DOCSLIB.ORG

Are Patients with Psoriasis Susceptible to the Classic Risk Factors for Actinic Keratoses?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Are Patients with Psoriasis Susceptible to the Classic Risk Factors for Actinic Keratoses? STUDY Are Patients With Psoriasis Susceptible to the Classic Risk Factors for Actinic Keratoses? Ora Paltiel, MDCM, MSc; Bella Adler, MPH; Klilah Herschko, MD; Boris Tsukrov, MD; Michael David, MD Background: Anincreasedprevalenceofbenignsolardam- skin, hair, and eye color and propensity or history of sun- age (eg, facial wrinkles) but not neoplastic lesions was ob- burn adjusted for age, ethnicity, and sun exposure. served among patients with psoriasis who were exposed to Dead Sea climatotherapy compared with controls. Results: Actinic keratoses were observed in 200 con- trols (27%) and 51 subjects (11%) (PϽ.001). This in- Objectives: To compare the prevalence of actinic kera- creased prevalence occurred in both sexes, participants tosis in psoriatic patients and controls and to assess whether aged 35 years or older, all ethnic groups, smokers, and known risk factors behave similarly in both groups. nonsmokers. The anatomical distribution of lesions did not substantially differ between subjects and controls. In Design: Multicenter cross-sectional study. multivariate analysis, psoriasis conferred a protective effect (odds ratio, Ͻ1), as did dark skin, dark eyes, and a his- Setting: Dermatology clinics in 4 participating Israeli tory of severe sunburn in childhood. However, signifi- hospitals and at a Dead Sea clinic. cant interactions were observed between psoriasis and hair color as well as psoriasis and propensity to sun- Participants: Adult subjects (n=460) with plaque- burn, whereby a linear association was observed for con- type psoriasis were recruited from the Israel Psoriasis As- trols but not for patients with psoriasis. sociation (volunteer sample) and from dermatology clin- ics (convenience sample). The control group (n=738) Conclusions: Psoriasis confers protection against ac- consisted of nonimmunosuppressed patients attending tinic keratosis. Hair color and propensity to sunburn these clinics for benign conditions unrelated to sun ex- exert differential effects among psoriatic patients and posure, such as atopic or contact dermatitis. controls. Main Outcome Measures: Prevalence and distribu- tion of actinic keratoses and odds ratios associated with Arch Dermatol. 2004;140:805-810 HERE IS A CONSENSUS AMONG melanoma skin cancer (NMSC) (espe- the scientific community cially SCC) has been reported in that the 3 major types of individuals with psoriasis who are ex- skin cancer—squamous cell posed to high cumulative doses of psor- carcinoma (SCC), basal cell alen–UV-A.8-11 In one study, climato- From the School of Public Health (Dr Paltiel and Ms carcinoma (BCC), and malignant mela- therapy at the Dead Sea among Danish T 1,2 Adler) and the Department noma—are caused by sun exposure. Fur- of Hematology (Dr Paltiel), thermore, inherited characteristics, such as For editorial comment Hadassah-Hebrew University skin type and propensity to sunburn, may Medical Center, Jerusalem, have a marked effect on the risk of skin can- see page 873 Israel; and the Departments cer.3 It is not known whether the presence of Dermatology, of other dermatologic conditions modi- patients was found to be associated with Hadassah-Hebrew University fies the association between sun expo- an increased risk of NMSC.12 The study re- Medical Center (Dr Herschko), sure, skin type, and actinic damage. sults, however, were possibly con- Rabin Medical Center, Petah Psoriasis is a chronic skin condition founded by the fact that patients selected Tikva, Israel (Drs Tsukrov and 4 David), and Tel-Aviv that affects approximately 2% of the popu- for Dead Sea climatotherapy were those University, Tel-Aviv, Israel lation, but with considerable ethnic and whose psoriasis was improved by sun ex- 5 (Drs Tsukrov and David). The geographic variation. Manifestations of the posure. Treatment with UV-B may also be authors have no relevant disease are often ameliorated by sun ex- associated with a mild increase (2% per financial interest in this article. posure.6,7 An increased incidence of non- year) of NMSC.13 High-dose psoralen– (REPRINTED) ARCH DERMATOL / VOL 140, JULY 2004 WWW.ARCHDERMATOL.COM 805 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 demographic characteristics, sun exposure, propensity to sun- Table 1. Prevalence of Actinic Keratoses Among Patients burn, and previously diagnosed benign and malignant neo- With Psoriasis and Controls by Sociodemographic Factors plasms. A structured physical examination was performed by a qualified dermatologist who noted skin type, hair color, eye No. (%) color, and the presence and location of suspected malignant skin lesions as well as solar keratosis and other signs of pho- Patients With todamage. Controls Psoriasis (n = 738) (n = 460) P Value STATISTICAL ANALYSIS Sex M 79 (27) 28 (11) .001 We compared characteristics of subjects with psoriasis and con- F 121 (28) 23 (12) .001 trols using the ␹2 test for categorical variables and the Mann- Prevalence by age, y Whitney test for comparing medians of continuous variables. 