Local interventions for actinic keratosis in organ transplant recipients: a systematic review

Heppt, Markus V.; Steeb, Theresa; Niesert, Anne‐Charlotte; Zacher, Martina T.; Leiter, Ulrike; Garbe, Claus; Berking, Carola

doi:10.1111/bjd.17148

Cited by 39 publications

(40 citation statements)

References 38 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…About this, there are data supporting the use of PDT in the treatment of AKs in OTRs; and a recent clinical trial compares PDT with IMI 5%, showing a higher efficacy of PDT (17,18). In a recent review, PDT shows the highest rates of complete clearance (40-76.4%), followed by IMI 5% (27.5-62.1%), diclofenac (41%) and 5-Fluorouracil (11%), in OTRs (19).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of topical imiquimod 3.75% in the treatment of actinic keratosis of the scalp in immunosuppressed patients: our case series

Zavattaro

Veronese

Landucci

et al. 2019

Journal of Dermatological Treatment

View full text Add to dashboard Cite

Background: Actinic keratoses (AK) represent common cutaneous lesions, appearing in 'Field cancerization areas' and potentially evolving toward invasive neoplasm. Immunosuppressed patients frequently develop numerous and aggressive AKs. Aim: In this observational study, we report our experience with topical Imiquimod 3.75% as 'Fielddirected therapy' in a cohort of immunosuppressed patients. Methods: A group of 13 immunosuppressed patients presenting multiple AKs of the balding scalp was treated with topical Imiquimod 3.75%. Each patient underwent clinical examination at fixed timepoints during the treatment (T0, T14, T28, T42) and eight weeks after the end. Results: In our cohort, the treatment was well tolerated, with minimal local adverse events. We observed a good clinical response, in terms of Lmax lesions (maximum lesion count during the course of therapy) and of AK clearance. In our group, 46% of patients showed no detectable lesions at the end of the observation period, and this result was maintained up to 1 year after the end of treatment. Conclusion: Topical Imiquimod 3.75% represents an effective and safe treatment for multiple AK of the scalp also in immunosuppressed patients. To the best of our knowledge, this is the first report on the use of this drug in this category of subjects. ARTICLE HISTORY

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy of topical imiquimod 3.75% in the treatment of actinic keratosis of the scalp in immunosuppressed patients: our case series

Zavattaro

Veronese

Landucci

et al. 2019

Journal of Dermatological Treatment

View full text Add to dashboard Cite

show abstract

“…A recent extensive systematic review by Heppt and colleagues (not included in the table as no meta‐analysis done) concluded that MAL‐cPDT has the most data and highest clearance rates of AK in SOTR of any treatment studied.…”

Section: Review Of Photodynamic Therapy Outcomes In Solid Organ Transmentioning

confidence: 99%

Photodynamic therapy: A targeted literature review focussing on outcomes and optimisation in solid organ transplant recipients

Lim

Gordon

2019

Aust J Dermatology

View full text Add to dashboard Cite

Squamous cell carcinoma incidence is 65-to 250fold in solid organ transplant recipients, BCC is 10fold and in Australia, rates of skin cancer in solid organ transplant recipients reach 70-82% prevalence within the first 20 years; hence, effective, evidence-based treatment of early and precancerous lesions is an essential tool in dermatological patient care. Photodynamic therapy is used to treat a range of conditions including actinic keratoses, squamous cell carcinoma in situ, superficial basal cell carcinoma and nodular basal cell carcinoma. A literature review was undertaken to examine the outcomes of photodynamic therapy in solid organ transplant recipients and methods of optimising outcomes in solid organ transplant recipients. Study sizes were small and protocols varied widely, so meta-analysis was not possible; however, photodynamic therapy appears to be an acceptable treatment for approved indications in solid organ transplant recipients in whom ongoing surveillance is maintained to ensure clearance and detect recurrence. Methods for improving efficacy were also reviewed for this population. Improved outcomes may be achieved by combining photodynamic therapy with other local methods such as 5-fluorouracil or ablative fractional laser.

show abstract

“…Although the goals of AK treatment in organ transplant recipients (OTRs) do not generally differ from those in immunocompetent patients, it is important to consider that some treatments may be less effective or have a different safety profile in OTRs as a result of their immune‐related mechanism of action. Considering the large number of OTRs and other people who are chronically immunosuppressed, the interesting and comprehensive systematic review included in this issue of the BJD is of great value.…”

mentioning

confidence: 99%

“…In their systematic assessment of evidence from randomized trials of treatments for AKs in OTRs, Heppt et al . found that photodynamic therapy was the intervention most frequently investigated and associated with the highest rates of complete clearance and reduction in lesion counts.…”

mentioning

confidence: 99%

See 1 more Smart Citation

‘Surprisingly little evidence’ on how best to treat actinic keratosis in organ transplant recipients

Werner

Nast

2019

Br J Dermatol

View full text Add to dashboard Cite

show abstract

Local interventions for actinic keratosis in organ transplant recipients: a systematic review

Abstract: Limited evidence is available for the treatment of AKs in OTRs. MAL-PDT is currently the best-studied intervention. Lesion-specific regimens may not be sufficient to achieve disease control. Field-directed regimens are preferable in this high-risk population.

Cited by 39 publications

References 38 publications

Efficacy of topical imiquimod 3.75% in the treatment of actinic keratosis of the scalp in immunosuppressed patients: our case series

Efficacy of topical imiquimod 3.75% in the treatment of actinic keratosis of the scalp in immunosuppressed patients: our case series

Photodynamic therapy: A targeted literature review focussing on outcomes and optimisation in solid organ transplant recipients

‘Surprisingly little evidence’ on how best to treat actinic keratosis in organ transplant recipients

Contact Info

Product

Resources

About