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MAL DL-PDT showed similar efficacy to c-PDT in the treatment of AK I of the face/scalp but was less effective than c-PDT for AKs II and III. DL-PDT was better tolerated being associated with lower pain and occurrence of fewer adverse events. Clinical response to DL-PDT was significantly moderated by outdoor temperature, increasing at higher temperatures.

Several immune-related markers have been implicated in basal cell carcinoma (BCC) pathogenesis. The BCC inflammatory infiltrate is dominated by Th2 cytokines, suggesting a specific state of immunosuppression. In contrast, regressing BCC are characterized by a Th1 immune response with IFN-γ promoting a tumor suppressive activity. IL-23/Th17-related cytokines, as interleukin (IL)-17, IL-23 and IL-22, play a significant role in cutaneous inflammatory diseases, but their involvement in skin carcinogenesis is controversial and is poorly investigated in BCC. In this study we investigated the expression of IFN-γ, IL-17, IL-23 and IL-22 cytokines in BCC at the protein and mRNA level and their modulation during imiquimod (IMQ) treatment or photodynamic therapy (PDT). IFN-γ, IL-17, IL-23 and IL-22 levels were evaluated by immunohistochemistry and quantitative Real Time PCR in 41 histopathologically-proven BCCs (28 superficial and 13 nodular) from 39 patients. All BCC samples were analyzed at baseline and 19 of 41 also during medical treatment (9 with IMQ 5% cream and 10 with MAL-PDT). Association between cytokines expression and clinico-pathological variables was evaluated. Higher levels of IFN-γ, IL-17, IL-23 and IL-22 were found in BCCs, mainly in the peritumoral infiltrate, compared to normal skin, with the expression being correlated to the severity of the inflammatory infiltrate. IFN-γ production was higher in superficial BCCs compared to nodular BCCs, while IL-17 was increased in nodular BCCs. A significant correlation was found between IFN-γ and IL-17 expression with both cytokines expressed by CD4+ and CD8+ T-cells. An increase of all cytokines occurred during the inflammatory phase induced by IMQ and at the early time point of PDT treatment, with significant evidence for IFN-γ, IL-23, and IL-22. Our results confirm the role of IFN-γ and support the involvement of IL-23/Th17-related cytokines in BCC pathogenesis and in the inflammatory response during IMQ and MAL-PDT treatments.

We observed an excellent rate (>99%) of adherence to ingenol mebutate. This was mirrored by the fact that our clinical outcomes broadly confirmed results obtained in RTCs. Our study showed that the efficacy and safety of ingenol mebutate observed in RCTs can be reliably translated in real-world practice.

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In this study, we assessed the efficacy and safety of four skin care products indicated for skin hydration (Aqua Therapy  and Perfecta ) and are formulated with a specific combination of active compounds (Dermo28  ). Evaluation of sebum secretion, hydration and pH of the skin (all groups), wrinkle severity (Unica Resurfacing Therapy  ) and erythema (Comfort Therapy  ) was performed at baseline and after 4 weeks of treatment. A significant increase in hydration was recorded in subjects with dry skin receiving Aqua Therapy  for facial hydration and Perfecta  for body hydration, respectively (p < 0.001 for both). A significant decrease in the modified Fitzpatrick wrinkle scale (p = 0.006) and an increase in sebum secretion and hydration (p = 0.013 and p < 0.001, respectively) were observed in the Unica Resurfacing Therapy  group. In subjects with sensitive skin (Comfort Therapy  ), a decrease in erythema (p = 0.012), an increase in sebum secretion (p = 0.001) and hydration (p < 0.001), and a reduction in pH (p = 0.005) were detected at the end of treatment. Only one patient reported a minor adverse event. This specific combination of active ingredients was clinically effective and safe, and contributed to skin surface hydrolipidic film regeneration, improvement of wrinkle depth and reduction of redness.

ALA-IPL treatment using 0.5% liposome-encapsulated 5-ALA spray and Ellipse Flex PPT system is effective and safe for the treatment of type 2 photoaging reducing the PDT-associated side effects.

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