20-34 8 (4) 1 (1) .45 Variables included in the analysis were group (patients with 35-49 33 (18) 8 (5) Ͻ.001 psoriasis or controls); skin type (I-IV reclassified into light or 50-59 76 (39) 15 (12) Ͻ.001 Ն60 83 (56) 27 (30) Ͻ.001 dark); eye color (black/brown or blue/green); hair color (black, Ethnic origin brown, or blonde/red); propensity to sunburn (often/always, Asia-Africa 30 (29) 7 (15) .07 sometimes, or never), and history of severe sunburn in child- Europe/America 63 (40) 14 (10) Ͻ.001 hood (yes or no). We also constructed a summary variable of Israel 106 (23) 28 (11) Ͻ.001 “fairness,” which took into account eye color, hair color, and Smoking complexion. We constructed logistic regression models for the Yes 38 (19) 10 (6) Ͻ.001 presence of solar keratosis on examination, controlling for age No 161 (30) 41 (14) Ͻ.001 (continuous variable), country of origin (Israel, Asia, North Africa, or other), yearly hours of sun exposure (recreational and occupational categorized into quartiles), and smoking his- tory (current smoker: yes or no). To these models we added UV-A therapy (1000 J/cm2) has also been reported to be psoriasis/control status and individual measures of sun sensi- associated with an increased risk of actinic keratosis.14 tivity, such as skin color, hair color, eye color, and propensity A cross-sectional study was previously performed to sunburn. The models were slightly modified in terms of the in Israel that compared actinic damage among patients covariates entered according to goodness-of-fit criteria (Hosmer- with psoriasis (87% of whom had undergone climato- Lemeshow test). therapy at the Dead Sea Solarium Clinic, Ein Bokek, Is- We then tested whether there were significant interac- tions between psoriasis/control status and these variables. We rael) and controls (individuals without psoriasis) (M.D., also tested whether solar elastosis and solar keratosis ap- B. T., B. A., et al, unpublished data, 2000). In that study, peared together in the same anatomical locations and mea- the control subjects had higher self-reported rates of pre- sured agreement using the ␬ statistic. All analyses were per- vious skin biopsies, removal of benign growth, or pre- formed using SPSS software (Version 10; SPSS Inc, Chicago, vious malignant neoplasms. There was an association be- III). For all tests of significance, a 2-sided P value of .05 was tween extent of exposure to the Dead Sea and benign considered statistically significant. photodamage, such as facial wrinkles, elastosis, solar len- tigo, and poikiloderma. However, solar keratosis was more RESULTS prevalent among controls than among patients with pso- riasis and showed no association with days of exposure at the Dead Sea. This surprising finding prompted a de- UNIVARIATE ANALYSIS tailed analysis of factors associated with the presence of solar keratoses, with a comparison of persons with and The study population consisted of 460 subjects with pso- without psoriasis. riasis and 738 controls (N=1198). Patients with psoria- sis were more likely to be current smokers (34% vs 27%), male (57% vs 40%), and of European origin (31% vs 22%) METHODS than the controls. Of the patients with psoriasis, 49 (12%) had received psoralen–UV-A therapy and 109 (26%) had STUDY POPULATION been treated with UV-B. Very few malignant neoplasms Subjects were patients with plaque-type psoriasis aged 20 to were noted on examination. Six cases of BCC and 3 of 70 years with a disease duration of at least 7 years. They were SCC were suspected among the patients with psoriasis, recruited from among members of the Israel Psoriasis Associa- whereas among the controls the corresponding num- tion at a Dead Sea psoriasis clinic or attended dermatology clin- bers were 11 and 3. Only 5 cases (2 SCCs [1 each among ics at 1 of the 4 participating hospitals. Controls were patients patients with psoriasis and controls] and 3 BCCs [1 among aged 20 to 70 years who were attending