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Guinovart, I. Bielsa, G. Pintos-Morell, C. Ferrándiz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R.M." "apellidos" => "Guinovart" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Bielsa" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Pintos-Morell" ] 3 => array:2 [ "nombre" => "C." 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"apellidos" => "García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012003432" "doi" => "10.1016/j.ad.2012.06.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012003432?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000450?idApp=UINPBA000044" "url" => "/15782190/0000010400000003/v1_201304241622/S1578219013000450/v1_201304241622/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Porokeratosis of Mibelli: A New Indication for Photodynamic Therapy?" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "259" "paginaFinal" => "261" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Gutiérrez Paredes, R. Bella Navarro, E. Montesinos Villaescusa, E. Jordá Cuevas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Gutiérrez Paredes" "email" => array:1 [ 0 => "ev_gutierrez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Bella Navarro" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Montesinos Villaescusa" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá Cuevas" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Poroqueratosis de mibelli, ¿una nueva indicación de la terapia fotodinámica?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1778 "Ancho" => 1335 "Tamanyo" => 435645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification ×20. Cornoid lamella (column of parakeratosis associated with hypogranulosis and dyskeratosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Porokeratosis is a skin keratinization disorder that gives rise to a number of clinical variants; the underlying disorder can be acquired or hereditary. Clinically, it presents as a macule or annular plaque characterized by a central atrophic patch surrounded by a clearly defined hyperkeratotic border. Histology shows a compact parakeratotic column known as a cornoid lamella. The various clinical forms of the disease are defined by the number and distribution of the lesions: porokeratosis of Mibelli, disseminated superficial actinic porokeratosis, linear porokeratosis, porokeratosis palmaris et plantaris disseminata, and punctate porokeratosis. Although the lesions are benign, some of their characteristics are associated with a greater risk of malignant transformation, hence the importance of deciding how to approach these lesions and knowing the different therapeutic options available.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of an 82-year-old woman with no relevant personal medical history, who visited our department with a skin lesion on the anterior aspect of her left leg that had grown gradually over 2-3 years. The solitary, erythematous, rounded plaque measuring 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm had well defined margins and was covered by a whitish scale (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The results of a skin biopsy revealed cornoid lamellae with no signs of cellular atypia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). On the basis of both the clinical examination and histology report, a diagnosis of porokeratosis of Mibelli was established. Because of the size and location of the lesion, photodynamic therapy (PDT) was proposed as a good therapeutic option. A cream containing methyl 5-aminolevulinate (MAL) was applied to the lesion, which was then covered with occlusive dressings for 3<span class="elsevierStyleHsp" style=""></span>hours. The cream used was Metvix. Upon removal of the dressings, the whole surface of the lesion was observed to emit intense red fluorescence under ultraviolet light. The lesion was then exposed to red light from an LED lamp (Aktilite, 37<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>) for 9<span class="elsevierStyleHsp" style=""></span>minutes. Two weeks later, the area of treated skin was ulcerated, perhaps as a result of exposure of the lesion to sunlight a few hours after the treatment; a new session of PDT was therefore ruled out and local therapies were prescribed. Three months after the PDT session, the lesion had almost completely resolved and only a slightly erythematous, crusted area remained (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The pathogenesis of porokeratosis is still poorly understood and the disorder is thought to be the result of the proliferation of abnormal clones of keratinocytes induced by the interaction of genetic factors, immunosuppression, and environmental triggers such as exposure to sunlight. The association with irradiation explains why the lesions are more often located in sun-exposed areas of the body and are more evident in summer.