has an increasing annual incidence. Although most cSCC is cured with office-based therapy, advanced cSCC poses a significant risk for morbidity, impact on quality of life, and death. This document provides evidence-based recommendations for the management of patients with cSCC. Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease.

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Guidelines of care for the management of basal cell carcinoma

Basal cell carcinoma (BCC) is the most common form of human cancer, with a continually increasing annual incidence in the United States. When diagnosed early, the majority of BCCs are readily treated with office-based therapy, which is highly curative. In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC.

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Sclerosing microcystic adenocarcinoma of the tongue: a report of two further cases and review of the literature.

Publication date: Available online 9 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): A. Wood, B.I. Conn
We present two further cases of sclerosing microcystic adenocarcinoma occurring in the tongue of two female patients; one aged 68 years old and the other 49 years old. Histopathologically, both tumours were characterized by a diffusely infiltrative lesion consisting of small cuboidal cells arranged in discrete, dispersed cords, isolated tubules and bilayered strands with intervening microcystic lumina set in a sclerotic background. Both lesions showed striking neurotopism with perineural and intraneural infiltration. Extensive invasion of adjacent skeletal muscle was also observed. The tumour cells showed diffuse staining with antibodies to CK7. A dual population of ductal and myoepithelial cells was identified, with antibodies to CAM5.2 & CK5/6 decorating the inner epithelial layer and antibodies to p63, p40 and S100 staining the outer myoepithelial cell layer. The Ki-67 proliferation index in both cases was <5%. An initial diagnosis of adenocarcinoma NOS of salivary gland origin was made on both incisional biopsies with a possible metastatic origin, particularly from breast, also raised. A local minor salivary gland origin was confirmed after staging investigations and surgical resection. Both patients were treated by surgery alone and remain well five years and one year and two months post treatment respectively.



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