Case and Research Letters
Daylight Photodynamic Therapy in the Treatment of Actinic Keratosis in Carriers of Oculocutaneous Albinism: Report of Three Cases
Terapia fotodinámica con luz de día en el tratamiento de queratosis actínicas en pacientes portadores de albinismo oculocutáneo: presentación de 3 casos
L.E. Garcia Galvão
, R. Tomaz, H. de Sá Gonçalves
Corresponding author
Centro de Dermatología «Dona Libânia», Fortaleza, Brasil
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"apellidos" => "Borbujo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018304290" "doi" => "10.1016/j.ad.2018.02.028" "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/S0001731018304290?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301155?idApp=UINPBA000044" "url" => "/15782190/0000011000000005/v1_201906050857/S1578219019301155/v1_201906050857/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Daylight Photodynamic Therapy in the Treatment of Actinic Keratosis in Carriers of Oculocutaneous Albinism: Report of Three Cases" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "407" "paginaFinal" => "410" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.E. Garcia Galvão, R. Tomaz, H. de Sá Gonçalves" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.E." "apellidos" => "Garcia Galvão" "email" => array:1 [ 0 => "lgalvaodermato@yahoo.com.br" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Tomaz" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "de Sá Gonçalves" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Dermatología «Dona Libânia», Fortaleza, Brasil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia fotodinámica con luz de día en el tratamiento de queratosis actínicas en pacientes portadores de albinismo oculocutáneo: presentación de 3 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 712 "Ancho" => 1255 "Tamanyo" => 120672 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Treatment area before and after 24 weeks of follow up.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Oculocutaneous albinism (OCA) leads to hypopigmentation of the skin, hair and eyes .<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The most severe phenotype, OCA1, is characterized by the complete lack of melanin production; in subtypes, OCA2, OCA3, and OCA4, some pigment production occurs over the years.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Actinic keratosis (AK) are premalignant lesions of the skin, commonly located in areas exposed to ultraviolet (UV) radiation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> OCA patients have an exaggerated sensitivity to UV radiation, which leads the onset of AK lesions and squamous-cell carcinomas, even at young age.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In daylight PDT (DL-PDT), the activation of the photosensitizer protoporphyrin IX (PpIX) from the methylaminolevulinate (MAL) cream by visible light, allows the treatment of AK with less adverse effects of pain and erythema ,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> which favors its use as an alternative to conventional PDT in patients with excessive photosensitivity.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Other therapeutic options focused on the field of cancerization, such as imiquimod and 5-fluorouracil creams require long-term home treatment regimens and may lead to intense local skin reactions while, ingenol mebutate gel is usually limited to areas of up to 25 cm<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> . Thus, the treatment of AK with DL-PDT presents a number of advantages in patients with OCA, in comparison with other treatments.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2015, we treated the first patients with OCA at Dona Libânia Dermatology Center in Fortaleza, Brazil. There were three female patients, aged 22, 48 and 65 years old. The use of DL-PDT in patients with OCAs was approved by the local ethics committee.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the day of the procedure, after the curettage of facial AK lesions, a chemical filter with sun protection factor (SPF) 50 plus lotion (Actinica<span class="elsevierStyleSup">®</span>, Galderma, France) was applied on the face and other exposed areas. Subsequently, approximately 1 g of of the 16% MAL cream (Metvix<span class="elsevierStyleSup">®</span>, Galderma, France) was applied throughout the face, and patients stayed outdoors, in the shade, between 7:30 and 9:30 AM. After that, the MAL cream was removed, and patients were discharged, with the instruction to strictly maintain the use of sunscreen at home. AK lesions were counted before the session and after 4, 12 and 24 weeks of follow-up. The patients were also assessed, after 2<span class="elsevierStyleHsp" style=""></span>hours of exposure, for the occurrence and grade of local skin reactions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 66 facial AK lesions were treated in the three patients, all of whom completed the 24-week period of follow-up. Of the 66 treated lesions, 52 lesions (78.8%) were considered as clinically cured at weeks 4 and 12, and 50 lesions (75.8%) were considered as cured at week 24 (<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 to 3</a>). No pain or burning sensation was reported by any of the patients during the 2-hour shade period. The 22-year-old patient was the only one who presented moderate facial erythema immediate after the procedure, with mild pruritus during outdoor exposure (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). However, she reported being exposed to the sun for about 10<span class="elsevierStyleHsp" style=""></span>minutes during the 2-hour period with MAL cream. None of the three patients had adverse effects at the 4-week follow-up visit.