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Although these chronic lesions are benign, all clinical forms of porokeratosis are associated with some risk of malignant transformation. Large, long-standing, or linear lesions and those that present in elderly or immunocompromised patients have the greatest risk of malignant transformation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Reported neoplasms, in order of frequency, are Bowen disease, epidermoid carcinoma, and basal cell carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Because of the risk of malignancy, it is important to consider the best approach to take when presented with this dermatosis and to know the different therapeutic options available.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The fact that many different therapies are used is indicative of the lack of an ideal treatment that is safe and effective; each case should therefore be evaluated on an individual basis. In the case of multiple, disseminated lesions, the most appropriate approach may be watchful waiting and biopsy of the lesions in which malignant transformation is suspected.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Usual treatments include the following: calcipotriol, tacalcitol, 5-fluorouracil, imiquimod, topical and systemic retinoids, laser therapy, cryotherapy, dermabrasion, and surgical excision.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> PDT is approved for the treatment of actinic keratosis, superficial and nodular basal cell carcinoma, and Bowen disease. Its use has recently been extended to a number of infectious and inflammatory skin disorders and certain cancers; the results reported to date indicate varying degrees of efficacy.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> PDT has been used to treat porokeratosis on the basis of the clinical and histological similarities between this disorder and actinic keratosis. Moreover, it is a safe, well tolerated technique associated with good cosmetic results and minimal side effects. However, the results of the few documented cases are contradictory. Most studies have been carried out in patients with disseminated superficial actinic porokeratosis and various photosensitizing agents have been used (δ-aminolevulinic acid, MAL, and hypericin), all with poor results. The lesions resolved in only 1 case,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and improved slightly or remained unchanged in the others.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> In the literature, we found only 1 case of porokeratosis of Mibelli that had been successfully treated with PDT. Unlike our case, those authors used a single session of PDT with MAL and blue light in combination with daily application of 5-fluorouracil cream.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While the normal PDT regimen in the treatment of most skin disorders involves more than 1 session, we were only able to apply a single session in the present case owing to the appearance of side effects, and this may explain the incomplete response obtained. However, it is also possible that the immunomodulatory effect of PDT and the inflammation already present in the lesion (visible in the clinical and histological images) may have favored a good therapeutic response with just 1 session. Ulceration is a rare adverse event,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and its appearance was probably due in some measure to the fact that the patient was an elderly woman and the leg was exposed to sunlight after treatment, contrary to express instructions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, we report a case of porokeratosis of Mibelli in which treatment with PDT obtained a partial response. Nevertheless, because the results achieved with photodynamic therapy in the treatment of porokeratosis are highly varied, we believe that further studies with larger series of cases are needed if we are to reach clear conclusions regarding its utility in this setting.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Gutiérrez Paredes E, et al. Poroqueratosis de mibelli, ¿ una nueva indicación de la terapia fotodinámica? Actas Dermosifiliogr. 2013;104:259–61.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1778 "Ancho" => 1335 "Tamanyo" => 303348 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous plaque measuring 4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm, covered with a thick, whitish scale.