Case and Research Letters
Daylight Photodynamic Therapy in the Treatment of Actinic Keratosis in Carriers of Oculocutaneous Albinism: Report of Three Cases
Terapia fotodinámica con luz de día en el tratamiento de queratosis actínicas en pacientes portadores de albinismo oculocutáneo: presentación de 3 casos
L.E. Garcia Galvão
, R. Tomaz, H. de Sá Gonçalves
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Centro de Dermatología «Dona Libânia», Fortaleza, Brasil
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Ruiz-Rivero, B. Echeverría-García, J.C. Tardío, J. Borbujo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Ruiz-Rivero" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Echeverría-García" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Tardío" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018304290" "doi" => "10.1016/j.ad.2018.02.028" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018304290?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301155?idApp=UINPBA000044" "url" => "/15782190/0000011000000005/v1_201906050857/S1578219019301155/v1_201906050857/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Daylight Photodynamic Therapy in the Treatment of Actinic Keratosis in Carriers of Oculocutaneous Albinism: Report of Three Cases" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "407" "paginaFinal" => "410" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.E. Garcia Galvão, R. Tomaz, H. de Sá Gonçalves" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.E." "apellidos" => "Garcia Galvão" "email" => array:1 [ 0 => "lgalvaodermato@yahoo.com.br" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Tomaz" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "de Sá Gonçalves" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Dermatología «Dona Libânia», Fortaleza, Brasil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia fotodinámica con luz de día en el tratamiento de queratosis actínicas en pacientes portadores de albinismo oculocutáneo: presentación de 3 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 712 "Ancho" => 1255 "Tamanyo" => 120672 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Treatment area before and after 24 weeks of follow up.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Oculocutaneous albinism (OCA) leads to hypopigmentation of the skin, hair and eyes .<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The most severe phenotype, OCA1, is characterized by the complete lack of melanin production; in subtypes, OCA2, OCA3, and OCA4, some pigment production occurs over the years.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Actinic keratosis (AK) are premalignant lesions of the skin, commonly located in areas exposed to ultraviolet (UV) radiation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> OCA patients have an exaggerated sensitivity to UV radiation, which leads the onset of AK lesions and squamous-cell carcinomas, even at young age.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In daylight PDT (DL-PDT), the activation of the photosensitizer protoporphyrin IX (PpIX) from the methylaminolevulinate (MAL) cream by visible light, allows the treatment of AK with less adverse effects of pain and erythema ,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> which favors its use as an alternative to conventional PDT in patients with excessive photosensitivity.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Other therapeutic options focused on the field of cancerization, such as imiquimod and 5-fluorouracil creams require long-term home treatment regimens and may lead to intense local skin reactions while, ingenol mebutate gel is usually limited to areas of up to 25 cm<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> . Thus, the treatment of AK with DL-PDT presents a number of advantages in patients with OCA, in comparison with other treatments.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 2015, we treated the first patients with OCA at Dona Libânia Dermatology Center in Fortaleza, Brazil. There were three female patients, aged 22, 48 and 65 years old. The use of DL-PDT in patients with OCAs was approved by the local ethics committee.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the day of the procedure, after the curettage of facial AK lesions, a chemical filter with sun protection factor (SPF) 50 plus lotion (Actinica<span class="elsevierStyleSup">®</span>, Galderma, France) was applied on the face and other exposed areas. Subsequently, approximately 1 g of of the 16% MAL cream (Metvix<span class="elsevierStyleSup">®</span>, Galderma, France) was applied throughout the face, and patients stayed outdoors, in the shade, between 7:30 and 9:30 AM. After that, the MAL cream was removed, and patients were discharged, with the instruction to strictly maintain the use of sunscreen at home. AK lesions were counted before the session and after 4, 12 and 24 weeks of follow-up. The patients were also assessed, after 2<span class="elsevierStyleHsp" style=""></span>hours of exposure, for the occurrence and grade of local skin reactions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 66 facial AK lesions were treated in the three patients, all of whom completed the 24-week period of follow-up. Of the 66 treated lesions, 52 lesions (78.8%) were considered as clinically cured at weeks 4 and 12, and 50 lesions (75.8%) were considered as cured at week 24 (<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 to 3</a>). No pain or burning sensation was reported by any of the patients during the 2-hour shade period. The 22-year-old patient was the only one who presented moderate facial erythema immediate after the procedure, with mild pruritus during outdoor exposure (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). However, she reported being exposed to the sun for about 10<span class="elsevierStyleHsp" style=""></span>minutes during the 2-hour period with MAL cream. None of the three patients had adverse effects at the 4-week follow-up visit.