Case and Research Letter
Photodynamic Therapy as a Response to the Challenge of Treating Actinic Keratosis in the Eyelid Area
Terapia fotodinámica como respuesta al reto de tratar una queratosis actínica en el área palpebral
F. Toledo- Alberola
, I. Belinchón-Romero, J. Guijarro-Llorca, P. Albares-Tendero
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Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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Toledo- Alberola, I. Belinchón-Romero, J. Guijarro-Llorca, P. Albares-Tendero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Toledo- Alberola" "email" => array:1 [ 0 => "ftoledo@coma.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Belinchón-Romero" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Guijarro-Llorca" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Albares-Tendero" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia fotodinámica como respuesta al reto de tratar una queratosis actínica en el área palpebral" ] ] "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" => 863 "Ancho" => 2333 "Tamanyo" => 280719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Clinical image before treatment, showing the presence of a tumor on the free border of the lower right eyelid. B, Final result at 6 months, after 2 sessions of photodynamic therapy and curettage of the residual lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Around 90% of nonmelanoma skin cancers arise on the head and neck and about 10% of these occur in the area of the eyelids.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Surgery continues to be the treatment of choice,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> but concerns about the risk of postoperative complications, local recurrence, or a poor cosmetic and functional outcome have led to the investigation of alternative options, such as cryotherapy, radiation therapy, chemotherapy, retinoids, topical immunomodulators, and photodynamic therapy (PDT). The choice of treatment will depend on the age of the patient, the site and size of the tumor, and the experience of the dermatologist.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of an 82-year-old man who was seen for a desquamating, partially exophytic erythematous plaque of 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter that had developed on the right lower eyelid and affected the free border (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Biopsy showed the lesion to be an actinic keratosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Photodynamic therapy (PDT) was chosen for treatment in accordance with the recommended protocol for the treatment of basal cell carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Topical methyl 5-aminolevulinate cream (Metvix) was applied to the lesion. The cream was removed after 3<span class="elsevierStyleHsp" style=""></span>hours and uptake by the lesion was confirmed with the aid of a Wood lamp. A sterile, opaque black plastic shield was used to protect the eye; topical anesthetic eye drops (0.1% tetracaine hydrochloride plus 0.4% oxybuprocaine hydrochloride) should be instilled into the eye 5<span class="elsevierStyleHsp" style=""></span>minutes before inserting the shield, and a viscoelastic substance such as Gonioftal gel (latex-free hydroxyethylcellulose) should be used to minimize contact with the surface of the eye. The lesion was infiltrated with local anesthetic (1% mepivacaine) and then illuminated using a light-emitting diode lamp with a wavelength of 634<span class="elsevierStyleHsp" style=""></span>nm (Aktilite; PhotoCure, Galderma), administering 37<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> over a period of 8<span class="elsevierStyleHsp" style=""></span>minutes at a distance of 10<span class="elsevierStyleHsp" style=""></span>cm. The patient's sensation of burning was reduced by the application of fine sprays of thermal water or liquid nitrogen from a distance. After completing the treatment session, we removed the shield by pulling down on the lower eyelid, thus minimizing the risk of corneal injury, and the patient was prescribed chloramphenicol eye drops for administration every 8<span class="elsevierStyleHsp" style=""></span>hours for the first 3 days. A second treatment session was performed 2 weeks later. The therapy was well tolerated and in the treated area there was only mild erythema and edema, which resolved within a