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Italian Journal of Dermatology and... Jun 2023Keratosis pilaris (KP) is a common, hyperkeratotic skin condition characterized by small, folliculocentric papules with variable perifollicular erythema. We provide an... (Review)
Review
Keratosis pilaris (KP) is a common, hyperkeratotic skin condition characterized by small, folliculocentric papules with variable perifollicular erythema. We provide an updated review on the pathogenesis, clinical manifestations, and management of this common, and often annoying, finding. KP represents a family of follicular disorders, of which KP simplex is by far the most common. Other variants and rare subtypes include keratosis pilaris rubra, erythromelanosis follicularis faciei et colli, and the spectrum of keratosis pilaris atrophicans. Inherited mutations of the FLG gene and ABCA12 gene have been implicated etiologically. KP may be associated with ichthyosis vulgaris and palmar hyperlinearity, but less likely atopic dermatitis. Some potential differential diagnoses for KP include lichen spinulosus, phrynoderma, ichthyosis vulgaris, and trichostasis spinulosa. General cutaneous measures such as hydrating skin, avoiding long baths or showers, and using mild soaps or cleansers should be recommended. Topical keratolytic agents are first-line therapy, followed by topical retinoids and corticosteroids. Recent options include a variety of lasers and microdermabrasion if the patient is refractory to topical therapy.
Topics: Humans; Ichthyosis Vulgaris; Darier Disease; Skin; Abnormalities, Multiple
PubMed: 37166753
DOI: 10.23736/S2784-8671.23.07594-1 -
International Journal of Dermatology Jun 2020Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp,... (Review)
Review
Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp, neck, hands, and forearms. AKs must be considered an early squamous cell carcinoma (SCC) for their probable progression into invasive SCC. For this reason, all AK should be treated, and clinical follow-up is recommended. The aims of treatment are: (i) to clinically eradicate evident and subclinical lesions, (ii) to prevent their evolution into SCC, and (iii) to reduce the number of relapses. Among available treatments, it is possible to distinguish lesion-directed therapies and field-directed therapies. Lesion-directed treatments include: (i) cryotherapy; (ii) laser therapy; (iii) surgery; and (iv) curettage. Whereas, field-directed treatments are: (i) 5-fluorouracil (5-FU); (ii) diclofenac 3% gel; (iii) chemical peeling; (iv) imiquimod; and (v) photodynamic therapy (PDT). Prevention plays an important role in the treatment of AKs, and it is based on the continuous use of sunscreen and protective clothing. This review shows different types of available treatments and describes the characteristics and benefits of each medication, underlining the best choice.
Topics: Aftercare; Carcinoma, Squamous Cell; Chemexfoliation; Cryotherapy; Curettage; Dermoscopy; Diclofenac; Disease Progression; Fluorouracil; Humans; Imiquimod; Keratosis, Actinic; Laser Therapy; Photochemotherapy; Practice Guidelines as Topic; Protective Clothing; Skin; Skin Neoplasms; Sunlight; Sunscreening Agents
PubMed: 32012240
DOI: 10.1111/ijd.14767 -
Deutsches Arzteblatt International Sep 2019Cutaneous squamous cell carcinoma (cSCC) and its precursors, actinic keratoses (AK), are common. Physicians of multiple specialties are confronted with their treatment. (Review)
Review
BACKGROUND
Cutaneous squamous cell carcinoma (cSCC) and its precursors, actinic keratoses (AK), are common. Physicians of multiple specialties are confronted with their treatment.
METHODS
This review is based on publications retrieved by a selective search in PubMed, as well as on the German guidelines on AK and cSCC, skin cancer prevention, and surgery with histologic guidance.