dermatology clinics patients with psoriasis and 2 among controls]) were con- for benign skin conditions, eg, contact dermatitis and atopic firmed histologically. Solar keratoses were present among dermatitis. Patients with vitiligo, immunosuppression, auto- 200 controls (27%) and 51 patients with psoriasis (11%) immunity, or suspected malignancy as the reason for the clinic (P=.001). In both psoriatic patients and controls, the visit were excluded as controls. We also excluded controls with skin types V or VI. prevalence of solar keratosis increased with age. At all All participants provided signed informed consent, and the ages, in both sexes, and in all ethnic groups, the preva- study protocol was approved by the institutional review boards lence of solar keratosis was higher among controls than of all participating hospitals. A questionnaire was adminis- among psoriatic patients (Table 1). Among the con- tered to subjects and controls and included items concerning trols, European-American origin was more common in (REPRINTED) ARCH DERMATOL / VOL 140, JULY 2004 WWW.ARCHDERMATOL.COM 806 ©2004 American Medical Association.
Load more

Recommended publications
  • In Dermatology Visit with Me to Discuss
    From time to time new treatments surface for any medical field, and the last couple of years have seen new treatments emerge, or new applications for familiar treatments. I wanted to summarize some of these New Therapies widely available remedies and encourage you to schedule a in Dermatology visit with me to discuss. Written by Board Certified Dermatologist James W. Young, DO, FAOCD Nicotinamide a significant reduction in melanoma in Antioxidants Nicotinamide (niacinamide) is a form high risk skin cancer patients at doses Green tea, pomegranate, delphinidin of vitamin B3. The deficiency of vitamin more than 600 and less than 4,000 IU and fisetin are all under current study for daily. B3 causes pellagra, a condition marked either oral or topical use in the reduction by 4D’s – (photo) Dermatitis, Dementia, Polypodium Leucotomos of the incidence of skin cancer, psoriasis Diarrhea and (if left untreated) Death. and other inflammatory disorders. I’ll be Polypodium leucotomos is a Central This deficiency is rare in developed sure to keep patients updated. countries, but is occasionally seen America fern that is available in several in alcoholism, dieting restrictions, or forms, most widely as Fernblock What Are My Own Thoughts? malabsorption syndromes. Nicotinamide (Amazon) or Heliocare (Walgreen’s and I take Vitamin D 1,000 IU and Heliocare does not cause the adverse effects of Amazon) and others. It is an antioxidant personally. Based on new research, I Nicotinic acid and is safe at doses up to that reduces free oxygen radicals and have also added Nicotinamide which 3,000mg daily. may reduce inflammation in eczema, dementia, sunburn, psoriasis, and vitiligo.
    [Show full text]
  • What Is Acne? Acne Is a Disease of the Skin's Sebaceous Glands
    What is Acne? Acne is a disease of the skin’s sebaceous glands. Sebaceous glands produce oils that carry dead skin cells to the surface of the skin through follicles. When a follicle becomes clogged, the gland becomes inflamed and infected, producing a pimple. Who Gets Acne? Acne is the most common skin disease. It is most prevalent in teenagers and young adults. However, some people in their forties and fifties still get acne. What Causes Acne? There are many factors that play a role in the development of acne. Some of these include hormones, heredity, oil based cosmetics, topical steroids, and oral medications (corticosteroids, lithium, iodides, some antiepileptics). Some endocrine disorders may also predispose patients to developing acne. Skin Care Tips: Clean skin gently using a mild cleanser at least twice a day and after exercising. Scrubbing the skin can aggravate acne, making it worse. Try not to touch your skin. Squeezing or picking pimples can cause scars. Males should shave gently and infrequently if possible. Soften your beard with soap and water before putting on shaving cream. Avoid the sun. Some acne treatments will cause skin to sunburn more easily. Choose oil free makeup that is “noncomedogenic” which means that it will not clog pores. Shampoo your hair daily especially if oily. Keep hair off your face. What Makes Acne Worse? The hormone changes in females that occur 2 to 7 days prior to period starting each month. Bike helmets, backpacks, or tight collars putting pressure on acne prone skin Pollution and high humidity Squeezing or picking at pimples Scrubs containing apricot seeds.
