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Quality of Life and Side Effects in Patients with Actinic Keratosis Treated With Ingenol Mebutate: A Pilot Study
Calidad de vida y efectos secundarios en los pacientes con queratosis actínica tratados con ingenol mebutato-estudio piloto
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"apellidos" => "Bauzá-Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Martín-Santiago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Jones-Caballero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, University of Sydney, Australia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calidad de vida y efectos secundarios en los pacientes con queratosis actínica tratados con ingenol mebutato-estudio piloto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1173 "Ancho" => 1673 "Tamanyo" => 150626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Change in clinical response from week 3 to month 3.NR indicates no response; CR1, clinical response at week 3; and CR2, clinical response at month 3.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A European study found the prevalence of actinic keratosis (AK) to be 15.4% in men and 5.9% in women and reported a strong association with age in both sexes, with a prevalence of 34.1% and 18.2%, respectively, in men and women aged 70 years or more.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Approximately 10% of AKs will progress to squamous cell carcinomas, and this figure rises to 40% in immunodeficient patients.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A review of published economic studies on the treatment of AK has estimated the direct cost of AK management in the US at $US1.2 billion per year, with 6% spent on topical therapy, 43% on office visits, and 51% on destructive procedures.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Greater understanding of the pathophysiological changes leading from AK to malignancy and the increasing global prevalence of AK has led to a new focus on the importance of combining local treatments to remove individual lesions with topical or procedural field therapies that treat the entire actinically damaged field.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> According to the treatment algorithm, individually tailored treatment should be started as soon as AK is diagnosed.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> The following important considerations should be taken into account when developing a comprehensive treatment plan: treatment-related factors (efficacy, safety, tolerance, and long-term outcomes); disease- and patient-related factors (number, location, and extension of lesions, age, comorbidity, mental status, history of skin cancer, prior treatments, costs, and patient preferences); and physician-related factors (experience with the procedure, availability, and preferences).<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several different topical treatments for AK are currently available. Outcomes in terms of clinical response and side effects vary, and most therapies require treatment over a period of weeks.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> The prolonged duration of treatment and the presence of side effects, which may include pain, discomfort, and disruption of daily activities, can affect the patient's quality of life (QoL) and reduce adherence to treatment,<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9–12</span></a> which is already poor in topical therapies.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> To improve adherence and, ultimately, to ensure QoL, it is important to identify options requiring a shorter treatment duration and offering more rapid resolution of local skin reactions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ingenol mebutate (IM), which was approved by the European Medicines Agency as a treatment for AK in November 2012, has demonstrated efficacy in clearing AK lesions on the face, scalp, trunk, and extremities.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14–16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this pilot study in patients with AKs was to evaluate the following outcomes in clinical practice: effect of IM on QoL, patient satisfaction with treatment, clinical efficacy, and side effects.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Nineteen patients with AK were enrolled in this prospective, non-randomized pilot study. Eligible patients were adults (>18 years old) with a clinical diagnosis of AK affecting any part of the body in whom treatment with IM was not contraindicated. Patients were recruited consecutively over a 6-week period (15 November 2013 to 28 December 2013) independently of whether or not they had received previous treatment for AK. As the aim of this study was to assess the treatment in clinical practice, patients were instructed to apply the standard dose of gel over the total area affected.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the Declaration of Helsinki and local laws and regulations and was approved by the Institutional Review Board of the Hospital Universitari Son Espases, Palma de Mallorca, Spain. All patients provided written informed consent.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This prospective study included 4 visits: visit 1 at baseline; visit 2 on day 3 (patients with lesions on the trunk or extremities) or day 4 (patients with face and scalp lesions); visit 3 at week 3; and visit 4 after 3 months (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). At visit 1 patient received IM, which they then applied for 2 consecutive days if their lesions were on the trunk or extremities or 3 consecutive days in the case of face and scalp lesions. Patients were also given fusidic acid in case inflammation occurred and were instructed in all cases to apply sun block.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The following data were collected at baseline: patient characteristics (sex, age and skin phototype); disease characteristics (time since initial diagnosis, prior AK treatments used in the previous 3 months; lesion size (measured using a millimeter ruler); and any clinical history of non-melanoma skin cancer (NMSC) or melanoma. The primary end points were patient QoL and treatment satisfaction. To assess QoL we used the validated Spanish version<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> of Skindex-29, a questionnaire specifically designed to assess QoL in patients with dermatological conditions.