Assessment of the Effect of 3% Diclofenac Sodium on Photodamaged Skin by Means of Reflectance Confocal Microscopy

Abstract

Chronic ultraviolet exposure causes changes over keratinocytes, melanocytes and connective tissue of the skin on sun-exposed areas, including keratinocyte atypia, increased melanocyte density, increased epidermal melanin and, deposition of elastotic material in superficial dermis. This photodamage results in wrinkling, pigment irregularities, coarseness and skin neoplasms. Treatment with 3% diclofenac sodium w/w in hyaluronic acid is associated with an improvement in irregular pigmentation, coarseness, keratinocyte atypia and mottled pigmentation. Therefore, treatment with 3% diclofenac sodium associates an improvement in signs of photodamaged skin. Treatment of actinic keratosis with 3% diclofenac sodium w/w in hyaluronic acid is associated with a concomitant improvement in signs of photodamaged skin. However this effect has not yet been examined in depth. Twenty patients with actinic keratosis and signs of photodamaged skin were studied. They received treatment with diclofenac sodium w/w in hyaluronic acid for 2 months. Clinical and reflectance confocal microscopy assessment on signs of photodamaged skin were performed. Regarding reflectance confocal microscopy, the most common descriptors were: irregular honeycomb pattern in 18/20 patients (90%), mottled pigmentation in 17/20 (85%), coarse collagen structures in all patients, and huddled collagen and curled bright structures in 16/20 (77.8%). After treatment, significant improvement in clinical parameters: irregular pigmentation and coarseness, and confocal parameters: irregular honeycomb pattern and mottled pigmentation, were noted. Reflectance confocal microscopy is a useful tool in monitoring changes in photodamaged skin after treatment. The use of diclofenac sodium w/w in hyaluronic acid is associated with an improvement in some clinical and reflectance confocal microscopy parameters of photodamaged skin.

In Vivo Reflectance Confocal Microscopy as a Response Monitoring Tool for Actinic Keratoses Undergoing Cryotherapy and Photodynamic Therapy

“…Our identification of atypical honeycomb patterns as a reliable RCM parameter for AK is consistent with many reports highlighting the utility of keratinocyte disarray/atypical honeycomb patterns in AK response monitoring [ 11 , 12 , 13 , 23 , 24 , 25 , 26 , 27 , 28 ]. Hyperkeratosis [ 8 , 13 , 15 , 17 , 23 , 25 , 29 ] and stratum corneum disruption [ 8 , 11 , 12 ] have also been identified as significant RCM parameters, although many studies have not included these criteria in the RCM analysis of AK treatment responses.…”

“…Subject to operator-dependence and differences in individual experience, interobserver variability is an inherent limitation to RCM [ 32 ]. Similar studies assessing AK treatment response through RCM have frequently incorporated two experienced evaluators, and some have included a single experienced reader [ 11 , 12 , 13 , 24 , 25 , 26 , 28 ]. In our study, interobserver agreement was measured between three experienced RCM evaluators.…”

Clinical efficacy and reflectance confocal microscopy monitoring in moderate‐severe skin aging treated with a polyvinyl gel containing retinoic and glycolic acid: An assessor‐blinded 1‐month study proof‐of‐concept trial

“…RCM, however, could be a potent tool to evaluate the skin changes in aged skin. A reduced epidermal thickness, an irregular honeycomb pattern, the presence of mottled pigmentation at epidermal level, and the presence of coarse and huddled collagen fibers and curled structures at dermal level are the main alterations observed with RCM evaluation in aged skin 8 . In our trial, the short‐term use of this gel containing retinoic and glycolic acid improved mainly the honeycomb keratinocytes pattern with a marked reduction in mottled pigmentation.…”

Use of Cytology in the Diagnosis of Basal Cell Carcinoma Subtypes

“…Moreover, the shaving biopsy may have missed some of the deepest BCC subtypes in the patients it was performed on [17,18]. Although dermoscopy was performed to exclude coexisting lesions, the location of most BCCs over photodamaged skin of the head and neck may hamper the recording of the squamous cell due to the background epidermal atypia [19].…”