    [Show full text]
  • What Is Acne and Why Do I Have Pimples?
    What is acne and why do I have pimples? The medical term for “pimples” is acne. Most people develop at least some acne, especially during their teenage years. Although many believe that acne comes from being dirty, this is not true; rather, acne is the result of changes that occur during puberty. Your skin is made of layers. To keep the skin from getting dry, the skin makes oil in little wells called “sebaceous glands” that are found in the deeper layers of the skin. “Whiteheads” or “blackheads” are clogged sebaceous glands. “Blackheads” are not caused by dirt blocking the pores, but rather by oxidation (a chemical reaction that occurs when the oil reacts with oxygen in the air). People with acne have glands that make more oil and are more easily plugged, causing the glands to swell. Hormones, bacteria (called P. acnes) and your family’s likelihood to have acne (genetic susceptibility) also play a role. SKIN HYGIENE Good skin care habits are important and support the medications your doctor prescribes for your acne. » Wash your face twice a day, once in the morning and once in the evening (which includes any showers you take). » Avoid over-washing/over-scrubbing your face as this will not improve the acne and may lead to dryness and irritation, which can interfere with your medications. » In general, milder soaps and cleansers are better for acne-prone skin. The soaps labeled “for sensitive skin” are milder than those labeled “deodorant soap” or “antibacterial soap.” » Many “acne washes” may contain salicylic acid. Salicylic acid (SA) fights oil and bacteria mildly but can be drying and can add to irritation.
    [Show full text]
  • Actinic Keratoses Final Report
    Actinic Keratoses Final Report Mark Helfand, MD, MPH Annalisa K. Gorman, MD Susan Mahon, MPH Benjamin K.S. Chan, MS Neil Swanson, MD Submitted to the Agency for Healthcare Research and Quality under contract 290-97-0018, task order no. 6 Oregon Health & Science University Evidence-based Practice Center 3181 SW Sam Jackson Park Road Portland, Oregon 97201 May 19, 2001 Actinic Keratoses Structured Abstract Objective: To examine evidence about the natural history and management of actinic keratoses (AKs). Search Strategy: We searched the MEDLINE database from January 1966 to January 2001, the Cochrane Controlled Trials Registry, and a bibliographic database of articles about skin cancer. We identified additional articles from reference lists and experts. Selection Criteria: We selected 45 articles that contained original data relevant to treatment of actinic keratoses, progression of AKs to squamous cell cancer (SCC ), means of identifying a high-risk group, or surveillance of patients with AKs to detect and treat SCCs early in their course. Data Collection and Analysis: We abstracted information from these studies to construct evidence tables. We also developed a simple mathematical model to examine whether estimates of the rate of progression of AK to SCC were consistent among studies. Finally, we analyzed data from the Medicare Statistical System to estimate the frequency of procedures attributable to AK among elderly beneficiaries. Main Results: The yearly rate of progression of an AK in an average-risk person in Australia is between 8 and 24 per 10,000. High-risk individuals with multiple AKs have progression rates as high as 12-30 percent over 3 years.