few days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">There was a marked reduction in the size of the lesion. Subsequent treatment with imiquimod 5% cream 3 times a week for 4 weeks produced no inflammation or improvement, and curettage biopsy was therefore performed for histological study, with electrocoagulation of the residual lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The biopsy revealed only seborrheic keratosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The incidence of actinic keratosis on the eyelids has increased in the last 2 decades. PDT has been shown to be effective in the treatment of basal cell carcinoma, actinic keratosis, and Bowen disease. A recently published case series described the effectiveness of PDT for patients with tumors on the eyelids.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The authors of that report recommended initial curettage of the lesion, the use of topical methyl 5-aminolevulinate, and repetition of the treatment after a week. PDT offers better cosmetic and functional results and is associated with a lower morbidity and cost than surgery.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> One of the important limitations of this treatment is the risk of phototoxic eye damage and the need for follow-up due to the long-term risk of recurrence.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Another effective therapeutic option in selected cases is topical imiquimod 5% cream. Its application 5 times a week for 6 weeks has been shown to be effective in the treatment of periocular tumors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However, its use is controversial in tumors situated at less than 5<span class="elsevierStyleHsp" style=""></span>mm from the free border of the eyelid because of the possibility of local adverse effects.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Our patient presented a satisfactory clinical course after PDT, with only a residual seborrheic keratosis that remained present after treatment. In conclusion, we must insist that tumors in the area of the eyelids are a therapeutic challenge for the dermatologist. Surgery continues to be the treatment of choice for tumors situated in areas difficult to treat, but PDT is an effective, noninvasive therapeutic alternative that is well tolerated by the patient and that offers good cosmetic and functional results, as we have shown with the case presented.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Toledo- Alberola F, et al. Terapia fotodinámica como respuesta al reto de tratar una queratosis actínica en el área palpebral. Actas Dermosifiliogr. 2012;103:938–9.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 863 "Ancho" => 2333 "Tamanyo" => 280719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Clinical image before treatment, showing the presence of a tumor on the free border of the lower right eyelid. B, Final result at 6 months, after 2 sessions of photodynamic therapy and curettage of the residual lesion.</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" => 867 "Ancho" => 2333 "Tamanyo" => 555153 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Histology showing the presence of hyperkeratosis alternating with parakeratosis and atypical keratinocytes occupying part of the thickness of the epidermis. B, Histology of the residual lesion. Observe the presence of epidermal acanthosis and corneal pseudocysts typical of seborrheic keratosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photodynamic therapy for tumors on the eyelid margins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Togsverd-Bo" 1 => "M. Hædersdal" 2 => "H.C. 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Sainz de Los Terreros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2006.07726.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "156" "paginaInicial" => "769" "paginaFinal" => "771" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17263811" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of basal cell carcinoma of the eyelids with 5% topical imiquimod: a 3-year follow-up study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Choontanom" 1 => "S. Thanos" 2 => "H. Busse" 3 => "T. Stupp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Graefes Arch Clin Exp Ophtalmol" "fecha" => "2007" "volumen" => "245" "paginaInicial" => "1217" "paginaFinal" => "1220" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000010/v1_201304241352/S1578219012003204/v1_201304241352/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000010/v1_201304241352/S1578219012003204/v1_201304241352/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012003204?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 16 | 26 |