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In the current study, we found that nearly 76% of the treated AK lesions could be considered cured after 6 months of follow-up. This cure rate is within the range found in the major European<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> and Australian<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> muticenter studies of DL-PDT. Since patients with OCA present with extensive AK, with a large number of lesions at an early age, it is important to develop alternative tratments that rapidly eliminate the lesions in large areas and with little local reaction.</p><p id="par0040" class="elsevierStylePara elsevierViewall">During DL-PDT, avoidance of exposure to direct UV radiation through permanence in the shade during the whole period of 2<span class="elsevierStyleHsp" style=""></span>hours is fundamental in patients with OCA. We observed moderate erythema immediately after the procedure in one of the patients, who, despite orientation, was exposed to sunlight for about 10<span class="elsevierStyleHsp" style=""></span>minutes. The city of Fortaleza is located at a low latitude (03°43’02” South), with average annual temperature of 26.3<span class="elsevierStyleHsp" style=""></span>°C. Such warm and sunny weather characteristics allow the use of DL-PDT throughout the year. On the other hand, patients with OCA undergoing DL-PDT in places with similar characteristics have to be carefully instructed about the procedure. Moreover, the use of SPF50 clothing and sunscreen is recommended during the 2-hour exposure in the shade. In our three patients, DL-PDT sessions were scheduled and performed early in the morning, with no overcast or rainy weather.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, DL-PDT may be an option in the treatment of multiple lesions of AK on the face of patients with OCA. One of the advantages of treating a wide area such as the face in a single day is the ability to maintain the daily activities of these patients, especially when compared with treatments that require a length of time at home and which may cause skin reactions, both of which can impair adherence to treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-19" "fechaAceptado" => "2018-02-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garcia Galvão LE, Tomaz R, de Sá Gonçalves H. Daylight Photodynamic Therapy in the Treatment of Actinic Keratosis in Carriers of Oculocutaneous Albinism: Report of Three Cases. Actas Dermosifiliogr. 2019;110:407–410.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 832 "Ancho" => 1255 "Tamanyo" => 128773 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical improvement after 6 months of DL-PDT.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 828 "Ancho" => 1255 "Tamanyo" => 130198 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Field cancerization of the skin before and 6 months after DL-PDT session.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 712 "Ancho" => 1255 "Tamanyo" => 120672 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Treatment area before and after 24 weeks of follow up.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1010 "Ancho" => 755 "Tamanyo" => 82514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Moderate facial erythema immediately after the 2-hour outdoor exposition.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oculocutaneous albinism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 8 | 15 |
| 2024 Octubre | 74 | 45 | 119 |
| 2024 Septiembre | 87 | 28 | 115 |
| 2024 Agosto | 105 | 61 | 166 |
| 2024 Julio | 92 | 27 | 119 |
| 2024 Junio | 84 | 29 | 113 |
| 2024 Mayo | 102 | 43 | 145 |
| 2024 Abril | 68 | 19 | 87 |
| 2024 Marzo | 73 | 26 | 99 |
| 2024 Febrero | 48 | 31 | 79 |
| 2024 Enero | 56 | 29 | 85 |
| 2023 Diciembre | 43 | 17 | 60 |
| 2023 Noviembre | 80 | 29 | 109 |
| 2023 Octubre | 59 | 28 | 87 |
| 2023 Septiembre | 62 | 41 | 103 |
| 2023 Agosto | 41 | 12 | 53 |
| 2023 Julio | 46 | 39 | 85 |
| 2023 Junio | 48 | 22 | 70 |
| 2023 Mayo | 43 | 21 | 64 |
| 2023 Abril | 42 | 22 | 64 |
| 2023 Marzo | 52 | 28 | 80 |
| 2023 Febrero | 56 | 17 | 73 |
| 2023 Enero | 53 | 42 | 95 |
| 2022 Diciembre | 65 | 46 | 111 |
| 2022 Noviembre | 54 | 32 | 86 |
| 2022 Octubre | 39 | 23 | 62 |
| 2022 Septiembre | 38 | 36 | 74 |
| 2022 Agosto | 29 | 30 | 59 |
| 2022 Julio | 29 | 45 | 74 |
| 2022 Junio | 29 | 25 | 54 |
| 2022 Mayo | 44 | 34 | 78 |
| 2022 Abril | 47 | 32 | 79 |
| 2022 Marzo | 51 | 45 | 96 |
| 2022 Febrero | 48 | 26 | 74 |
| 2022 Enero | 55 | 33 | 88 |
| 2021 Diciembre | 40 | 37 | 77 |
| 2021 Noviembre | 47 | 45 | 92 |
| 2021 Octubre | 44 | 47 | 91 |
| 2021 Septiembre | 46 | 46 | 92 |
| 2021 Agosto | 41 | 24 | 65 |
| 2021 Julio | 28 | 22 | 50 |
| 2021 Junio | 34 | 28 | 62 |
| 2021 Mayo | 28 | 31 | 59 |
| 2021 Abril | 69 | 73 | 142 |
| 2021 Marzo | 61 | 19 | 80 |
| 2021 Febrero | 45 | 24 | 69 |
| 2021 Enero | 32 | 17 | 49 |
| 2020 Diciembre | 25 | 11 | 36 |
| 2020 Noviembre | 17 | 19 | 36 |
| 2020 Octubre | 23 | 15 | 38 |
| 2020 Septiembre | 44 | 14 | 58 |
| 2020 Agosto | 24 | 20 | 44 |
| 2020 Julio | 22 | 15 | 37 |
| 2020 Junio | 22 | 22 | 44 |
| 2020 Mayo | 19 | 13 | 32 |
| 2020 Abril | 8 | 10 | 18 |
| 2020 Marzo | 17 | 5 | 22 |
| 2020 Febrero | 1 | 0 | 1 |
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