Actinic keratoses: pain severity after cryotherapy and patient tolerability of treatment

Abstract

which was observed in our patient. Nevertheless, the diagnosis of POEMS syndrome-associated multicentric Castleman disease was not supported by the absence of peripheral neuropathy in our case. 3 Prior to anakinra treatment, we treated the patient with tocilizumab, 4 which only partially improved urticarial rash on the localized erythematous patches. On the other hand, the administration of anakinra demonstrated prompt favourable responses to clinical manifestations. 2 Taken together, although the possibility of Castleman disease and cutaneous plasmacytosis cannot be completely excluded, our case is considered as Schnitzler syndrome.We agree with the insightful notion by Dr Wang that skinassociated lymphoid tissue (SALT) can be formed under the influence of hypercytokinaemia as a sign of systemic disease. Therefore, we termed these lymphoid follicles as inducible SALT (iSALT). It is yet to be elucidated whether iSALT formation is a characteristic of Schnitzler syndrome or a unique phenomenon detected in our patient, who manifested wheals on recurrent localized erythema, which is not commonly observed in Schnitzler syndrome. We believe that further investigation is required to clarify the pathogenesis and the function of iSALT in various skin diseases. Acknowledgments: We thank Dr Prof. H. Kawabata of Kanazawa Medical University for his informative guidance about the diagnosis of Castleman disease.

Cryotherapy for Actinic Keratosis: Basic Principles and Literature Review

“…It is generally well tolerated by patients so that local anaesthesia is usually not necessary. A recent study of Quinn et al 29 measured pain after cryotherapy in 95 AKs patients using a visual analogue scale (VAS) at five time points: prior to treatment, immediately and 10 minutes after treatment, 3 and 24 hours after cryotherapy. Moderate-to-severe pain was reported by 46.3% of patients immediately after treatment, but only 10% reported persisting strong pain at following time points.…”