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RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations
FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares
A. Alegre-Sánchez
, P. Boixeda
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Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, Spain
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Aguayo-Carreras, F.J. Navarro-Triviño, R. Ruiz-Villaverde, S. Saenz-Guirado" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Aguayo-Carreras" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Saenz-Guirado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018300735" "doi" => "10.1016/j.ad.2017.07.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018300735?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901830372X?idApp=UINPBA000044" "url" => "/15782190/0000010900000010/v1_201812060634/S157821901830372X/v1_201812060634/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "915" "paginaFinal" => "916" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Alegre-Sánchez, P. Boixeda" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Alegre-Sánchez" "email" => array:1 [ 0 => "adrian.alegresanchez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Boixeda" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Láser, Departamento de Dermatología, Hospital Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">To date, the gold-standard treatment for capillary malformations (CM) is pulsed dye laser (PDL). The lightening achieved is, however, incomplete and persistence or redarkening of the malformation appears to be the norm.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Revascularization of the lesions after laser treatment appears to be the reason for the varying efficacy of PDL in CM. Different topical antiangiogenic molecules have been tried in an attempt to halt this revascularization. Of these molecules, the most widely studied is rapamycin (RPM), for which studies of different kinds and with different results are available.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The antiangiogenic action of RPM works by inhibiting its specific target (mTOR). This action is conditioned by a reduction of vascular endothelial growth factor (VEGF) and other proangiogenic signals. RPM is known in dermatology for its considerable efficacy, when applied topically, in managing facial angiofibromas characteristic of tuberous sclerosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Experiments with mouse models have shown strong induction of proangiogenic genes between 3 and 7 days after exposure in conjunction with PDL. Application of 1% topical RPM appears to systematically reverse this induction.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Initial trials in healthy human skin with histologic monitoring showed that the combination of topical RPM once daily for 14 days, following the PDL session, inhibited normal vascular repair in the superficial and middle dermis, measured using immunohistochemical markers (CD31).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The first randomized, double-blind, intraindividual placebo-controlled clinical trial was carried out by a Spanish multicenter group. Twenty-three patients were enrolled in this trial. The combination of PDL (2 sessions) and 1% topical RPM (once daily for 12 weeks) showed greater clearance than the other combinations (PDL alone, topical placebo alone, and PDL with placebo). A limitation of that study is that PDL was only applied to the sides of the face, which are areas that generally respond better to PDL.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In more recent placebo-controlled trials, however, the combination of PDL and RPM has shown no greater efficacy of statistical significance than PDL alone.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a> One of these studies included 13 patients with nonfacial CM and the other study included 6 such patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In terms of the safety profile, only 1 case of allergic contact dermatitis has been reported in association with the use of RPM as an adjuvant to PDL.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> No cases of systemic toxicity have been reported.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In light of the available evidence, the use of RPM as an adjuvant to PDL in CM appears to have a solid foundation supported by quality research. Nevertheless, its real efficacy and optimum recommended dosage and formulation have yet to be determined.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another factor to be taken into account is the fact that RPM is not yet available for sale in Spain, which means that its use would be off-label. Furthermore, its formulation is expensive for patients and complicated for pharmacists.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1058701" "palabras" => array:4 [ 0 => "Capillary malformation" 1 => "Port-wine stain" 2 => "Rapamycin" 3 => "Pulsed-dye laser" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alegre-Sánchez A, Boixeda P. FR- Rapamicina tópica adyuvante al tratamiento con láser en malformaciones capilares. Actas Dermosifiliogr. 2018;109:915–916.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and Safety of Topical Sirolimus Therapy for Facial Angiofibromas in the Tuberous Sclerosis Complex" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Wataya-Kaneda" 1 => "A. Nakamura" 2 => "M. Tanaka" 3 => "M. Hayashi" 4 => "S. Matsumoto" 5 => "K. 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| 2021 Septiembre | 44 | 40 | 84 |
| 2021 Agosto | 25 | 41 | 66 |
| 2021 Julio | 17 | 31 | 48 |
| 2021 Junio | 18 | 34 | 52 |
| 2021 Mayo | 32 | 52 | 84 |
| 2021 Abril | 60 | 97 | 157 |
| 2021 Marzo | 60 | 36 | 96 |
| 2021 Febrero | 66 | 39 | 105 |
| 2021 Enero | 30 | 33 | 63 |
| 2020 Diciembre | 32 | 24 | 56 |
| 2020 Noviembre | 30 | 23 | 53 |
| 2020 Octubre | 19 | 15 | 34 |
| 2020 Septiembre | 30 | 25 | 55 |
| 2020 Agosto | 24 | 30 | 54 |
| 2020 Julio | 18 | 20 | 38 |
| 2020 Junio | 27 | 31 | 58 |
| 2020 Mayo | 17 | 13 | 30 |
| 2020 Abril | 14 | 10 | 24 |
| 2020 Marzo | 15 | 12 | 27 |
| 2020 Febrero | 1 | 0 | 1 |
| 2019 Mayo | 2 | 0 | 2 |
| 2019 Abril | 0 | 1 | 1 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 1 | 0 | 1 |
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