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RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations
FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares
A. Alegre-Sánchez
, P. Boixeda
Corresponding author
Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, Spain
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Aguayo-Carreras, F.J. Navarro-Triviño, R. Ruiz-Villaverde, S. Saenz-Guirado" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Aguayo-Carreras" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Saenz-Guirado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018300735" "doi" => "10.1016/j.ad.2017.07.025" "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/S0001731018300735?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901830372X?idApp=UINPBA000044" "url" => "/15782190/0000010900000010/v1_201812060634/S157821901830372X/v1_201812060634/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "915" "paginaFinal" => "916" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Alegre-Sánchez, P. Boixeda" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Alegre-Sánchez" "email" => array:1 [ 0 => "adrian.alegresanchez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Boixeda" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">To date, the gold-standard treatment for capillary malformations (CM) is pulsed dye laser (PDL). The lightening achieved is, however, incomplete and persistence or redarkening of the malformation appears to be the norm.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Revascularization of the lesions after laser treatment appears to be the reason for the varying efficacy of PDL in CM. Different topical antiangiogenic molecules have been tried in an attempt to halt this revascularization. Of these molecules, the most widely studied is rapamycin (RPM), for which studies of different kinds and with different results are available.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The antiangiogenic action of RPM works by inhibiting its specific target (mTOR). This action is conditioned by a reduction of vascular endothelial growth factor (VEGF) and other proangiogenic signals. RPM is known in dermatology for its considerable efficacy, when applied topically, in managing facial angiofibromas characteristic of tuberous sclerosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Experiments with mouse models have shown strong induction of proangiogenic genes between 3 and 7 days after exposure in conjunction with PDL. Application of 1% topical RPM appears to systematically reverse this induction.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Initial trials in healthy human skin with histologic monitoring showed that the combination of topical RPM once daily for 14 days, following the PDL session, inhibited normal vascular repair in the superficial and middle dermis, measured using immunohistochemical markers (CD31).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The first randomized, double-blind, intraindividual placebo-controlled clinical trial was carried out by a Spanish multicenter group. Twenty-three patients were enrolled in this trial. The combination of PDL (2 sessions) and 1% topical RPM (once daily for 12 weeks) showed greater clearance than the other combinations (PDL alone, topical placebo alone, and PDL with placebo). A limitation of that study is that PDL was only applied to the sides of the face, which are areas that generally respond better to PDL.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In more recent placebo-controlled trials, however, the combination of PDL and RPM has shown no greater efficacy of statistical significance than PDL alone.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a> One of these studies included 13 patients with nonfacial CM and the other study included 6 such patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In terms of the safety profile, only 1 case of allergic contact dermatitis has been reported in association with the use of RPM as an adjuvant to PDL.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> No cases of systemic toxicity have been reported.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In light of the available evidence, the use of RPM as an adjuvant to PDL in CM appears to have a solid foundation supported by quality research. Nevertheless, its real efficacy and optimum recommended dosage and formulation have yet to be determined.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another factor to be taken into account is the fact that RPM is not yet available for sale in Spain, which means that its use would be off-label. Furthermore, its formulation is expensive for patients and complicated for pharmacists.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1058701" "palabras" => array:4 [ 0 => "Capillary malformation" 1 => "Port-wine stain" 2 => "Rapamycin" 3 => "Pulsed-dye laser" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alegre-Sánchez A, Boixeda P. FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares. Actas Dermosifiliogr. 2018;109:915–916.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and Safety of Topical Sirolimus Therapy for Facial Angiofibromas in the Tuberous Sclerosis Complex" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Wataya-Kaneda" 1 => "A. Nakamura" 2 => "M. Tanaka" 3 => "M. Hayashi" 4 => "S. Matsumoto" 5 => "K. 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Prens" 3 => "M.B. van Doorn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cod.12589" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2016" "volumen" => "75" "paginaInicial" => "184" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27480514" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000010/v1_201812060634/S1578219018303718/v1_201812060634/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000010/v1_201812060634/S1578219018303718/v1_201812060634/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303718?idApp=UINPBA000044" ]
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| 2021 March | 60 | 36 | 96 |
| 2021 February | 66 | 39 | 105 |
| 2021 January | 30 | 33 | 63 |
| 2020 December | 32 | 24 | 56 |
| 2020 November | 30 | 23 | 53 |
| 2020 October | 19 | 15 | 34 |
| 2020 September | 30 | 25 | 55 |
| 2020 August | 24 | 30 | 54 |
| 2020 July | 18 | 20 | 38 |
| 2020 June | 27 | 31 | 58 |
| 2020 May | 17 | 13 | 30 |
| 2020 April | 14 | 10 | 24 |
| 2020 March | 15 | 12 | 27 |
| 2020 February | 1 | 0 | 1 |
| 2019 May | 2 | 0 | 2 |
| 2019 April | 0 | 1 | 1 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
Show all