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18,19</span></a> Each question on the survey was rated by the patients on a 5-point scale, with response choices and corresponding scores ranging from “never” (0) to “all the time” (100); the lower the final score, the better the patient's overall QoL. The overall QoL score can be divided into 3 subscales, which correspond to the patient's emotional state, symptom severity, and functional state. Patients completed the questionnaire at baseline and at visit 3.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patient satisfaction with treatment was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM). The TSQM 1.4 is a 14-item psychometrically robust and validated instrument comprising 4 domains<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a>: effectiveness (questions 1–3), side effects (questions 4–8), convenience (questions 9–11), and global satisfaction (questions 12–14). TSQM 1.4 domain scores range from 0 to 100, with higher scores representing higher satisfaction in that domain. The TSQM questionnaire was completed at baseline by patients who had received any treatment in the 3 months prior to inclusion in the study and by all patients at week 3.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Secondary end points were the results of the assessment of local skin responses (LSRs) and clinical response. To ensure uniform reporting, LSRs were assessed quantitatively using a grading scale and photographic guide images, a method similar to that used in published studies with IM.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14,15,21</span></a> The following responses were assessed on a scale that ranged from 0 to 4 (with higher numbers indicating more severe reactions): swelling, vesiculation or pustulation, erosion or ulceration, flaking or scaling, crusting, and erythema. The composite LSR score was defined as the sum of the 6 individual scores (maximum composite score, 24).<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> LSR were assessed at visits 2 and 3.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Clinical response was assessed at visit 3 and at the end of the study (visit 4). Response was assessed by the investigator using a 6-point scale, as follows: worsening or no change compared to baseline (0); improvement of less than 25% (1); improvement of 25–49% (2); improvement of 50–75% (3); improvement greater than 75% (4), and complete response, that is, complete clinical disappearance of the lesion (5). The degree of infiltration, erythema, and flake injury was also considered.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The data were analyzed using SPSS version 21.0 (IBM Corporation). The qualitative variables were described using absolute frequencies and percentages. Standard descriptive statistics, such as median, interquartile range (Q1–Q3), minimum, and maximum, were calculated. Non-parametric statistics for paired data were used for comparisons. Missing data were not imputed.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">The study enrolled 19 subjects (17 men and 2 women). The mean age was 76 years and the mean interval since diagnosis was 44 months. Almost half of the participants had facial lesions and 58% had a clinical history of NMSC. The 13 patients who had AK lesions which had proven refractory to earlier treatments completed the TSQM questionnaire at baseline and visit 3; the other 6 patients were treatment-naive and completed the TSQM questionnaire only at visit 3 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The demographic details and baseline clinical characteristics of the patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Primary end points</span><p id="par0080" class="elsevierStylePara elsevierViewall">The change in QoL was measured by comparing the results of the Skindex-29 questionnaire obtained at baseline and at the end of the study (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). After IM treatment, significant improvement was observed in the subscales relating to the patients’ emotional state (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.026) and to symptom severity (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.041), as well as in the overall score (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.014). A trend toward improvement in functional state was also observed (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.066).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The TSQM 1.4 results from visit 3 were compared with those obtained at the baseline visit in patients who had received prior AK treatments (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). In this group, median scores for effectiveness, convenience, and global satisfaction were higher at week 3—after IM treatment—than at baseline (assessment of prior treatment). The greatest differences between the assessment of prior treatment and IM were observed in convenience (median scores of 66.7 vs. 83.3, respectively) and global satisfaction (median scores of 61.1 vs. 69.4, respectively). The differences observed were not statistically significant in any of the 4 domains, but a trend toward a better global satisfaction score with IM as compared to previous treatments was observed (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.059).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The TSQM 1.4 results for IM were also compared to those corresponding to each previous treatment (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). Imiquimod 5% and IM had the highest median scores for effectiveness, 72.2 in both cases. Imiquimod 5%, cryotherapy, and photodynamic therapy had the highest scores for satisfaction with respect to side effects (a median of 93.8, in all 3 cases). IM had the highest score related to satisfaction with the convenience of treatment (median of 83.3). Finally, the highest score for global satisfaction was observed in patients treated with imiquimod 5% and IM, with median scores of 72.9 and 69.4, respectively (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Secondary end points</span><p id="par0095" class="elsevierStylePara elsevierViewall">IM was applied for 2 consecutive days on lesions on the trunk or extremities and for 3 consecutive days on facial and scalp lesions. Side effects were assessed on day 3 or 4, that is, the day after the treatment was completed (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). The LSRs with the highest median score were erythema, crusting, and flaking or scaling (2.0, in all 3 cases). The median composite LSR score was 8.0. All LSRs had resolved by week 3.