    [Show full text]
  • What Are Basal and Squamous Cell Skin Cancers?
    cancer.org | 1.800.227.2345 About Basal and Squamous Cell Skin Cancer Overview If you have been diagnosed with basal or squamous cell skin cancer or are worried about it, you likely have a lot of questions. Learning some basics is a good place to start. ● What Are Basal and Squamous Cell Skin Cancers? Research and Statistics See the latest estimates for new cases of basal and squamous cell skin cancer and deaths in the US and what research is currently being done. ● Key Statistics for Basal and Squamous Cell Skin Cancers ● What’s New in Basal and Squamous Cell Skin Cancer Research? What Are Basal and Squamous Cell Skin Cancers? Basal and squamous cell skin cancers are the most common types of skin cancer. They start in the top layer of skin (the epidermis), and are often related to sun exposure. 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer cells. To learn more about cancer and how it starts and spreads, see What Is Cancer?1 Where do skin cancers start? Most skin cancers start in the top layer of skin, called the epidermis. There are 3 main types of cells in this layer: ● Squamous cells: These are flat cells in the upper (outer) part of the epidermis, which are constantly shed as new ones form. When these cells grow out of control, they can develop into squamous cell skin cancer (also called squamous cell carcinoma).
    [Show full text]
  • Sunburn, Suntan and the Risk of Cutaneous Malignant Melanoma the Western Canada Melanoma Study J.M
    Br. J. Cancer (1985), 51, 543-549 Sunburn, suntan and the risk of cutaneous malignant melanoma The Western Canada Melanoma Study J.M. Elwood1, R.P. Gallagher2, J. Davison' & G.B. Hill3 1Department of Community Health, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK; 2Division of Epidemiology and Biometry, Cancer Control Agency of British Columbia, 2656 Heather Street, Vancouver BC, Canada V5Z 3J3; and 3Department of Epidemiology, Alberta Cancer Board, Edmonton, Alberta, Canada T6G OTT2. Summary A comparison of interview data on 595 patients with newly incident cutaneous melanoma, excluding lentigo maligna melanoma and acral lentiginous melanoma, with data from comparison subjects drawn from the general population, showed that melanoma risk increased in association with the frequency and severity of past episodes of sunburn, and also that melanoma risk was higher in subjects who usually had a relatively mild degree of suntan compared to those with moderate or deep suntan in both winter and summer. The associations with sunburn and with suntan were independent. Melanoma risk is also increased in association with a tendency to burn easily and tan poorly and with pigmentation characteristics of light hair and skin colour, and history freckles; the associations with sunburn and suntan are no longer significant when these other factors are taken into account. This shows that pigmentation characteristics, and the usual skin reaction to sun, are more closely associated with melanoma risk than are sunburn and suntan histories.
    [Show full text]
  • Prior Authorization Criteria
    PRIOR AUTHORIZATION CRITERIA Last Updated 09/01/2021 This is a complete list of drugs that have written coverage determination policies. Drugs on this list do not indicate that this particular drug will be covered under your medical or prescription drug benefit. Please verify drug coverage by checking your formulary and member handbook. Additional restrictions and exclusions may apply. If you have questions, please contact Providence Health Plan Customer Service at 503-574-7500 or 1-800-878-4445 (TTY: 711). Service is available five days a week, Monday through Friday, between 8 a.m. and 6 p.m. ACTINIC KERATOSIS AGENTS MEDICATION(S) CARAC, FLUOROURACIL 0.5% CREAM, IMIQUIMOD 3.75% CREAM, IMIQUIMOD 3.75% CREAM PUMP, KLISYRI, PICATO, TOLAK, ZYCLARA COVERED USES N/A EXCLUSION CRITERIA • Treatment of basal cell carcinoma or other skin cancers REQUIRED MEDICAL INFORMATION 1. For the treatment of Actinic Keratosis (AK): Documentation of trial and failure*, contraindication or intolerance to two of the following formulary, generic topical agents: a. Diclofenac 3% gel b. 5-fluorouracil 2% or 5% cream/solution c. Imiquimod 5% cream *An adequate trial and failure is defined as failure to achieve clearance of AK lesion(s) after adherence to recommended treatment dosing and duration Reauthorization: Requires documentation of a reduction in the number and/or size of lesions of AK and medical rationale for continuing therapy beyond recommended treatment course. 1. For the treatment of external genital and perianal warts/condyloma acuminate (Zyclara® 3.75% only): Documentation of trial and failure*, contraindication, or intolerance to formulary, generic imiquimod 5% cream.
