Sequential treatment of actinic keratosis with cryotherapy and ingenol mebutate: reflectance confocal microscopy monitoring of efficacy and local skin reaction
Sequential treatment of actinic keratosis with cryotherapy and ingenol mebutate: reflectance confocal microscopy monitoring of efficacy and local skin reaction
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DOI：
10.1111/ijd.14164
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发表时间：
2018-10-01
影响因子：
3.6
通讯作者：
Gonzalez, Salvador
中科院分区：
文献类型：
--
作者：
Pasquali, Paola;Segurado-Miravalles, Gonzalo;Gonzalez, Salvador
研究背景冷冻法和美丁酸吲哚美丁酸酯(IM)序贯治疗光化性角化病(AK)和癌变区已广泛应用于临床，但序贯治疗的应用顺序尚未得到检验。目的比较IM和冷冻治疗AK的不同序贯疗法，并通过反射共聚焦显微镜(RCM)监测治愈率和局部皮肤反应(LSR)。A组在冷冻治疗前先进行肌注治疗，B组先进行冷冻治疗后再进行肌注治疗。在首次治疗前(第0周)、第二次治疗前(第2周)、治疗后1个月和2个月进行RCM评估。结果26例患者中，A组14例，B组12例。两组患者治疗前后RCM参数均有明显改善。在LSR参数方面，A组在第二次访问时提供的LSR参数比B组少。A组第3次复诊与B组第2次复诊比较仍有差异。结论两种治疗方法均有效，但由于LSR较低，建议在冷冻治疗前进行IM治疗。这可能会减少患者的不适，提高依从性。
BackgroundSequential treatment of actinic keratosis (AK) and cancerization field with cryotherapy and ingenol mebutate (IM) is widely used in clinical practice, however, the order of application of sequential treatment has not been examined yet.ObjectiveTo compare different sequential treatments of IM and cryotherapy in AK and to monitor cure rates and local skin reactions (LSR) through reflectance confocal microscopy (RCM).MethodsPatients with AK were treated with IM and cryotherapy. Group A received treatment with IM before cryotherapy, and group B patients were firstly treated with cryotherapy and secondly IM. RCM evaluation of epidermal dysplasia and LSR was performed prior to the first treatment (Week 0), before the second treatment (Week 2), and one month and two months after initial assessment.ResultsThe study included 26 patients - 14 patients in group A and 12 patients in group B. In both groups, significant improvement in epidermal dysplasia RCM parameters between the first and last visit was observed. Regarding LSR parameters, group A presented fewer LSR parameters than group B on the second visit. This difference was present even if comparison was made between the third visit of group A and the second visit of group B.ConclusionsBoth sequences of treatment are effective, but IM treatment before cryotherapy is recommended because of the lower LSR. This probably decreases patient discomfort and improves compliance.