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1778 "Ancho" => 1335 "Tamanyo" => 435645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification ×20. Cornoid lamella (column of parakeratosis associated with hypogranulosis and dyskeratosis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1778 "Ancho" => 1335 "Tamanyo" => 222041 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mild erythema and desquamation 3 months after the photodynamic therapy session.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of porokeratosis of Mibelli with combined use of photodynamic therapy and fluorouracil cream" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 24 | 14 | 38 |
2024 October | 118 | 72 | 190 |
2024 September | 147 | 45 | 192 |
2024 August | 146 | 77 | 223 |
2024 July | 120 | 44 | 164 |
2024 June | 148 | 47 | 195 |
2024 May | 99 | 42 | 141 |
2024 April | 92 | 23 | 115 |
2024 March | 98 | 47 | 145 |
2024 February | 97 | 37 | 134 |
2024 January | 74 | 43 | 117 |
2023 December | 100 | 32 | 132 |
2023 November | 110 | 38 | 148 |
2023 October | 128 | 38 | 166 |
2023 September | 104 | 38 | 142 |
2023 August | 90 | 37 | 127 |
2023 July | 109 | 42 | 151 |
2023 June | 106 | 46 | 152 |
2023 May | 154 | 42 | 196 |
2023 April | 107 | 37 | 144 |
2023 March | 101 | 41 | 142 |
2023 February | 70 | 21 | 91 |
2023 January | 51 | 32 | 83 |
2022 December | 68 | 47 | 115 |
2022 November | 48 | 40 | 88 |
2022 October | 42 | 27 | 69 |
2022 September | 59 | 50 | 109 |
2022 August | 44 | 33 | 77 |
2022 July | 70 | 41 | 111 |
2022 June | 36 | 21 | 57 |
2022 May | 46 | 31 | 77 |
2022 April | 55 | 43 | 98 |
2022 March | 76 | 47 | 123 |
2022 February | 79 | 20 | 99 |
2022 January | 71 | 39 | 110 |
2021 December | 75 | 45 | 120 |
2021 November | 93 | 36 | 129 |
2021 October | 98 | 46 | 144 |
2021 September | 88 | 43 | 131 |
2021 August | 72 | 25 | 97 |
2021 July | 98 | 38 | 136 |
2021 June | 102 | 39 | 141 |
2021 May | 81 | 41 | 122 |
2021 April | 147 | 80 | 227 |
2021 March | 100 | 27 | 127 |
2021 February | 93 | 35 | 128 |
2021 January | 70 | 18 | 88 |
2020 December | 48 | 18 | 66 |
2020 November | 34 | 16 | 50 |
2020 October | 35 | 8 | 43 |
2020 September | 30 | 10 | 40 |
2020 August | 43 | 20 | 63 |
2020 July | 39 | 17 | 56 |
2020 June | 39 | 20 | 59 |
2020 May | 24 | 17 | 41 |
2020 April | 37 | 22 | 59 |
2020 March | 32 | 21 | 53 |
2020 February | 3 | 14 | 17 |
2020 January | 0 | 8 | 8 |
2019 December | 4 | 8 | 12 |
2019 November | 0 | 6 | 6 |
2019 October | 0 | 4 | 4 |
2019 September | 4 | 2 | 6 |
2019 August | 2 | 6 | 8 |
2019 July | 0 | 12 | 12 |
2019 June | 12 | 11 | 23 |
2019 May | 0 | 35 | 35 |
2019 April | 0 | 49 | 49 |
2019 March | 2 | 19 | 21 |
2019 February | 0 | 2 | 2 |
2019 January | 2 | 4 | 6 |
2018 December | 5 | 2 | 7 |
2018 November | 3 | 0 | 3 |
2018 October | 3 | 0 | 3 |
2018 September | 4 | 2 | 6 |
2018 August | 0 | 3 | 3 |
2018 July | 0 | 1 | 1 |
2018 June | 0 | 4 | 4 |
2018 May | 0 | 13 | 13 |
2018 April | 0 | 2 | 2 |
2018 March | 6 | 1 | 7 |
2018 February | 38 | 8 | 46 |
2018 January | 54 | 12 | 66 |
2017 December | 66 | 5 | 71 |
2017 November | 43 | 12 | 55 |
2017 October | 59 | 10 | 69 |
2017 September | 50 | 13 | 63 |
2017 August | 48 | 26 | 74 |
2017 July | 46 | 9 | 55 |
2017 June | 81 | 15 | 96 |
2017 May | 51 | 14 | 65 |
2017 April | 68 | 16 | 84 |
2017 March | 48 | 7 | 55 |
2017 February | 46 | 10 | 56 |
2017 January | 49 | 18 | 67 |
2016 December | 52 | 12 | 64 |
2016 November | 101 | 14 | 115 |
2016 October | 98 | 23 | 121 |
2016 September | 143 | 14 | 157 |
2016 August | 110 | 21 | 131 |
2016 July | 57 | 6 | 63 |
2016 June | 7 | 10 | 17 |
2016 May | 5 | 9 | 14 |
2016 April | 4 | 16 | 20 |
2016 March | 4 | 15 | 19 |
2016 February | 6 | 2 | 8 |
2016 January | 6 | 2 | 8 |
2015 December | 4 | 3 | 7 |
2015 November | 7 | 1 | 8 |
2015 October | 5 | 2 | 7 |
2015 September | 8 | 2 | 10 |
2015 August | 13 | 2 | 15 |
2015 July | 92 | 110 | 202 |
2015 June | 78 | 11 | 89 |
2015 May | 100 | 24 | 124 |
2015 April | 69 | 12 | 81 |
2015 March | 43 | 5 | 48 |
2015 February | 45 | 3 | 48 |
2015 January | 37 | 6 | 43 |
2014 December | 49 | 4 | 53 |
2014 November | 28 | 7 | 35 |
2014 October | 47 | 2 | 49 |
2014 September | 29 | 7 | 36 |
2014 August | 25 | 4 | 29 |
2014 July | 22 | 7 | 29 |
2014 June | 43 | 6 | 49 |
2014 May | 59 | 7 | 66 |
2014 April | 43 | 3 | 46 |
2014 March | 47 | 15 | 62 |
2014 February | 42 | 7 | 49 |
2014 January | 56 | 5 | 61 |
2013 December | 35 | 11 | 46 |
2013 November | 37 | 8 | 45 |
2013 October | 21 | 3 | 24 |
2013 September | 30 | 8 | 38 |
2013 August | 25 | 8 | 33 |
2013 July | 12 | 4 | 16 |
2013 June | 7 | 5 | 12 |
2013 May | 5 | 5 | 10 |
2013 April | 3 | 4 | 7 |