scholarly journals Effective Combination of Photodynamic Therapy and Imiquimod 5% Cream in the Treatment of Actinic Keratoses: Three Cases

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Laura Held ◽  
Thomas Kurt Eigentler ◽  
Ulrike Leiter ◽  
Claus Garbe ◽  
Mark-Jürgen Berneburg
Keyword(s):  
Photodynamic Therapy ◽  
Patient Adherence ◽  
Proof Of Concept ◽  
Treatment Area ◽  
Skin Reactions ◽  
Local Skin ◽  
Once Daily ◽  
Actinic Keratoses ◽  
Effective Combination

Background. The therapy for actinic keratoses includes photodynamic therapy (PDT) and imiquimod 5% cream. The sequential use of both could result in better clinical outcomes.Objectives. To enhance efficacy of therapies while improving tolerability, convenience, and patient adherence with a scheme combining two concomitant or sequential AK treatments.Methods. All patients underwent one session of conventional PDT. Two weeks after, the PDT imiquimod 5% cream was applied to the treatment area once daily for three days per week. One course continued for four weeks followed by a clinical evaluation and decision about further treatment. Patients who had not cleared all of their AK lesions in the treatment area in course 1 participated in a second 4-week course of treatment.Limitations. Small size of population.Results. Three participants were enrolled. Two patients showed complete clinical clearance of AKs. The effect was also noted after long-term followup, at months seven and eleven. No subject discontinued for an adverse event. There were severe local skin reactions in two participants which were severe erythema, scaling, and crusting. One patient showed no response to the therapy.Conclusions. Photodynamic therapy followed by imiquimod was well tolerated and improved reduction of actinic keratoses. This initial proof-of-concept should be studied in larger clinical trials.

Viral and Nonviral Uses of Imiquimod: A Review

2004 ◽  
Vol 8 (5) ◽  
pp. 338-352 ◽  
Author(s):  
Aditya K. Gupta ◽  
Andrea M. Cherman ◽  
Stephen K. Tyring
Keyword(s):  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Basal Cell ◽  
Skin Diseases ◽  
Interleukin 12 ◽  
Antitumor Effects ◽  
Skin Reactions ◽  
Local Skin ◽  
Actinic Keratoses ◽  
Skin Conditions

Background: Imiquimod is a topical immunomodulator that is indicated for the treatment of external genital and perianal warts. This drug has been recently approved for the treatment of actinic keratoses and superficial basal cell carcinoma. There is a growing body of evidence for its effectiveness in treating a variety of other skin conditions. Objective: This review examines the role of imiquimod 5% cream in the treatment of skin diseases such as actinic keratoses, basal cell carcinoma, Bowen's disease, lentigo maligna, and extramammary Paget's disease. Methods: Published literature containing the words “Imiquimod” or “Aldara” was reviewed and summarized. Results: This agent has demonstrated indirect antiviral and antitumor effects in animal models. Although the exact mechanism of action is unknown, imiquimod is an agonist for toll-like receptor (TLR) 7 and is thought to act by inducing cytokines, such as interferon alpha (IFN-α), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNF-α). These cytokines trigger the immune system to recognize the presence of a viral infection or tumor and the associated lesion is ultimately eradicated. Side effects are generally well tolerated with local skin reactions reported most frequently. Conclusion: Imiquimod has been shown to be a safe and effective treatment for a variety of skin conditions.

scholarly journals Considerations in the Management of Actinic Keratoses: The Importance of Adherence and Persistence to Therapy

2021 ◽  
Vol 5 (2) ◽  
pp. 83-89
Author(s):  
Justin Marson ◽  
James Del Rosso ◽  
Neal Bhatia ◽  
Darrell Rigel
Keyword(s):  
Treatment Regimen ◽  
Positive Impact ◽  
Malignant Lesion ◽  
Invasive Squamous Cell Carcinoma ◽  
Skin Reactions ◽  
Patient Behavior ◽  
Local Skin ◽  
Treatment Regimens ◽  
Long Term Treatment

Background: Actinic keratosis (AK) is a pre-malignant lesion with a poorly defined risk of progression to invasive squamous cell carcinoma (SCC). AKs are also associated with increased future risk of invasive SCC. However, there are many barriers to therapy adherence that may affect long-term treatment efficacy. Objective: To review the current literature reporting known known factors of AK treatment non-adherence intrinsic to patient behavior and treatment regimens and re-examine how dermatologists can navigate these challenges. Methods: A Medline literature search was performed to identify existing evidence regarding barriers to adherence with AK treatment regimens intrinsic to patient behavior, patient counseling, and treatment regimens pertinent for review.  Results & Discussion: Factors intrinsic to prescribed patient-applied therapy that can exacerbate  non-adherence include: 1) length of treatment duration, 2) frequency of application, 3) complexity of treatment regimen, 4) duration and 5) severity of local skin reactions (LSR) and adverse reactions. Novel mechanisms of action that induce cellular apoptosis (as opposed to necrosis) via inhibition of tubulin polymerization and cell cycle arrest, may promote treatment regimen adherence and long-term outcomes. Dermatologists should also be conscious of how they counsel patients as insufficient counseling may also lead to poor adherence. Conclusion: Dermatologists must understand the value of shorter course therapies and their positive impact on adherence and be well-versed in the mechanisms, efficacy and adverse events associated with treatment options. By doing so, dermatologists may best counsel and educate patients and devise regimens that address individualized patient concerns.  