</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Average lesion size was 97.0<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> before treatment and 42.2<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> after treatment, an average reduction of 54.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> (95% CI, 25.1–84.4; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001).</p><p id="par0105" class="elsevierStylePara elsevierViewall">The percentage of patients with an improvement in clinical response of at least 75% was 26.4% at week 3 and had doubled by month 3 (52.6%). The difference in clinical response between these 2 periods was statistically significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.008) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Apart from their association with malignancy, AK lesions also have a significant impact on patients’ QoL.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11,22</span></a> The authors of a study of QoL in patients with NMSC reported that 43% of patients with moderate QoL impairment and 33% with severe QoL impairment had AK.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Moreover, the long duration of treatment and the presence of side effects can also affect QoL.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Three weeks after completing treatment with IM, the patients in the present study reported improvement in all 3 subscales of the Skindex-29 questionnaire (emotional state, symptom severity, and functional state) and in the overall score, as compared with the assessment of prior treatments made at baseline; these differences were statistically significant in the subscales relating to symptom severity and the patient's emotional state, and in the overall score. A pooled analysis of data from clinical trials in patients treated with IM in the US and Australia reported results in all Skindex subscales similar to those observed in the present study.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">An earlier study focusing on the effects of photodynamic therapy on QoL in patients with AK highlighted the impact of side effects on QoL.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> In that study the Dermatology Life Quality Index (DLQI) score rose from 1.6 before treatment to 7.3 after completion of photodynamic therapy as a result of side effects. However, as the intensity of side effects decreased after treatment, the DLQI decreased to 4.4 (at 2 weeks) and 0.1 (at 4 weeks). A recently published QoL questionnaire specifically designed for AK<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> has just been validated in Spanish and could be used in future studies.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In the case of side effects, our results showed that on the day after completion of treatment the median LSR score was 2 or less in all the LSR assessed (flaking or scaling, swelling, vesiculation or pustulation, erosion or ulceration, erythema, and crusting), and the composite LSR score was 8.0, which is considered to be low to intermediate intensity (≤12). All LSR had resolved by week 3, an important consideration because with other topical treatments, such as imiquimod, side effects tend to peak during the first 2 weeks of treatment and resolve 3–4 weeks after cessation of treatment at week 4.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> The results with respect to side effects in the present study are in line with those reported in clinical trials in the US and Australia, which showed that most patients treated with IM had a maximum composite LSR score of 12 or less.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Moreover, similar results were reported previously in patients with AK treated with IM, with a mean maximum composite LSR of 9.1 for patients with AK on the face or scalp and 6.8 for patients with AK on the trunk or extremities.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> Other authors have reported that the composite score peaked on day 3 or 4 (the day after completion of treatment) and that side effects had begun to resolve by day 15, giving rise to a score lower than or similar to the baseline score at the end of follow-up (day 57).<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14,15</span></a> The maximum composite LSR in our study was slightly lower than that reported by Lebwohl et al.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> This may be because our patients distributed the dose over a larger area than that indicated in the Summary of Product Characteristics (SmPC), giving rise to a decrease in the concentration of IM and consequently of side effects. In addition, prior cycles of treatment, even if these were not enough to clear the lesions, may improve subclinical field cancerization, thereby decreasing the side effects associated with subsequent treatment.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> The short treatment period required with IM has been shown to be associated with relatively rapid resolution of LSR and very high adherence to therapy (>98%).<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14,15</span></a> A similar scale has recently been validated to measure the severity of topical 5-fluorouracil toxicity.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Of particular note is the benefit associated with improved patient adherence due to the short duration of the IM treatment cycle, especially considering the high level of non-adherence observed with other topical AK treatments (around 90%), which has been attributed to the long duration of treatment cycles.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> A global study of physician perceptions of treatment for AK showed that 70% of physicians had specific concerns about the negative effect on adherence of long treatment durations, long-lasting LSRs, and low patient tolerance of the adverse effects of treatment.