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In the current study, we found that nearly 76% of the treated AK lesions could be considered cured after 6 months of follow-up. This cure rate is within the range found in the major European<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> and Australian<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> muticenter studies of DL-PDT. Since patients with OCA present with extensive AK, with a large number of lesions at an early age, it is important to develop alternative tratments that rapidly eliminate the lesions in large areas and with little local reaction.</p><p id="par0040" class="elsevierStylePara elsevierViewall">During DL-PDT, avoidance of exposure to direct UV radiation through permanence in the shade during the whole period of 2<span class="elsevierStyleHsp" style=""></span>hours is fundamental in patients with OCA. We observed moderate erythema immediately after the procedure in one of the patients, who, despite orientation, was exposed to sunlight for about 10<span class="elsevierStyleHsp" style=""></span>minutes. The city of Fortaleza is located at a low latitude (03°43’02” South), with average annual temperature of 26.3<span class="elsevierStyleHsp" style=""></span>°C. Such warm and sunny weather characteristics allow the use of DL-PDT throughout the year. On the other hand, patients with OCA undergoing DL-PDT in places with similar characteristics have to be carefully instructed about the procedure. Moreover, the use of SPF50 clothing and sunscreen is recommended during the 2-hour exposure in the shade. In our three patients, DL-PDT sessions were scheduled and performed early in the morning, with no overcast or rainy weather.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, DL-PDT may be an option in the treatment of multiple lesions of AK on the face of patients with OCA. One of the advantages of treating a wide area such as the face in a single day is the ability to maintain the daily activities of these patients, especially when compared with treatments that require a length of time at home and which may cause skin reactions, both of which can impair adherence to treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-19" "fechaAceptado" => "2018-02-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garcia Galvão LE, Tomaz R, de Sá Gonçalves H. Daylight Photodynamic Therapy in the Treatment of Actinic Keratosis in Carriers of Oculocutaneous Albinism: Report of Three Cases. Actas Dermosifiliogr. 2019;110:407–410.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 832 "Ancho" => 1255 "Tamanyo" => 128773 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical improvement after 6 months of DL-PDT.</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" => 828 "Ancho" => 1255 "Tamanyo" => 130198 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Field cancerization of the skin before and 6 months after DL-PDT session.</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" => 712 "Ancho" => 1255 "Tamanyo" => 120672 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Treatment area before and after 24 weeks of follow up.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1010 "Ancho" => 755 "Tamanyo" => 82514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Moderate facial erythema immediately after the 2-hour outdoor exposition.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "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" => "Oculocutaneous albinism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 9 | 18 |
| 2024 October | 74 | 45 | 119 |
| 2024 September | 87 | 28 | 115 |
| 2024 August | 105 | 61 | 166 |
| 2024 July | 92 | 27 | 119 |
| 2024 June | 84 | 29 | 113 |
| 2024 May | 102 | 43 | 145 |
| 2024 April | 68 | 19 | 87 |
| 2024 March | 73 | 26 | 99 |
| 2024 February | 48 | 31 | 79 |
| 2024 January | 56 | 29 | 85 |
| 2023 December | 43 | 17 | 60 |
| 2023 November | 80 | 29 | 109 |
| 2023 October | 59 | 28 | 87 |
| 2023 September | 62 | 41 | 103 |
| 2023 August | 41 | 12 | 53 |
| 2023 July | 46 | 39 | 85 |
| 2023 June | 48 | 22 | 70 |
| 2023 May | 43 | 21 | 64 |
| 2023 April | 42 | 22 | 64 |
| 2023 March | 52 | 28 | 80 |
| 2023 February | 56 | 17 | 73 |
| 2023 January | 53 | 42 | 95 |
| 2022 December | 65 | 46 | 111 |
| 2022 November | 54 | 32 | 86 |
| 2022 October | 39 | 23 | 62 |
| 2022 September | 38 | 36 | 74 |
| 2022 August | 29 | 30 | 59 |
| 2022 July | 29 | 45 | 74 |
| 2022 June | 29 | 25 | 54 |
| 2022 May | 44 | 34 | 78 |
| 2022 April | 47 | 32 | 79 |
| 2022 March | 51 | 45 | 96 |
| 2022 February | 48 | 26 | 74 |
| 2022 January | 55 | 33 | 88 |
| 2021 December | 40 | 37 | 77 |
| 2021 November | 47 | 45 | 92 |
| 2021 October | 44 | 47 | 91 |
| 2021 September | 46 | 46 | 92 |
| 2021 August | 41 | 24 | 65 |
| 2021 July | 28 | 22 | 50 |
| 2021 June | 34 | 28 | 62 |
| 2021 May | 28 | 31 | 59 |
| 2021 April | 69 | 73 | 142 |
| 2021 March | 61 | 19 | 80 |
| 2021 February | 45 | 24 | 69 |
| 2021 January | 32 | 17 | 49 |
| 2020 December | 25 | 11 | 36 |
| 2020 November | 17 | 19 | 36 |
| 2020 October | 23 | 15 | 38 |
| 2020 September | 44 | 14 | 58 |
| 2020 August | 24 | 20 | 44 |
| 2020 July | 22 | 15 | 37 |
| 2020 June | 22 | 22 | 44 |
| 2020 May | 19 | 13 | 32 |
| 2020 April | 8 | 10 | 18 |
| 2020 March | 17 | 5 | 22 |
| 2020 February | 1 | 0 | 1 |
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