Randomized controlled trial comparing 35% trichloroacetic acid peel and 5-aminolevulinic acid photodynamic therapy for the treatment of multiple actinic keratosis

Summary

Background

Photodynamic therapy (PDT) and chemical peels with trichloroacetic acid (TCA) can be applied to larger skin areas and thus are suitable treatment options for patients with multiple actinic keratosis (AK). Despite its long use TCA has, however, only been investigated rarely in this indication.

Objectives

This randomized, observer-blinded, intrapatient comparison study sought to investigate the efficacy and safety of 35% TCA versus 20% aminolevulinic acid PDT (ALA PDT) in patients with extensive field cancerisation and multiple AK in the face or on the scalp.

Methods

28 patients with at least 5 AK in two comparable anatomical areas on the head were treated with 35% TCA and ALA PDT randomly assigned to each area. Therapeutic efficacy, adverse events and cosmetic outcome were assessed by a blinded investigator at 1, 3, 6 and 12 months after treatment.

Results

After 12-months follow up TCA and ALA PDT reduced the total lesion count, the primary outcome, by 31,9% and 58,0%, respectively (p=0,006). Complete clearance of preexisting AK were 48,8% for TCA and 73,7% for ALA PDT (p=0,011). Treatment failure (Number of AK greater than 50% of the baseline count) was observed in 7 patients (25%) after TCA and in 2 patients (7,1%) after PDT treatment. Treatment-related pain was significantly higher for ALA PDT (VAS 7,5±2,3 vs TCA: 5,1±2,6; p=0,04) whereas scarring (n=6, 21,4%) was only seen in TCA treated patients.

Conclusions

ALA PDT provided better clinical results than TCA in the treatment of patients with extensive field cancerisation and multiple AK.

This article is protected by copyright. All rights reserved.

http://ift.tt/2i1uSPv

A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate to dark skin patients

Abstract

Background

Atopic dermatitis (AD) assessment is more difficult in patients with skin of colour (SOC). We sought to compare the reliability of commonly used outcome measures for assessing AD in SOC patients and evaluated a novel greyscale in this population.

Method

Twenty-five AD patients each attended a one-day scoring exercise based in either Sydney or Melbourne, Australia. Each patient was scored by the same five physicians using the Eczema Area Severity Index (EASI), objective-Scoring Atopic Dermatitis score (oSCORAD), Investigator's Global Assessment (IGA) and a novel greyscale. Patients also completed the Patient-Oriented Eczema Measure (POEM) and quality of life measures. A mexameter was used for measuring baseline melanin indices. Ten random patients were re-scored to test intra-rater reliability.

Results

We included 11 light skinned patients (melanin index ≤200) and 14 SOC patients (melanin index >200) in the cohort. The inter-rater ICCs were: EASI 0.827 (95% CI 0.658-0.941) for light skin and 0.774 (95% CI 0.598-0.906) for SOC; oSCORAD 0.680 (95% CI 0.441-0.880) for light skin and 0.736 (95%CI 0.544-0.889) for SOC; IGA 0.803 (95%CI 0.618-0.932) for light skin and 0.696 (95%CI 0.490-0.868) for SOC; the greyscale had an ICC of 0.776 (95%CI: 0.601-0.907) when replacing the EASI's erythema scale for SOC patients. All scores showed excellent intra-rater reliability for all skin types. Erythema component analysis showed that erythema did not contribute to variability.

Conclusions

EASI showed excellent reliability for patients of all skin colours, and is recommended as the optimal core measure for patients with all skin colours.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hhpkBq

Treatment Patterns and Outcomes among Adults Admitted to Hospital in the United Kingdom (UK) due to Plaque or Erythrodermic Psoriasis

Abstract

The National Institute for Health and Care Excellence (NICE) identified treatment of moderate-to-severe psoriasis as an area for research.^1-2 No recent studies have assessed treatment patterns and outcomes among patients hospitalised for psoriasis in the UK.^3-5

This study evaluated clinician- and patient-reported outcomes, treatment patterns, and hospital length of stay (LOS) in patients admitted to hospital for plaque or erythrodermic psoriasis, and enrolled 61 eligible patients across 9 UK hospital sites from 15 November 2013 to 2 June 2014.

This article is protected by copyright. All rights reserved.

http://ift.tt/2i1pqvY

Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: A cohort study

Abstract

Background

Organ transplant recipients have a highly increased risk of cutaneous squamous cell carcinomas. Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive cutaneous squamous cell carcinomas in organ transplant recipients.

