光化性角化病 Actinic keratosis - PubMed 文献
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关于 光化性角化病
光化性角化病（Actinic keratosis，AK）是一种由长期紫外线暴露引起的皮肤癌前病变，主要发生于日光暴露部位如面部、头皮、手背和前臂。其病理特征为角质形成细胞异型增生，临床表现为红斑性、角化性丘疹或斑块，触之粗糙。该病属于皮肤科（Dermatology）范畴，与鳞状细胞癌（Squamous cell carcinoma）密切相关，部分病例可进展为侵袭性癌。近义词包括日光性角化病（Solar keratosis）、老年性角化病（Senile keratosis）和光线性角化病。英文术语统一为 Actinic keratosis，中文文献中常简称为 AK。
光化性角化病的研究热点集中在发病机制、风险分层与治疗优化。经典议题包括紫外线诱导的基因突变（如 TP53）、免疫抑制与病变进展的关系，以及非侵入性诊断技术（如皮肤镜、反射共聚焦显微镜）的应用。治疗方面，局部药物（如 5-氟尿嘧啶、咪喹莫特）、光动力疗法和冷冻手术的疗效比较是持续关注点。代表性期刊包括《Journal of the American Academy of Dermatology》、《British Journal of Dermatology》和《Dermatologic Surgery》。学者如 Ulrich 等致力于领域内临床研究。
PubMed增强版为光化性角化病研究者提供多项实用功能：支持中英文摘要翻译，帮助快速理解非母语文献；显示期刊影响因子，辅助评估文献影响力；提供PDF下载链接，便于获取全文；AI阅读功能可提炼核心结论与数据，节省筛选时间。这些工具尤其适合皮肤科医生和研究生高效追踪该领域证据。
光化性角化病 的 PubMed 搜索结果
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Actinic keratosis and surrounding skin exhibit changes in corneocyte surface topography and decreased levels of filaggrin degradation products. 光化性角化病及其周围皮肤表现为角化细胞表面形态的改变以及丝聚蛋白降解产物水平降低。
Actinic keratosis (AK) is a frequent premalignant skin lesion mainly caused by chronic sun exposure. AK lesions are often surrounded by invisible, subclinical alterations, called field of cancerization (FoC). Definition of FoC is of importance for therapy management; however, the criteria and non-invasive tools to characterize FoC are lacking. Atomic force microscopy (AFM) proved to be a suitable tool for detection of changes in the corneocyte surface topography in inflammatory skin diseases, which share similar clinical features with AK such as hyper- and parakeratosis. Therefore, in this study we applied AFM to investigate AK and surrounding skin obtained by non-invasive collection of the stratum corneum (SC) with adhesive tapes. Furthermore, we determined degradation products of structural protein filaggrin (natural moisturizing factor, NMF), which previously showed association with the changes in corneocyte surface topography. Ten patients with multiple AK on the face were recruited from the outpatient clinic. SC samples were collected from the AK lesion, skin sites adjacent to the AK, 5 cm from the AK and retroauricular area. Corneocyte surface topography was determined by AFM, and NMF by liquid chromatography. The AK lesion showed alterations of the corneocyte surface topography characterized by an increased number of nanosize protrusions, which gradually decreased with the distance from the lesion. NMF levels show an inverse pattern. Atomic force microscopy showed to be a suitable tool to detect changes in the corneocyte surface topography on the AK lesion and surrounding skin in a non-invasive manner.
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Comparison of efficacy, adverse effects and costs between 20 % ALA-PDT and 10 % ALA-PDT for the treatment of actinic keratosis in Chinese patients. 20%ALA-PDT与10%ALA-PDT治疗中国患者光化性角化病的疗效、不良反应及费用比较。
5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) is a reliable treatment for actinic keratosis (AK), though the concentration of 20 % is applied in most ALA-PDT for the treatment of AK, it was found that 10 % ALA could achieve similar outcome during clinical practice. However, there are limited number of reports comparing the efficacy and the safety of ALA-PDT with different ALA doses when treating AK. This study was designed to compare the efficacy, the adverse effects and the costs of 10 % and 20 % ALA-PDT for AK treatment. We reviewed the records of patients who had received ALA-PDT in our department between January 1, 2012, and April 30, 2017, the efficacy, the adverse effects were recorded, and the costs were analyzed. Follow-up data were collected until April 30, 2018. A total of 59 AK patients' records were analyzed for the efficacy, the adverse events, the recurrence and the costs. All the AK lesions were tapped with plum-blossom needle as a pre-treatment before receiving ALA-PDT. There was no statistical difference between 10 % ALA-PDT and 20 % ALA-PDT in terms of efficacy and adverse events. In the 10 % ALA group, there was one recurrence out of 34 patients and in the 20 % group there were none. The average treatment cost of each lesion was significantly lower in 10 % ALA group than in 20 % ALA group. 10 % ALA-PDT has similar efficacy and adverse effects as 20 % ALA-PDT with lower costs. Taken together, this supports the use of 10 % ALA-PDT in clinical practice.