    [Show full text]
  • What to Expect Following Cryosurgery “Freezing”
    What to Expect Following CryoSurgery “Freezing” What is Cryosurgery? Cryosurgery is a technique for removing skin lesions that primarily involve the surface of the skin, such as warts, seborrheic keratosis, or actinic keratosis. It is a quick method of removing the lesions with minimal scarring. The liquid nitrogen needs to be applied long enough to freeze the affected skin. By freezing the skin, a blister is created underneath the lesion. Ideally, as the new skin forms underneath the blister, the abnormal skin on the roof of the blister peels off. Occasionally if the lesion is very thick (such as a large wart), only the surface is blistered off. The base or residual lesion may need to be frozen at another visit. What to Expect Over the Next Few Weeks? During Treatment – Area being treated will sting, burn and then possibly itch. Immediately After Treatment – Area will be red sore and swollen. Next Day- Blister or blood blister has formed, tenderness starts to subside. Apply a Band-Aid if necessary. 7 Days- Surface is dark red/brown and scab-like. Apply Vaseline or an antibacterial ointment if necessary. 2 to 4 Weeks- The surface starts to peel off. This may be encouraged gently during bathing, when the scab is softened. No makeup should be applied until area is fully healed. How to Take care of the Skin after Cryosurgery A Band-Aid can be used for larger blisters or blisters in areas that are more likely to be traumatized- such as fingers and toes. If the area becomes dry or crusted, an ointment (Vaseline, Aquaphor) can also be applied.
    [Show full text]
  • Lumps & Bumps: Approach to Common Dermatologic Neoplasms
    Case-Based Approach to Common Dermatologic Neoplasms Patrick Retterbush, MD, FAAD Mohs Surgery & Dermatologic Oncology Associate Member of the American College of Mohs Surgery Private Practice: Lockman Dermatology January 27th 2018 Disclosure of Relevant Financial Relationships • I do not have any relevant financial relationships, commercial interests, and/or conflicts of interest regarding the content of this presentation. Goals/Objectives • Recognize common benign growths • Recognize common malignant growths • Useful clues & examination for evaluating melanocytic nevi and when to be concerned for melanoma/atypical moles • How to perform a basic skin biopsy and which method/type to choose • Basic treatment/when to refer Key Questions & Physical Examination Findings for a Growth History Physical Examination • How long has the lesion been • Describing a growth present? – flat or raised? • flat – macule (<1cm) or patch (>1cm) – years, months, weeks • raised – papule (<1cm) or plaque (>1cm) – nodule if deep (majority of lesion in • Has it changed? dermis/SQ) – Size – secondary descriptive features • scaly (hyperkeratosis, retention of strateum – Shape corneum) – Color • crusty (dried serum, blood, or pus on surface) • eroded or ulcerated (partial vs. full thickness – Symptoms – pain, bleeding, itch? epidermal loss) – Over what time frame? • color (skin colored, red, pigmented, pearly) • feel (hard or soft, mobile or fixed) • PMH: • size: i.e. 6 x 4mm – prior skin cancers • Look at the rest of the skin/region of skin • SCC/BCCs vs. melanoma
    [Show full text]
  • USMPAKL00310919(1) AKLIEF Patient Brochure
    You may pay as little as $0*† LIGHTEN YOUR LOAD Patients† May pay as little as: Avoid wearing a backpack or sports equipment with $0 commercially unrestricted | $75 uninsured patients a chin strap or anything that rubs against your skin, Visit GaldermaCC.com/patients which can cause acne to fl are. to download your savings card now. * Certain limitations may apply. Visit Galdermacc.com/patients for program details. GUARD AGAINST THE SUN † Galderma CareConnect is only available for commercially insured or uninsured patients. You may have heard spending time in the sun can Patients who are enrolled in a government-run or government-sponsored healthcare plan with a pharmacy benefi t are not eligible to use the Galderma CareConnect Patient help clear up skin but, in fact, sunlight may darken Savings Card. the appearance of acne and cause it to last longer. DON'T LET IMPORTANT SAFETY INFORMATION Be sure to ask your dermatology YOUR ACNE BE ® provider if you have any questions INDICATION: AKLIEF (trifarotene) Cream, 0.005% is a retinoid indicated for the topical treatment of acne THE FOCUS. about AKLIEF Cream. vulgaris in patients 9 years of age and older. ADVERSE EVENTS: The most common adverse reactions (incidence ≥ 1%) in patients treated with AKLIEF Cream were application site irritation, application site pruritus (itching), and sunburn. WARNINGS/PRECAUTIONS: Patients using AKLIEF Cream may experience erythema, scaling, dryness, and stinging/burning. Use a moisturizer from the initiation of treatment, and, if appropriate, depending upon the severity of these adverse reactions, reduce the frequency of application of AKLIEF Cream, suspend or discontinue use.