| 2024 Octubre | 61 | 51 | 112 |
| 2024 Septiembre | 67 | 33 | 100 |
| 2024 Agosto | 97 | 65 | 162 |
| 2024 Julio | 72 | 45 | 117 |
| 2024 Junio | 66 | 46 | 112 |
| 2024 Mayo | 101 | 43 | 144 |
| 2024 Abril | 63 | 31 | 94 |
| 2024 Marzo | 78 | 33 | 111 |
| 2024 Febrero | 55 | 44 | 99 |
| 2024 Enero | 50 | 28 | 78 |
| 2023 Diciembre | 84 | 34 | 118 |
| 2023 Noviembre | 75 | 41 | 116 |
| 2023 Octubre | 51 | 24 | 75 |
| 2023 Septiembre | 74 | 38 | 112 |
| 2023 Agosto | 48 | 25 | 73 |
| 2023 Julio | 57 | 53 | 110 |
| 2023 Junio | 81 | 30 | 111 |
| 2023 Mayo | 52 | 37 | 89 |
| 2023 Abril | 46 | 35 | 81 |
| 2023 Marzo | 47 | 21 | 68 |
| 2023 Febrero | 58 | 22 | 80 |
| 2023 Enero | 51 | 29 | 80 |
| 2022 Diciembre | 52 | 30 | 82 |
| 2022 Noviembre | 39 | 26 | 65 |
| 2022 Octubre | 19 | 18 | 37 |
| 2022 Septiembre | 24 | 28 | 52 |
| 2022 Agosto | 15 | 30 | 45 |
| 2022 Julio | 16 | 16 | 32 |
| 2022 Junio | 19 | 26 | 45 |
| 2022 Mayo | 29 | 53 | 82 |
| 2022 Abril | 47 | 48 | 95 |
| 2022 Marzo | 45 | 55 | 100 |
| 2022 Febrero | 33 | 31 | 64 |
| 2022 Enero | 38 | 42 | 80 |
| 2021 Diciembre | 36 | 48 | 84 |
| 2021 Noviembre | 56 | 43 | 99 |
| 2021 Octubre | 106 | 57 | 163 |
| 2021 Septiembre | 54 | 42 | 96 |
| 2021 Agosto | 31 | 33 | 64 |
| 2021 Julio | 38 | 29 | 67 |
| 2021 Junio | 33 | 36 | 69 |
| 2021 Mayo | 43 | 46 | 89 |
| 2021 Abril | 36 | 62 | 98 |
| 2021 Marzo | 59 | 29 | 88 |
| 2021 Febrero | 51 | 23 | 74 |
| 2021 Enero | 30 | 22 | 52 |
| 2020 Diciembre | 31 | 23 | 54 |
| 2020 Noviembre | 26 | 25 | 51 |
| 2020 Octubre | 16 | 12 | 28 |
| 2020 Septiembre | 19 | 14 | 33 |
| 2020 Agosto | 20 | 17 | 37 |
| 2020 Julio | 18 | 19 | 37 |
| 2020 Junio | 36 | 27 | 63 |
| 2020 Mayo | 20 | 13 | 33 |
| 2020 Abril | 24 | 20 | 44 |
| 2020 Marzo | 25 | 22 | 47 |
| 2020 Febrero | 5 | 3 | 8 |
| 2020 Enero | 0 | 2 | 2 |
| 2019 Diciembre | 4 | 2 | 6 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 0 | 2 | 2 |
| 2019 Julio | 0 | 10 | 10 |
| 2019 Junio | 2 | 29 | 31 |
| 2019 Mayo | 2 | 18 | 20 |
| 2019 Abril | 0 | 15 | 15 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Febrero | 0 | 4 | 4 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 2 | 5 | 7 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 62 | 5 | 67 |
| 2018 Enero | 52 | 9 | 61 |
| 2017 Diciembre | 72 | 10 | 82 |
| 2017 Noviembre | 40 | 3 | 43 |
| 2017 Octubre | 30 | 3 | 33 |
| 2017 Septiembre | 42 | 9 | 51 |
| 2017 Agosto | 54 | 10 | 64 |
| 2017 Julio | 47 | 5 | 52 |
| 2017 Junio | 60 | 8 | 68 |
| 2017 Mayo | 42 | 7 | 49 |
| 2017 Abril | 50 | 10 | 60 |
| 2017 Marzo | 30 | 58 | 88 |
| 2017 Febrero | 23 | 9 | 32 |
| 2017 Enero | 34 | 8 | 42 |
| 2016 Diciembre | 41 | 11 | 52 |
| 2016 Noviembre | 56 | 9 | 65 |
| 2016 Octubre | 51 | 13 | 64 |
| 2016 Septiembre | 75 | 21 | 96 |
| 2016 Agosto | 51 | 13 | 64 |
| 2016 Julio | 42 | 5 | 47 |
| 2016 Junio | 12 | 11 | 23 |
| 2016 Mayo | 5 | 10 | 15 |
| 2016 Abril | 6 | 1 | 7 |
| 2016 Marzo | 9 | 0 | 9 |
| 2016 Febrero | 3 | 5 | 8 |
| 2016 Enero | 7 | 2 | 9 |
| 2015 Diciembre | 11 | 1 | 12 |
| 2015 Noviembre | 12 | 2 | 14 |
| 2015 Octubre | 12 | 3 | 15 |
| 2015 Septiembre | 13 | 2 | 15 |
| 2015 Agosto | 13 | 4 | 17 |
| 2015 Julio | 75 | 11 | 86 |
| 2015 Junio | 49 | 10 | 59 |
| 2015 Mayo | 72 | 14 | 86 |
| 2015 Abril | 53 | 12 | 65 |
| 2015 Marzo | 39 | 11 | 50 |
| 2015 Febrero | 39 | 10 | 49 |
| 2015 Enero | 54 | 23 | 77 |
| 2014 Diciembre | 61 | 9 | 70 |
| 2014 Noviembre | 17 | 7 | 24 |
| 2014 Octubre | 25 | 9 | 34 |
| 2014 Septiembre | 17 | 7 | 24 |
| 2014 Agosto | 18 | 8 | 26 |
| 2014 Julio | 13 | 4 | 17 |
| 2014 Junio | 26 | 2 | 28 |
| 2014 Mayo | 30 | 10 | 40 |
| 2014 Abril | 14 | 3 | 17 |
| 2014 Marzo | 8 | 2 | 10 |
| 2014 Febrero | 11 | 5 | 16 |
| 2014 Enero | 10 | 3 | 13 |
| 2013 Diciembre | 21 | 5 | 26 |
| 2013 Noviembre | 13 | 6 | 19 |
| 2013 Octubre | 13 | 0 | 13 |
| 2013 Septiembre | 7 | 5 | 12 |
| 2013 Agosto | 9 | 7 | 16 |
| 2013 Julio | 6 | 6 | 12 |
| 2013 Junio | 6 | 10 | 16 |
| 2013 Mayo | 5 | 8 | 13 |
| 2013 Abril | 15 | 9 | 24 |
| 2013 Marzo | 14 | 5 | 19 |
| 2013 Febrero | 25 | 6 | 31 |
| 2013 Enero | 41 | 6 | 47 |
| 2012 Diciembre | 29 | 8 | 37 |
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