Objectives

The impact of painful compared to painless skin lesions and cutaneous squamous cell carcinoma (SCC) compared to other skin lesions on the overall mortality risk in organ transplant recipients (OTR) was investigated.

Methods

We followed 410 OTR from 10 different centres across Europe and North America during the period between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis and risk factors were analysed with Cox proportional hazard analysis.

Results

There was an increased overall mortality risk in OTR who reported painful compared to painless skin lesions with a hazard ratio adjusted for age, sex, and other relevant factors of 1.6 (95% CI 0.97-2.7). There was also an increased overall mortality risk in OTR diagnosed with SCC compared to other skin lesions with an adjusted hazard ratio of 1.7 (95% CI 1.0-2.8). Mortality due to internal malignancies and systemic infections appeared to prevail in OTR with SCC.

Conclusions

We suggest that OTR have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hhnpwG

Development of a Multidimensional Assessment Tool for Uremic Pruritus in Dialysis Patients (UP-Dial)

Abstract

Background

Dialysis patients with uremic pruritus (UP) have a significantly impaired quality of life. To assess the therapeutic effect of UP treatments, a well-validated comprehensive and multidimensional instrument needed to be established.

Objectives

To develop and validate a multidimensional scale assessing the UP in dialysis patients: Uremic Pruritus in Dialysis Patients (UP-Dial).

Methods

The development and validation of the UP-Dial instrument was conducted in four phases: (1) item generation, (2) development of pilot questionnaire, (3) refinement of questionnaire with patient recruitment, and (4) psychometric validation. Participants completed the UP-Dial, the visual analogue scale (VAS) of UP, the Dermatology Life Quality Index (DLQI), the Kidney Disease Quality of Life-36 (KDQOL-36), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI) during May 15, 2012 to November 30, 2015.

Results

The 27-item pilot UP-Dial was generated with 168 participants completing the pilot scale. After factor analysis was performed, the final 14-item UP-Dial encompassed the structure of three domains: signs and symptoms, psychosocial, and sleep. Face and content validity were satisfied through the item generation process and review of experts. The psychometric analysis demonstrated that the UP-Dial had good convergent validity and discriminant validity. The UP-Dial was significantly correlated (Spearman rank, [95% CI]) with the VAS-UP (0.76 [0.69 to 0.83]), DLQI (0.78 [0.71 to 0.85]), KDQOL-36 (-0.86 [-0.91 to -0.81]), PSQI (0.85 [0.80 to 0.89]), and BDI (0.70 [0.61 to 0.79]). The UP-Dial revealed excellent internal consistency (Cronbach's α 0.90 [0.87 to 0.92]) and reproducibility (intraclass correlation 0.95 [0.90 to 0.98]).

Conclusions

The UP-Dial is valid and reliable for assessing UP among dialysis patients. Future research should increase the cross-cultural adaptation and translation of the scale to other languages.

This article is protected by copyright. All rights reserved.

http://ift.tt/2i1ogAE

Hyperspectral imaging in detecting dermal invasion in lentigo maligna melanoma

Abstract

Invasive lentigo maligna melanoma (LMM) and its in situ precursor lentigo maligna (LM) are the most common melanoma types on the head and neck areas ¹. Clinically unsuspected invasion is revealed histologically in 5-52% of LMs ². Thus, correct early diagnoses are crucial for determining accurate resection margins and the discussion of sentinel lymph node examination ³.

Hyperspectral imaging is based on the detection of spectral differences reflecting a tissue's biological properties and can be used for detecting skin malignancies ^4,5.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hhiZpM

Biopsy correlation of surface area vs single axis measurements on CT scan of lymph nodes in patients with erythrodermic mycosis fungoides and Sezary syndrome

Abstract

Sezary syndrome (SS) presents with erythroderma, leukaemic blood involvement and frequent lymphadenopathy whilst 15% of mycosis fungoides (MF) patients present with erythroderma¹. Staging of patients with erythrodermic (e)MF/SS includes IIIA, IIIB, IVA or IVB dependant on blood, lymph node (LN) or visceral involvement².

In MF/SS; an abnormal LN is either firm, irregular, clustered, or fixed on examination or ≥15mm on imaging. Excisional biopsy is indicated of the largest, most suspicious node ^{2 −4}.

This article is protected by copyright. All rights reserved.

http://ift.tt/2i1rR1o