Journal of Clinical and Aesthetic Dermatology

Updates on Psoriasis & Cutaneou Oncology

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S33 P r o c e e D i n G s JCAD jOUrnAl Of ClInICAl And AEsthEtIC dErMAtOlOgy september 2017 • volume 10 • number 9 • supplement PDt is that more than 60 percent of PDt patients experience moderate-to-severe burning pain, and many patients report intolerable pain. in a prospective, split-face study comparing short ala incubation times (15 minutes) with 60 minutes of blue light ("painless therapy") versus conventional ala-PDt, three patients underwent aK procedures in a single center. 181 the painless patients showed a 52-percent reduction in lesions compared to 44 percent for the conventional group. Patients rated pain during treatment on a scale from 0 to 10 (where 0 was no pain and 10 the most severe pain imaginable). Painless therapy was scored as 0 for pain at all time points, whereas the average pain score for ala-PDt was 7. thus, painless PDt is not only possible, it appears to be safe and edective. bf-200 for Pdt: new kid on the block. Bf-200 10% ala gel is a novel product for PDt and allows for deep Ppix induction down to the basal membrane. When this gel is used for PDt, the protocol should call for lesions to be lightly abraded before the gel is applied topically and then should be allowed to dry for about 10 minutes. a light-tight occlusive dressing should then be placed over the treatment area. a three- hour incubation period is recommended. at the conclusion of the incubation period, the dressing should be removed and any gel still on the surface should be wiped away. three Phase 3 pivotal trials for aK patients were conducted in Germany comparing Bf-200 10% ala gel (ameluz®, Biofrontera inc., Boston, Massachusetts) to Metvix®/Metvixia® (Galderma laboratories, fort Worth, texas), and placebo. 182,183 in all three studies combined, 779 patients with 4 to 8 mild-to-moderate aKs were enrolled. complete clearance of all lesions after one or two PDt sessions was the primary endpoint. complete clearance was achieved by 62 percent of Bf-200 patients after one treatment and 91 percent achieved complete clearance after one or two sessions. in the comparator study between Bf-200 PDt and Mal-PDt, Bf-200 PDt was found to be non- inferior to Mal PDt. Most of the Bf-200 patients experienced adverse events (96%) but the rates were higher with narrow-spectrum PDt compared to broad-spectrum PDt. some of the most frequently reported adverse events were erythema, burning, and pain. 1 83 does Pdt decrease the incidence of nMsC? the role of PDt with ala 20% in reducing the rate of nMsc continues to be investigated. a 52-week study of patients at high-risk for aK compared ala-PDt to placebo following cryotherapy and evaluated the development of nMsc. 1 84 the study included 166 patients with clinically evident facial aKs, a history of nonmelanoma skin cancer, and histological evidence of dysplasia within clinically normal-looking perilesional skin. Patients were frst treated with cryotherapy and then randomized to one of three groups: ala-2x (two ala-PDt treatments, baseline, Week 4), ala-3x (three ala-PDt treatments, baseline, Week 4, Week 24), and veH-PDt (placebo treatments that were matched in a 1:1 ratio to the two active groups). ala or vehicle was applied to the full facial region an hour before blue light treatment, which lasted 16 minutes and 40 seconds. all patients were evaluated 24 hours after each PDt session. signifcantly more ala patients had zero aKs on the face at 52 weeks compared to the placebo (vehicle) patients. 175 in the safety population, it was determined that ala-3x signifcantly decreased the rate of nonmelanoma skin cancer development over time (5 versus 12) compared to vehicle. the fDa has approved numerous treatments for topical feld therapy for aK, giving clinicians and their patients many options (table 9). the burden of aK may further be reduced with liquid nitrogen cryotherapeutic treatments (1 to 4 times a year, or more, as appropriate), more feld therapies, sunscreen education and recommendations, topical retinoid therapy (tretinoin or tazarotene), and vitamin B3. an alternative approach to reducing the aK burden may be a protocol involving a daily application of 3.75% imiquimod for seven days, followed by a two-week rest period (no treatment), then a once-a-week application of 3.75% imiquimod from then on (indefnitely, therapy may persist over years). this is an od-label therapy and should not be recommended for patients with autoimmune disorders or in immunocompromised patients. Old school versus new school 5-fluorouracil. the old-school "scorched earth" approach using 5-fu was associated with burning pain, which could limit treatment. yet, 5-fu was highly edective; in two Phase 3 vehicle-controlled trials, over 70-percent clearance was achieved with one single week of treatment. 185, 186 a new-school approach handles this in two cycles. in the frst cycle, 5-fu is applied daily over seven days (face) or over 10 days (nonfacial areas). Patients are then given a one-month rest period when no 5-fu is applied. the second cycle calls for daily application for two or three more weeks (individualized for patient). dIsrUPtIVE tEChnOlOgIEs fOr sKIn CAnCEr: ElECtrOnIC brAChythErAPy And sUPErfICIAl rAdIAtIOn electronic brachytherapy (eBx) and superfcial radiation oder the potential for long- lasting edective treatments of nMsc in patients unable or unwilling to undergo surgery. eBx and superfcial radiation dider from conventional external-beam radiation. Patients typically undergo a course of 35 therapies in a seven- week period with a dose of 70Gg . Brachytherapy involves an external applicator positioned at a very short distance from its

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