Photodynamic Therapy for Actinic Cheilitis

Abyaneh, Mohammad Ali Yazdani; Falto‐Aizpurua, Leyre; Griffith, Robert; Nouri, Keyvan

doi:10.1097/dss.0000000000000254

Cited by 35 publications

(21 citation statements)

References 46 publications

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“…In a retrospective analysis of real‐life practice, PDT cleared 27 of 43 (63%) patients with complete response maintained at 4.2 ± 5.9 months . A recent systematic review of PDT in actinic cheilitis reviewed 15 eligible studies with a complete response of 62% at final follow‐up ranging from 3 to 30 months, although histological cure, where assessed, was lower, at 47% overall at final follow‐up (1.5–30 months) …”

Section: Current Indicationsmentioning

confidence: 99%

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Morton¹,

Szeimies

Basset-Séguin

et al. 2019

Acad Dermatol Venereol

138

146

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Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, Bowen's disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas. Recurrence rates when standard treatment protocols are used are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as lesional and field therapies and has the potential to delay/reduce the development of new lesions. A protocol using daylight to treat actinic keratoses is widely practised, with conventional PDT using a red light after typically a 3‐h period of occlusion employed for other superficial skin cancer indications as well as for actinic keratoses when daylight therapy is not feasible. PDT is a well‐tolerated therapy although discomfort associated with conventional protocol may require pain‐reduction measures. PDT using daylight is associated with no or minimal pain and preferred by patient. There is an emerging literature on enhancing conventional PDT protocols or combined PDT with another treatment to increase response rates. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical PDT in dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence.

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Section: Current Indicationsmentioning

confidence: 99%

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Morton¹,

Szeimies

Basset-Séguin

et al. 2019

Acad Dermatol Venereol

138

146

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“…Since these drugs have a lengthy dosage, bad patient compliance is indeed a major factor impairing successful treatment (2,7,8). Both photodynamic therapy and laser ablation have been reported as safe and effective treatment options of AC (6,9). Unfortunately, they are not always available, and this is an important limiting factor.…”

Section: Discussionmentioning

confidence: 97%

“…Cryotherapy is probably the strategy with more widespread use. It is easy to be performed and well tolerated and it can be effective in cases of focal AC, but recurrences are usual (2,6). Field therapies, such as 5-fluorouracil, imiquimod and diclofenac, can cause erythema, edema, erosions and crusting.…”

Section: Discussionmentioning

confidence: 98%

Management of actinic cheilitis using ingenol mebutate gel: A report of seven cases

Flórez

Batalla

Torre

2016

Journal of Dermatological Treatment

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Actinic cheilitis (AC) can precede the development of squamous cell carcinoma of the lip, a location with high risk of invasiveness and metastasis. We communicate the good results that we obtained when treating seven patients suffering from AC with ingenol mebutate (IM) 0,015% concentration gel on three consecutive days. Three patients achieved complete clearance and four significant improvement. IM is a topical field treatment approved for actinic keratosis. To our knowledge, reported experience in the management of AC with IM is very limited. Local skin responses grade 3 were the main adverse event observed and they resolved in all patients without specific therapy within 1 to 2 weeks. IM is characterized by its rapid clinical effect, its favorable safety profile and its dosing period of only 3 days, shorter than with other field therapies. All these facts make it an attractive new therapy for AC, with need for further study.

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“…17 Treatment options for AC include topical therapy or surgical interventions, although due to a lack of comparative studies, there is little consensus regarding optimal treatment. [18][19][20][21][22][23][24][25] Ingenol mebutate appears to be a viable treatment option for AC, supported by two small case series. [18][19][20][21][22][23][24][25] Ingenol mebutate appears to be a viable treatment option for AC, supported by two small case series.…”

Section: Actinic Keratosis On the Periorbital Region Eyelids Ears Amentioning

confidence: 99%

“…[18][19][20][21][22][23][24][25] Ingenol mebutate appears to be a viable treatment option for AC, supported by two small case series. [20][21][22]25 Daylight PDT (dPDT) may also be a useful, less painful treatment option (Prof. Basset-Seguin personal communcation). [20][21][22]25 Daylight PDT (dPDT) may also be a useful, less painful treatment option (Prof. Basset-Seguin personal communcation).…”

Section: Actinic Keratosis On the Periorbital Region Eyelids Ears Amentioning

confidence: 99%

Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians

Richard

Amici

Basset-Séguin

et al. 2018

Acad Dermatol Venereol

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Actinic keratoses (AK) arise on sun-exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents and patients with chronic lymphocytic leukaemia. The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC. A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high-risk patients are presented, taking into account the experts' own clinical experience and current guidelines. In most of these 'at-risk' situations, patients can be treated according to the AKTeam treatment algorithm. Difficult-to-treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun protection strategies are mandatory, and patients should undergo more regular follow-up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions. This expert consensus provides guidance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs.

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Photodynamic Therapy for Actinic Cheilitis

Abstract: Photodynamic therapy is safe and has the potential to clinically and histologically treat AC, with a need for future randomized controlled trials.

Cited by 35 publications

References 46 publications

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen's disease and basal cell carcinomas

Management of actinic cheilitis using ingenol mebutate gel: A report of seven cases

Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians

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