RESULTS
Local treatments for AK include lesional cryotherapy, curettage, and laser ablation as well as field-directed treatments with topical agents, e.g., diclofenac plus hyaluronic acid, imiquimod, 5-fluorouracil, ingenol mebutate, and photodynamic therapy. These treatments can be administered in various sequences or combinations, depending on individual factors and the stage of the disease. The gold standard of treatment for cSCC is histologically confirmed complete resection; radiotherapy is an alternative. Locally uncontrollable or metastatic disease is treated with systemic drugs. The use of various chemotherapeutic agents, EGFR-directed therapies, and the PD-I inhibitor cemiplimab, either singly or in combination, has been described in uncontrolled trials and case series. Cemiplimab has a reported response rate of 47% and was recently approved for the treatment of advanced cSCC.
CONCLUSION
There are many options for the treatment of AK and cSCC that must be considered in the interdisciplinary care of these entities.
Topics: Carcinoma, Squamous Cell; Humans; Keratosis, Actinic; Skin Neoplasms
PubMed: 32048593
DOI: 10.3238/arztebl.2019.0616 -
Biomolecules Jul 2023Non-melanoma skin cancers (NMSCs), which include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and actinic keratosis (AK), are the most common cancer... (Review)
Review
Non-melanoma skin cancers (NMSCs), which include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and actinic keratosis (AK), are the most common cancer diseases in the Caucasian race. If diagnosed late and improperly treated, BCC and SCC can become locally advanced and metastasize. Malignant melanoma (MM) is less frequent but more lethal than NMSC. Given the individual and social burdens of skin cancers, performing an adequate prevention is needed. Ultraviolet (UV) ray exposure is one of the main risk factors for skin cancer. Thus, the first-choice prevention strategy is represented by photoprotection that can be both topical and systemic. The latter consists of the oral administration of molecules which protect human skin against the damaging effects of UV rays, acting through antioxidant, anti-inflammatory, or immunomodulator mechanisms. Although several compounds are commonly used for photoprotection, only a few molecules have demonstrated their effectiveness in clinical trials and have been included in international guidelines for NMSC prevention (i.e., nicotinamide and retinoids). Moreover, none of them have been demonstrated as able to prevent MM. Clinical and preclinical data regarding the most common compounds used for systemic photoprotection are reported in this review, with a focus on the main mechanisms involved in their photoprotective properties.
Topics: Humans; Skin Neoplasms; Melanoma; Carcinoma, Basal Cell; Keratosis, Actinic; Carcinoma, Squamous Cell; Syndrome; Melanoma, Cutaneous Malignant
PubMed: 37509103
DOI: 10.3390/biom13071067 -
Tidsskrift For Den Norske Laegeforening... Mar 2023Keratosis pilaris, or 'plucked chicken skin', is a very common condition. It is caused by keratin accumulation in the hair follicles. Although mild cases of the...
Keratosis pilaris, or 'plucked chicken skin', is a very common condition. It is caused by keratin accumulation in the hair follicles. Although mild cases of the condition can be considered to be a normal variant, it can lead to multiple appointments with general practitioners and dermatologists. In rare cases, keratosis pilaris can form part of specific syndromes or be associated with other diseases. The aim of this article is to give an overview of the different variants of keratosis pilaris and discuss the pathogenesis and treatment options.
Topics: Humans; Darier Disease; Eyebrows; Abnormalities, Multiple
PubMed: 36987905
DOI: 10.4045/tidsskr.22.0513 -
F1000Research 2019Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa... (Review)
Review
Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients. Whereas common SKs are more frequent in Caucasians, dermatosis papulosa nigra is more prevalent in patients with a Fitzpatrick skin type of at least 3. There seems to be a link between extrinsic skin aging and the occurrence of SK. Mutations of fibroblast growth factor receptor 3 and other signaling molecules are a frequent finding in SK lesions. However, this does not translate into any malignant potential. Viral infections are particularly common in genital lesions, although their pathogenetic relevance for SK is questionable. Different histologic and clinical subtypes have been identified. The great variability of SKs raises some difficulties in diagnosis. Dermoscopy is the preferred non-invasive diagnostic method, in particular to differentiate pigmented SKs from other pigment tumors, including cutaneous melanoma. Eruptive SKs can be a paraneoplastic condition known as the Leser-Trélat sign. New targeted cancer treatments can cause a pseudo-Leser-Trélat sign. The treatment in practice is mainly minor surgery, including cryosurgery, shave excisions, and laser-assisted removal. The medical approaches have only limited effects. Recently, two formulations for topical therapy have been evaluated: a product with 40% hydrogen peroxide (HP40) and an aqueous nitric-zinc complex. Based on clinical trials, HP40 seems to be a promising alternative to surgery, in particular for facial lesions.