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Since LSRs are treatment related, their duration tends to correlate with the duration of the therapy. This means that shorter therapies would be associated with a corresponding shortening in the duration of treatment-emergent LSRs.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Furthermore, treatment-related factors, such as duration of treatment, side effects, frequency of use, ease of use, and efficacy, can also affect patient satisfaction and consequently adherence to treatment.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In a recent qualitative study, the main complaints of patients concerning the topical treatment of AK were the local inflammatory reaction, pain (especially with photodynamic therapy) as well as the lack of information about using the treatment at home, about alternative treatment options, and about the cost of the treatment.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Nonetheless, patients in that study displayed a willingness to be compliant with treatment despite the adverse effects.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The authors of clinical trials have reported significantly greater satisfaction with effectiveness, side effects, and the overall results of treatment (global satisfaction) at day 57 in patients treated with IM than in those treated with the vehicle alone.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Our results showed patients to be more satisfied with IM than with their previous AK treatments in all domains (effectiveness, side effects, and convenience). A trend toward a higher global satisfaction with IM was observed, indicating a higher level of overall satisfaction in patients treated with IM compared to all the other prior treatments received.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Clinical trials evaluating topical treatments for AK have certain limitations that hinder the application of the results to clinical practice. In particular, they often exclude patients who have recently received other treatments and limit the number of lesional fields (normally to 1 or 2) or the global extent of the lesions to be treated (usually to 25<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>). This is paradoxical, since the aim of most of these studies is to assess the effect of these treatments on the cancerization field, which is usually larger than the treatment area approved in the SmPC (25<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>). In this respect, it should be noted that the approach used in the present study was in line with clinical practice and that no restrictions were imposed regarding the size of the area of application or the number of sites. Consequently, the treatment areas in this study were larger than those recommended by the SmPC, with a mean lesion area of 97<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>, which was reduced to 42<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> within 3 months of completion of treatment, a result that could be considered to indicate an effective action on the field cancerization. The treatment in this study of larger areas of skin does not appear to have had any impact on the results of Skindex or TSQM, which were similar to those reported in previously published in clinical trials.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Complete clearance has been reported in 61.6% of lesions on face and scalp at week 8 following treatment with IM,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> but the relative frequency of lesions in different sites may affect overall efficiency. This effect is especially evident when using IM, which has 79% complete response for chest lesions, 35% for arm lesions, and only 23% on the scalp and 19% on the dorsum of the hands, and intermediate response rates in other sites.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> In our study, 42% of patients had AK on the scalp, which may have affected overall efficacy. Complete lesion clearance in our study was achieved in only 10% of patients at month 3. We considered the measurement of the affected area to be a more appropriate outcome for assessing improvement in the cancerization field. However, this choice makes it difficult to compare our results with those of studies in which the clinical lesion count was used as a measure of improvement.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14–16</span></a> The lesion count appears to provide more reproducible results than area measurement.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> However, neither method is perfect for assessing subclinical field cancerization.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">One of the limitations of this study is the small sample size. Our findings could be seen as preliminary results that should be explored in a bigger sample; however, they are consistent with those obtained in clinical trials with IM.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In conclusion, this pilot study indicates that QoL in patients with AK improves after treatment with IM. Improvement on a subjective patient scale is also observed. The presence of side effects affected neither QoL nor patients’ satisfaction with treatment probably because of their short duration.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">The writing of this manuscript was financially supported by Leo Pharma.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres563325" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec579848" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres563326" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec579847" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Primary end points" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Secondary end points" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack189997" "titulo" => "Acknowledgement" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-19" "fechaAceptado" => "2015-04-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec579848" "palabras" => array:5 [ 0 => "Actinic keratosis" 1 => "Ingenol mebutate" 2 => "Skindex-29" 3 => "TSMQ 1.4" 4 => "Side effects" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec579847" "palabras" => array:5 [ 0 => "Queratosis actínica" 1 => "Ingenol mebutato" 2 => "Skindex-29" 3 => "TSMQ 1.4" 4 => "Efectos secundarios" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Actinic keratosis (AK) lesions are in situ squamous cell carcinoma. These lesions have a low risk of progressing to invasive disease but significant impact on patients’ quality of life (QoL). The aim of this study was to assess QoL and side effects in patients with AK receiving treatment with ingenol mebutate.