scholarly journals Photodynamic Therapy in 2020: Lights in the Darkness

2020 ◽  
Vol 4 (4) ◽  
pp. 312-320
Author(s):  
Neal Bhatia
Keyword(s):  
Photodynamic Therapy ◽  
Red Light ◽  
Underlying Disease ◽  
Term Treatment ◽  
Skin Reactions ◽  
Local Skin ◽  
Patient Demographics ◽  
Long Term Treatment ◽  
Consensus Statements ◽  
Integral Treatment

Photodynamic therapy (PDT) is an integral treatment modality for treating the entire process of photodamage, based on what is understood about the pathogenesis of actinic keratosis and the consequences from treating only visible spots and not the underlying disease. Dermatologists must consider incorporation of treatment in combination with duration, frequency, and tolerability of local skin reactions. These considerations are important, along with the combination of topical therapies and intermittent cryotherapy of individual actinic keratoses. Aside from costs and patient demographics, adaptation by dermatologists can influence variability in long-term treatment algorithms. There are multiple published guidelines and consensus statements for the US and Europe to promote safe incorporation of both blueand red light along with the variable concentrations of ALA by dermatologists. However, there is a lack of head to head studies and comparative superiority as well as any evidence to support the use of topical agents. As management of local skin reactions becomes more commonplace, so will improved management of PDT to foster patient safety.

scholarly journals Long-term Outcome of Low-concentration Hexyl-5-aminolaevulinate Daylight Photodynamic Therapy for Treatment of Actinic Keratoses

2017 ◽  
Vol 97 (1) ◽  
pp. 120-121 ◽  
Author(s):  
N Neittaanmäki-Perttu ◽  
T Karppinen ◽  
T Tani ◽  
E Snellman ◽  
M Grönroos
Keyword(s):  
Photodynamic Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Actinic Keratoses ◽  
Low Concentration

Extended-release Antiepilepsy Drugs—Review of the Effects of Once-daily Dosing on Tolerability, Effectiveness, Adherence, Quality of Life, and Patient Preference

US Neurology ◽  
2014 ◽  
Vol 10 (01) ◽  
pp. 30 ◽  
Author(s):  
Basim M Uthman ◽  
Keyword(s):  
Quality Of Life ◽  
Extended Release ◽  
Treatment Effectiveness ◽  
Patient Adherence ◽  
Treatment Strategies ◽  
Therapeutic Window ◽  
Negative Consequences ◽  
Once Daily

Long-term adherence to antiepilepsy drug (AED) regimens is frequently suboptimal. Poor adherence to therapy is associated with a number of negative consequences, including an increase in patient seizures and mortality. Nonadherence is related to a variety of factors, such as treatment-related adverse events, convenience of treatment, efficacy, and quality of life. There is therefore a need for treatment strategies in epilepsy that improve long-term adherence. One such strategy is the use of extended-release (ER) AED formulations. Advantages of ER AEDs over other AED formulations include the potential for once-daily dosing, a more stable mean drug concentration over time, improved tolerability profiles, maximal use of the therapeutic window, and the possibility to achieve better seizure control. Improvements in overall treatment effectiveness may therefore increase patient adherence. This review presents evidence related to patient adherence and preference patterns for ER AEDs and highlights the beneficial properties of ER AEDs.

Open-Label Study to Assess the Safety and Efficacy of Imiquimod 5% Cream Applied Once Daily Three Times per Week in Cycles for Treatment of Actinic Keratoses on the Head

2008 ◽  
Vol 12 (3) ◽  
pp. 97-101 ◽  
Author(s):  
Jason K. Rivers ◽  
Les Rosoph ◽  
Nathalie Provost ◽  
Robert Bissonnette
Keyword(s):  
Treatment Cycle ◽  
Open Label ◽  
Effective Treatment Option ◽  
Skin Reactions ◽  
Local Skin ◽  
Once Daily ◽  
Open Label Study ◽  
Label Study ◽  
Safety And Efficacy ◽  
Complete Clearance

Background: Local skin reactions are common during imiquimod treatment of actinic keratosis (AK). Cyclical application of imiquimod may improve tolerability while maintaining efficacy. Objective: To assess the tolerability of imiquimod and clearance rate of AK lesions after imiquimod application. Methods: Imiquimod 5% cream was administered three times per week for 4 weeks followed by 4 weeks of rest (cycle 1) to AK lesions on the head. If AK lesions remained visible at the end of cycle 1, a second treatment cycle was instituted. Results: Fifty percent (30 of 60) of patients experienced complete clearance of AK lesions, and 75% (30 of 40) of patients experienced partial clearance of AK lesions after imiquimod treatment at the end of cycle 2. Moreover, 77% of patients who achieved complete clearance had no visible AK lesions 12 weeks post-treatment. Imiquimod was well tolerated. Conclusion: Imiquimod cycle therapy may be a safe and effective treatment option for AK lesions.

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