    [Show full text]
  • DRUG-INDUCED PHOTOSENSITIVITY (Part 1 of 4)
    DRUG-INDUCED PHOTOSENSITIVITY (Part 1 of 4) DEFINITION AND CLASSIFICATION Drug-induced photosensitivity: cutaneous adverse events due to exposure to a drug and either ultraviolet (UV) or visible radiation. Reactions can be classified as either photoallergic or phototoxic drug eruptions, though distinguishing between the two reactions can be difficult and usually does not affect management. The following criteria must be met to be considered as a photosensitive drug eruption: • Occurs only in the context of radiation • Drug or one of its metabolites must be present in the skin at the time of exposure to radiation • Drug and/or its metabolites must be able to absorb either visible or UV radiation Photoallergic drug eruption Phototoxic drug eruption Description Immune-mediated mechanism of action. Response is not dose-related. More frequent and result from direct cellular damage. May be dose- Occurs after repeated exposure to the drug dependent. Reaction can be seen with initial exposure to the drug Incidence Low High Pathophysiology Type IV hypersensitivity reaction Direct tissue injury Onset >24hrs <24hrs Clinical appearance Eczematous Exaggerated sunburn reaction with erythema, itching, and burning Localization May spread outside exposed areas Only exposed areas Pigmentary changes Unusual Frequent Histology Epidermal spongiosis, exocytosis of lymphocytes and a perivascular Necrotic keratinocytes, predominantly lymphocytic and neutrophilic inflammatory infiltrate dermal infiltrate DIAGNOSIS Most cases of drug-induced photosensitivity can be diagnosed based on physical examination, detailed clinical history, and knowledge of drug classes typically implicated in photosensitive reactions. Specialized testing is not necessary to make the diagnosis for most patients. However, in cases where there is no prior literature to support a photosensitive reaction to a given drug, or where the diagnosis itself is in question, implementing phototesting, photopatch testing, or rechallenge testing can be useful.
    [Show full text]
  • Cryotherapy for Skin Lesions
    PATIENT & CAREGIVER EDUCATION Cryotherapy for Skin Lesions This information explains what cryotherapy is and how to care for yourself after your cryotherapy procedure. About Cryotherapy Cryotherapy is a procedure that uses extreme cold (liquid nitrogen) to destroy tissue. It’s often used to treat skin lesions, which are skin growths or patches that don’t look like the skin around them. The lesions can be: Benign (not cancerous) Actinic keratosis. These are precancerous skin cancers that look like scaly patches on your skin, and they can turn into cancer in the future. Superficial skin cancer (skin cancer that’s on the surface of your skin). Cryotherapy also helps save the area around the lesions and to reduce the scarring as much as possible. You don’t have to do anything to get ready for cryotherapy, but you may need to remove makeup, lotion, or powder before your procedure. Your doctor will then spray liquid nitrogen on the area being treated to freeze it. After Cryotherapy The treated area will become red soon after your procedure. It may also blister and swell. If this happens, don’t break open the blister. You may also see clear drainage on the treated area. This is normal. The treated area will heal in about 7 to 10 days. It probably won’t leave a scar. Cryotherapy for Skin Lesions 1/3 Caring for yourself after cryotherapy Starting the day after your procedure, wash the treated area gently with fragrance-free soap and water daily. Put Vaseline ® or Aquaphor ® on the treated area every day for 2 weeks.
    [Show full text]