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a prospective, non-randomized pilot study carried out in Spain. The target population was adults with a clinical diagnosis of AK affecting any part of the body. Outcomes were assessed on the basis of a QoL questionnaire (Skindex-29), local skin response, the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), and clinical response.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 19 patients were studied. Most of the participants were men (89.5%) and mean age was 76.2 years. After treatment with ingenol mebutate, significant improvement was observed in the Skindex-29 subscales relating to symptom severity (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.041), the patients’ emotional state (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.026), and in the overall score (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.014). Erythema, crusting, and flaking or scaling were the local skin responses with highest median score (2.0 in all 3 cases). Imiquimod 5% and ingenol mebutate achieved higher median scores for effectiveness and global satisfaction than any other previous treatments (as measured by TSQM 1.4). In the patients’ assessment of convenience, ingenol mebutate had a higher median score than previous treatments. Over half of the patients (52.6%) had an improvement of at least 75% at month 3.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">QoL in patients with AK improves after treatment with ingenol mebutate. The presence of side effects did not affect QoL or patient satisfaction with treatment.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las queratosis actínicas (QA) se consideran carcinomas espinocelulares “in situ” con poca capacidad invasiva pero con un impacto significativo en la calidad de vida (CV). El objetivo fue evaluar la CV y los efectos secundarios de ingenol mebutato (IM) en pacientes con QA.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio piloto, prospectivo, no aleatorizado, en pacientes >18 años, con diagnóstico clínico de QA de cualquier localización. Se valoraron: la CV, mediante el cuestionario Skindex- 29; la satisfacción con el tratamiento mediante el cuestionario TSQM 1.4; la respuesta clínica, y la reacción cutánea local (RCL).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 19 pacientes, el 89,5% eran hombres, con una edad media 76,2 años. Después del tratamiento con IM, se observó una mejoría significativa en las subescalas del Skindex-29 (emocional y sintomática) y en la puntuación global (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,026, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,041 y <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,014), respectivamente). Al día 3–4, el eritema, la costra y la descamación fueron las RCLs con una mediana de puntuación más alta (2,0, en los 3 casos). La efectividad y la satisfacción global (según TSQM 1,4) presentaron puntuaciones medianas más altas con imiquimod 5% e IM comparado con los otros tratamientos previos. La valoración de la conveniencia mostró una puntuación más alta en IM comparado con los otros tratamientos previos. Más de la mitad de pacientes (52,6%) lograron una mejoría ≥75% al tercer mes.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La CV en pacientes con QA mejora después del tratamiento con IM. La presencia de efectos secundarios no afecta ni a la CV ni a la satisfacción de los pacientes con el tratamiento.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1173 "Ancho" => 1673 "Tamanyo" => 150626 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Change in clinical response from week 3 to month 3.NR indicates no response; CR1, clinical response at week 3; and CR2, clinical response at month 3.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: IM, ingenol mebutate; LSR, local skin response; TSQM, treatment satisfaction Questionnaire for Medication.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Assessments \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 1 (day 0) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 2 (day 3/4) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 3 (week 3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit 4 (month 3) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Area measurement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Clinical picture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Skindex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LSR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TSQM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IM administration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Clinical response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">X \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab913349.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">TSQM was completed at the first visit only by the patients who had received other treatments in the 3 months before their inclusion in the study.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Study design.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Demographic and baseline clinical characteristics</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male sex, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (89.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean age, <span class="elsevierStyleItalic">y</span> (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.2 (7.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean interval time since diagnosis, mo (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.7 (41.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean lesion area, cm<span class="elsevierStyleSup">2</span> (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.0 (81.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Site of AK lesion, <span class="elsevierStyleItalic">n</span> (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Face \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (47.