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Bucher's indirect comparison of daylight photodynamic therapy with methyl aminolevulinate cream versus diclofenac plus hyaluronic acid gel for the treatment of multiple actinic keratosis. Bucher间接比较日光光动力疗法联合氨基乙酰丙酸甲酯乳膏与双氯芬酸加透明质酸凝胶治疗多发性光化性角化病。
Actinic keratosis (AK) is a pre-cancerous condition characterised by patches of thick, scaly skin developing on sun-exposed areas of the body. When multiple AKs develop on severely photodamaged skin, commonly used treatments include photodynamic therapy and diclofenac plus hyaluronic acid gel (DHA). Methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) is an alternative to conventional photodynamic therapy (MAL c-PDT). Trials have indicated that MAL DL-PDT is as effective as MAL c-PDT but reduces treatment-related pain and dermatological side effects. To indirectly compare between MAL DL-PDT and DHA in patients with AK. A total of three randomised trials were collected using a systematic literature review. An adjusted indirect comparison was conducted on complete lesion response rate at 12 weeks. The data indicated that mild lesions, moderate lesions, and mild and moderate lesions treated with MAL DL-PDT were more than four times more likely to undergo a complete response than lesions treated with DHA at 12 weeks, with ORs ranging from 4.23 to 4.81. Results were all statistically significant. This is the first indirect comparison demonstrating the effectiveness of MAL-PDT over DHA for the treatment of AK, and further research is needed to assess the long-term efficacy of these interventions (i.e. six months and beyond), as well as safety and patient-reported outcomes.
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Randomized, Controlled Trial of Fractional Carbon Dioxide Laser Resurfacing Followed by Ultrashort Incubation Aminolevulinic Acid Blue Light Photodynamic Therapy for Actinic Keratosis. 点阵二氧化碳激光换肤后联合超短孵育氨基乙酰丙酸蓝光光动力疗法治疗光化性角化病的随机对照试验。
Aminolevulinic acid (ALA) photodynamic therapy (PDT) is an established treatment option for actinic keratosis (AK), and recently fractional carbon dioxide (CO2) laser was shown to improve outcomes; but studies of short incubation photosensitizer are lacking. Assess the efficacy of short incubation ALA followed by blue light PDT with and without previous fractional CO2 treatment for the treatment of AK. Randomized, paired split-design, controlled trial of fractional CO2 followed by ultrashort 15-minute versus 30-minute incubation ALA and blue light PDT for the treatment of AK on the face. The complete clearance rates (CRs) at 8 weeks after ALA PDT with and without FxCO2 at 30- and 15-minute ALA incubation times were 89.78% (+FxCO2) versus 71.20% CR (-FxCO2) at 30', and 86.38% (+FxCO2) versus 69.23% (-FxCO2) at 15' ALA incubation. All lesion improvements were statistically significant. This randomized, comparative paired group controlled clinical study demonstrates that ultrashort 15- and 30-minute incubation ALA PDTs are of limited efficacy for the treatment of AK. Pretreatment with fractional ablative resurfacing yields statistically significant greater AK clearance with ALA-PDT at ultrashort ALA incubations followed by blue light.
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The prevalence of actinic keratosis in patients visiting dermatologists in two hospitals in China. 中国两家医院皮肤科就诊患者中光化性角化病的患病率。
Actinic keratosis (AK) is one of the most common conditions treated by dermatologists in western countries. Studies have shown that AK prevalence in Europe, the U.S.A. and Australia is 4·5-60%. No data of AK prevalence in China has been reported. This study aimed to explore the prevalence of AK in patients visiting dermatologists in two hospitals in China. This study was conducted in the dermatology departments of two teaching hospitals (Peking University First Hospital, Beijing, and Fourth Military Medical University, Xi'an). All records for 5 years between 2008 and 2012 with clinically or pathologically diagnosed AKs were collected from the pathological databases of both hospitals. Data from these records were used to calculate the prevalence of AKs among patients who were seen by dermatologists in these hospitals. To estimate the reliability of data from the previous database, a cross-sectional study was conducted simultaneously in the two hospitals from 15 October to 8 December in 2012 after all dermatologists in the two departments were retrained through intensive courses on recognizing AK clinically. The prevalence of total clinical AKs through 2008-2012 was 0·52% in 1 590 817 patient visits in the two hospitals. The yearly prevalence of clinical AKs was 0·30-1·20%. In the cross-sectional study, 72 437 clinical patients were screened and 76 patients (1·05%) were identified to have clinically recognized AK. The overall prevalence of AKs in patients visiting dermatologists in the two hospitals in China was 0·52%, which is much lower than the prevalence in western countries.