Topics: Adult; Diagnosis, Differential; Humans; Keratosis, Seborrheic; Melanoma; Skin Neoplasms
PubMed: 31508199
DOI: 10.12688/f1000research.18983.1 -
Actas Dermo-sifiliograficas Apr 2022
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Orphanet Journal of Rare Diseases Jul 2022Ichthyosis covers a wide spectrum of diseases affecting the cornification of the skin. In recent years, new advances in understanding the pathophysiology of ichthyosis... (Review)
Review
Ichthyosis covers a wide spectrum of diseases affecting the cornification of the skin. In recent years, new advances in understanding the pathophysiology of ichthyosis have been made. This knowledge, combined with constant development of pathogenesis-based therapies, such as protein replacement therapy and gene therapy, are rather promising for patients with inherited skin diseases. Several ongoing trials are investigating the potency of these new approaches and various studies have already been published. Furthermore, a lot of case series report that biological therapeutics are effective treatment options, mainly for Netherton syndrome and autosomal recessive congenital ichthyosis. It is expected that some of these new therapies will prove their efficacy and will be incorporated in the treatment of ichthyosis.
Topics: Humans; Ichthyosis; Netherton Syndrome; Skin; Skin Neoplasms
PubMed: 35840979
DOI: 10.1186/s13023-022-02430-6 -
Anais Brasileiros de Dermatologia 2019Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules,... (Review)
Review
Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.
Topics: Carcinoma, Squamous Cell; Dermoscopy; Humans; Keratosis, Actinic; Risk Factors; Severity of Illness Index; Skin Neoplasms
PubMed: 31789244
DOI: 10.1016/j.abd.2019.10.004 -
International Journal of Molecular... Mar 2023Actinic keratosis (AK) is among the most commonly diagnosed skin diseases with potentially life-threatening repercussions if left untreated. Usage of pharmacologic... (Review)
Review
Actinic keratosis (AK) is among the most commonly diagnosed skin diseases with potentially life-threatening repercussions if left untreated. Usage of pharmacologic agents represents one of many therapeutic strategies that can be used to help manage these lesions. Ongoing research into these compounds continues to change our clinical understanding as to which agents most benefit particular patient populations. Indeed, factors such as past personal medical history, lesion location and tolerability of therapy only represent a few considerations that clinicians must account for when prescribing appropriate treatment. This review focuses on specific drugs used in either the prevention or treatment of AKs. Nicotinamide, acitretin and topical 5-fluorouracil (5-FU) continue to be used with fidelity in the chemoprevention of actinic keratosis, although some uncertainty persists in regard to which agents should be used in immunocompetent vs. immunodeficient/immunosuppressed patients. Topical 5-FU, including combination formulations with either calcipotriol or salicylic acid, as well as imiquimod, diclofenac and photodynamic light therapy are all accepted treatment strategies employed to target and eliminate AKs. Five percent of 5-FU is regarded as the most effective therapy in the condition, although the literature has conflictingly shown that lower concentrations of the drug might also be as effective. Topical diclofenac (3%) appears to be less efficacious than 5% 5-FU, 3.75-5% imiquimod and photodynamic light therapy despite its favorable side effect profile. Finally, traditional photodynamic light therapy, while painful, appears to be of higher efficacy in comparison to its more tolerable counterpart, daylight phototherapy.
Topics: Humans; Keratosis, Actinic; Aminolevulinic Acid; Diclofenac; Imiquimod; Photochemotherapy; Fluorouracil; Photosensitizing Agents; Treatment Outcome
PubMed: 36902419
DOI: 10.3390/ijms24054989