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Scalp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (42.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dorsum of hands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Forearm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Skin phototype, <span class="elsevierStyleItalic">n</span> (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Type II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (63.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Type III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (21.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Type IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Non-melanoma skin cancer, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (57.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Prior treatments, <span class="elsevierStyleItalic">n</span> (%)<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cryotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (41.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Imiquimod 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (17.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diclofenac 3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (17.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Photodynamic therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (17.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (5.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab913350.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Percentage refers to the total number of patients who received prior treatment (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics of the study population.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Domain \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">End of Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Functional state \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 (0.0–0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 (0.0–0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.066 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Emotional state \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 (0.0–17.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 (0.0–7.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–17.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Symptom severity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.4 (7.1–28.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2 (7.1–17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6–46.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–46.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Overall state \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.9 (3.4–13.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 (1.7–7.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9–20.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–19.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab913351.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Skindex-29 quality-of-life questionnaire.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TSQM Scale \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">End of study \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Global satisfaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.1 (29.9–72.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.4 (61.1–76.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6–76.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2–94.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Effectiveness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 (44.4–72.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.2 (66.7–77.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3–83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3–100.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Side effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.8 (65.6–93.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.5 (81.3–93.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.3–100.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Convenience \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 (58.3–75.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3 (66.7–83.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4–83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.9–94.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab913348.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">None of the differences were significant, but a trend toward better global satisfaction with IM was observed (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.059).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">TSQM 1.4 scores by domain at baseline and the end of the study.<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a></p>" ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>: PDT; photodynamic therapy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Global satisfaction \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Effectiveness \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Side effects \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Convenience \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cryotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.1 (29.9–72.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 (44.4–72.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.8 (65.6–93.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 (58.3–75.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6–76.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3–83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4–83.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diclofenac 3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.8 (5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.0 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.5 (0.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.1 (44.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6–61.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3–66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–87.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4–83.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PDT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.1 (43.7–71.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.4 (48.6–73.