Conexión Andrómaco 34

| 34 | En tema II Conclusiones Las características socio-epidemiológicas y culturales de nuestra población sugieren que en los próximos años las QA aumen- tarán su prevalencia y en consecuencia, la demanda asistencial. Los pacientes con QA tienen riesgo de desarrollar CEC invasor, y los pacientes tratados satisfactoriamente para QA están predispuestos a desarrollar nuevas lesiones, por lo que el seguimiento por el dermatólogo debe ser dos veces por año, durante toda la vida. Debido a que el comportamiento biológico es impredecible, y en un alto porcentaje pueden evolucionar a CEC invasor, la instauración del tratamiento debe ser precoz y oportuna, tanto para lesiones únicas como para el campo de cancerización. Dentro de los tratamientos tópicos, destacamos al Ingenol Mebutato, como un tratamiento novedoso, eficaz y seguro, para QA y campo de cancerización, de fácil aplicación, con una posología de corta duración, con efectos adversos predecibles, y de rápida resolución, traduciéndose en mayores tasas de cumplimiento y adherencia para los pacientes. Bibliografía: 1. Berker DD, McGregor JM, Hughes BR. Guidelines for the management of actinic keratoses. Br J Dermatol 2007;156:222-230. 2. Rossi R, Calzavara-Pinton PG, Giannetti A. Italian guidelines and therapeutic algorithm for actinic keratoses. G Ital DermatolVenereol 2009;144(6):713-723. 3. Samuel M, Brooke RCC, Hollis S, Griffiths CEM. Interventions for photodamaged skin. Cochrane DatabaseSystRev 2005;(1):CD001782. 4. Ascenso A., Ribeiro H, Marques HC, Oliveira H, Santos C, Simoes S. Is tretimoin still a key agent fort photoaging Management? Mini Rev Med Chem. 2014;14(8):629-641. 5. Fenske NA, Spencer J, Adam F. Actinic keratoses: Past, present and future. J Drugs Dermatol. 2014;9:s45-9. 6. Schmitt JV, Miot HA. Actinic keratosis: A clinical and epidemiological revision. An Bras Dermatol. 2014;87:425-34. 7. Lebwohl M, Shumack S, Stein Gold L, Melgaard A, Larsson T, Tyring SK. Long-term follow-up study of ingenol mebutate gel for the tre- atment of actinic keratoses. JAMA Dermatol. 2013;149:666-70. 8. Krawtchenko N, Roewert-Huber J, Ulrich M, Mann I, Sterry W, Stockfleth E. A randomised study of topical 5% imiquimod vs. topical 5- fluorouracil vs. cryosurgery in immunocompetent patients with actinic keratoses: A comparison of clinical and histological outcomes inclu- ding 1-year follow-up. Br J Dermatol. 2007;157 Suppl 2:3440. 9. Serra-Guillen C, Nagore E, Hueso L, Llombart B, Requena C, Sanmartin O, et al. A randomized comparative study of tolerance and satis- faction in the treatment of actinic keratosis of the face and scalp between 5% imiquimod cream and photodynamic therapy with methyl ami- nolaevulinate. Br J Dermatol. 2011;164:429-33. 10. Hanke CW, Beer KR, Stockfleth E, Wu J, Rosen T, Levy S. Imiquimod 2.5% and 3.75% for the treatment of actinic keratoses: Results of two placebo-controlled studies of daily application to the face and balding scalp for two 3-week cycles. J Am Acad Dermatol. 2014;62:573- 81. 11. Swanson N, Abramovits W, Berman B, Kulp J, Rigel DS, Levy S. Imiquimod 2.5% and 3.75% for the treatment of actinic keratoses: results of two placebo-controlled studies of daily application to the face and balding scalp for two 2-week cycles. J Am Acad Dermatol. 2014;62:582- 90. 12. Serra-Guillen C, Nagore E, Hueso L, Traves V, Messeguer F, Sanmartin O, et al. A randomized pilot comparative study of topical methyl aminolevulinate photodynamic therapy versus imiquimod 5% versus sequential application of both therapies in immunocompetent patients with actinic keratosis: Clinical and histologic outcomes. J Am Acad Dermatol. 2012;66:e131-7. 13. Berardesca E, Bertona M, Altabas K, Altabas V, Emanuele E. Reduced ultraviolet-induced DNA damage and apoptosis in human skin with topical application of a photolyase-containing DNA repair enzyme cream: Clues to skin cancer prevention. Mol Med Report. 2012;5:570-4. 14. Stockfleth E, Terhorst D, Braathen L, Cribier B, Cerio R, Ferrandiz C, et al. Guideline on Actinic Keratoses, developed by the Guideline Subcommittee «Actinic Keratoses» of the European Dermatology Forum. 2011 [consultado 3 May 2013]. Disponible en: http://www.euro - derm.org/images/stories/guidelines/ guideline Management Actinic Keratoses-update2011.pdf 15. Rosen, R., Gupta, A., Tyring, S. Dual mechanism of action of ingenol mebutate gel for topical treatment of actinic keratoses: Rapid lesion necrosis followed by lesion-specific immune response. J Am Acad Dermatol. 2012; 487-492. 16. Jacks, S., Kudrewicz k., Carr D. Ingenol Mebutate: An Emerging Therapy in the Treatment of Actinic Keratoses. Curr Derm Rep. 2013; 2:113–117 17. Lebwohl, M., Swanson, N., Andreson, L., Meelgard, A., Xu, Z., & Berman, B. Ingenol Mebutate Gel for Actinic Keratosis. The New England Journal of Medicine. 2012; 1010-1020. 18. Longo, C. et al. Management of local skin reactions after the application of ingenol mebutate gel for the treatment of actinic keratosis: four illustrative cases. Journal of the European Academy of Dermatology and Venereology. 2014. 19. Erlendsson a., et al. Topical corticosteroide has no influence on inflammation or efficacy alter ingenol mebutate treatment of grade I to III actinic keratoses (AK): A randomized clinical trial. J Am Acad Dermatol 2016; 74: 709-715 20. Samorano, L. P., Torezan, L. A., Sanches, J. A. Evaluation of the tolerability and safety of a 0.015% ingenol mebutate gel compared to 5% 5-fluorouracil cream for the treatment of facial actinic keratosis: a prospective randomized trial. Journal of the European Academy of Dermatology and Venereology. 2015 21. Berman, B., Goldenberg, G., Hanke, W., Tyring, S., Werschler, P., Knudsen, K., et al. Efficacy and Safety of Ingenol Mebutate 0.015% Gel After Cryosurgery of Actinic Keratosis: 12-Months Results. J Drugs Dermatol. 2014; 743-747.

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