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.8 (65.6–95.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.4 (61.1–75.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5–76.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4–77.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4–83.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Imiquimod 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.9 (63.2–76.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.2 (68.1–72.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.8 (75.0–93.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 (58.3–70.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.1–76.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7–72.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.8–93.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.6–72.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ingenol mebutate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (Q1–Q3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.4 (61.1–76.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.2 (66.7–77.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.5 (81.3–93.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3 (66.7–83.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Min–Max \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2–94.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3–100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.3–100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.9–94.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab913347.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Some patients had received more than one prior treatment.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">TSQM 1.4 results for the study treatment and each previous AK treatment.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Q1–Q3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Min–Max \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Swelling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–1.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vesiculation/postulation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–3.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Erosion/ulceration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0–2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–2.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Crusting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0–2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–3.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Flaking/scaling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0–2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0–3.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Erythema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0–2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0–3.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Local skin reactions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0–10.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0–13.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab913352.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 16 | 26 |
| 2024 Octubre | 40 | 45 | 85 |
| 2024 Septiembre | 39 | 29 | 68 |
| 2024 Agosto | 73 | 49 | 122 |
| 2024 Julio | 62 | 39 | 101 |
| 2024 Junio | 74 | 43 | 117 |
| 2024 Mayo | 62 | 33 | 95 |
| 2024 Abril | 69 | 53 | 122 |
| 2024 Marzo | 47 | 47 | 94 |
| 2024 Febrero | 44 | 37 | 81 |
| 2024 Enero | 41 | 46 | 87 |
| 2023 Diciembre | 35 | 55 | 90 |
| 2023 Noviembre | 32 | 44 | 76 |
| 2023 Octubre | 34 | 45 | 79 |
| 2023 Septiembre | 40 | 51 | 91 |
| 2023 Agosto | 29 | 24 | 53 |
| 2023 Julio | 50 | 79 | 129 |
| 2023 Junio | 46 | 56 | 102 |
| 2023 Mayo | 41 | 29 | 70 |
| 2023 Abril | 39 | 26 | 65 |
| 2023 Marzo | 61 | 31 | 92 |
| 2023 Febrero | 57 | 21 | 78 |
| 2023 Enero | 22 | 34 | 56 |
| 2022 Diciembre | 64 | 39 | 103 |
| 2022 Noviembre | 39 | 45 | 84 |
| 2022 Octubre | 80 | 43 | 123 |
| 2022 Septiembre | 38 | 65 | 103 |
| 2022 Agosto | 42 | 41 | 83 |
| 2022 Julio | 42 | 61 | 103 |
| 2022 Junio | 41 | 47 | 88 |
| 2022 Mayo | 38 | 63 | 101 |
| 2022 Abril | 37 | 70 | 107 |
| 2022 Marzo | 39 | 74 | 113 |
| 2022 Febrero | 33 | 53 | 86 |
| 2022 Enero | 50 | 93 | 143 |
| 2021 Diciembre | 33 | 54 | 87 |
| 2021 Noviembre | 44 | 52 | 96 |
| 2021 Octubre | 51 | 65 | 116 |
| 2021 Septiembre | 27 | 36 | 63 |
| 2021 Agosto | 36 | 39 | 75 |
| 2021 Julio | 21 | 47 | 68 |
| 2021 Junio | 43 | 38 | 81 |
| 2021 Mayo | 23 | 39 | 62 |
| 2021 Abril | 46 | 79 | 125 |
| 2021 Marzo | 75 | 36 | 111 |
| 2021 Febrero | 69 | 37 | 106 |
| 2021 Enero | 47 | 29 | 76 |
| 2020 Diciembre | 42 | 20 | 62 |
| 2020 Noviembre | 26 | 33 | 59 |
| 2020 Octubre | 39 | 25 | 64 |
| 2020 Septiembre | 40 | 30 | 70 |
| 2020 Agosto | 34 | 38 | 72 |
| 2020 Julio | 28 | 25 | 53 |
| 2020 Junio | 47 | 59 | 106 |
| 2020 Mayo | 36 | 29 | 65 |
| 2020 Abril | 44 | 31 | 75 |
| 2020 Marzo | 27 | 34 | 61 |
| 2020 Febrero | 5 | 10 | 15 |
| 2020 Enero | 0 | 6 | 6 |
| 2019 Diciembre | 2 | 16 | 18 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 0 | 2 | 2 |
| 2019 Julio | 0 | 4 | 4 |
| 2019 Junio | 2 | 18 | 20 |
| 2019 Mayo | 2 | 51 | 53 |
| 2019 Abril | 0 | 6 | 6 |
| 2019 Marzo | 2 | 3 | 5 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 6 | 3 | 9 |
| 2018 Noviembre | 15 | 1 | 16 |
| 2018 Octubre | 17 | 3 | 20 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Julio | 0 | 2 | 2 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 7 | 7 |
| 2018 Marzo | 0 | 5 | 5 |
| 2018 Febrero | 29 | 6 | 35 |
| 2018 Enero | 20 | 10 | 30 |
| 2017 Diciembre | 47 | 13 | 60 |
| 2017 Noviembre | 27 | 10 | 37 |
| 2017 Octubre | 24 | 5 | 29 |
| 2017 Septiembre | 13 | 14 | 27 |
| 2017 Agosto | 6 | 8 | 14 |
| 2017 Julio | 4 | 4 | 8 |
| 2017 Junio | 13 | 28 | 41 |
| 2017 Mayo | 10 | 12 | 22 |
| 2017 Abril | 8 | 25 | 33 |
| 2017 Marzo | 9 | 27 | 36 |
| 2017 Febrero | 7 | 12 | 19 |
| 2017 Enero | 7 | 10 | 17 |
| 2016 Diciembre | 15 | 24 | 39 |
| 2016 Noviembre | 13 | 28 | 41 |
| 2016 Octubre | 13 | 25 | 38 |
| 2016 Septiembre | 1 | 4 | 5 |
| 2016 Julio | 9 | 0 | 9 |
| 2016 Junio | 7 | 0 | 7 |
| 2016 Mayo | 7 | 13 | 20 |
| 2016 Abril | 2 | 4 | 6 |
| 2016 Febrero | 0 | 21 | 21 |
| 2016 Enero | 0 | 8 | 8 |
| 2015 Noviembre | 0 | 20 | 20 |
| 2015 Octubre | 0 | 27 | 27 |
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