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In vivo thickness measurement of basal cell carcinoma and actinic keratosis with optical coherence tomography and 20-MHz ultrasound. 光学相干断层扫描与20-MHz超声对基底细胞癌和光化性角化病的在体厚度测量。
Accurate assessment of tumour size is important when planning treatment of nonmelanoma skin cancer (NMSC). Imaging with optical coherence tomography (OCT) has the potential to diagnose and measure depth of NMSC. To compare accuracy of mean tumour thickness measurement in NMSC tumours < 2 mm of depth using OCT and 20-MHz high-frequency ultrasound (HFUS). In addition, OCT morphology of NMSC was studied in OCT images and the influence of histological and colorimetric values on the quality and penetration depth in OCT images was estimated. In total, 93 patients were scanned and 34 lesions [23 basal cell carcinoma (BCC) and 11 actinic keratosis (AK) lesions] < 2 mm thick and easily identified in OCT images were studied. OCT and HFUS were compared with biopsies. The influence of skin pigmentation and infiltration analgesia on OCT image quality was studied. Skin colour was measured with a colorimeter. OCT presented narrower limits of agreement than HFUS. Both methods overestimated thickness but OCT was significantly less biased (0.392 mm vs. 0.713 mm). No relation between OCT penetration depth and skin colour was found. OCT appears more precise and less biased than HFUS for thickness measurement in AK and BCC lesions < 2 mm, but both OCT and especially HFUS tended to overestimate tumour thickness.
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Regression Analysis of Local Skin Reactions to Predict Clearance of Actinic Keratosis on the Face in Patients Treated With Ingenol Mebutate Gel: Experience from Randomized Controlled Trials. 局部皮肤反应预测ingenol mebutate凝胶治疗患者面部光化性角化病清除的回归分析：来自随机对照试验的经验。
<p>Ingenol mebutate gel, a topical field treatment for actinic keratosis (AK), elicits inflammatory application-site reactions in most patients. This analysis explored the relationship between the intensity of local skin reactions (LSRs) and AK clearance, measured by the reduction in AK count from baseline in 218 patients who were treated for AK on the face in the pivotal Phase 3 studies. The analysis modeled the AK count at week 8, adjusted for baseline count, with the composite LSR score at 1 day after the last treatment application for each patient as a predictor to estimate the mean and 90% prediction interval for the percent reduction in AK count. The predicted mean percent reduction in AK count was higher in patients with higher composite LSR scores. Lower composite scores demonstrated a variable, less predictive percentage reduction in efficacy. Therefore, a large inflammatory reaction from ingenol mebutate gives a more reliable prognosis for improved AK clearance.</p> <p><em>J Drugs Dermatol. 2017;16(2):112-114.</em></p>.
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Topical treatment of actinic keratosis with 3.0% diclofenac in 2.5% hyaluronan gel: review of the literature about the cumulative evidence of its efficacy and safety. 3.0%双氯芬酸溶于2.5%透明质酸凝胶局部治疗光化性角化病：关于其疗效和安全性累积证据的文献综述。
Topical 3% diclofenac in 2.5% hyaluronic acid (HA) gel is a nonsteroidal anti-inflammatory drug approved for the treatment of actinic keratosis (AK). It has been shown to be a safe and effective for treatment of AK on both skin and mucosal lip. A PubMed search was carried out from 1997 to 2015 using key words in multiple combinations. Different studies from the literature shown the efficacy and safety of HA in both immunocompetent and immunosuppressed patients, with important impact on preventing field cancerization. In different clinical trials, the product was effective in significantly reducing lesions when applied for 60 or 90 days. Despite the effectiveness of the treatment with topical 3% diclofenac in 2.5% HA, the patients who achieve the complete clinical response should be adequately educated to continue their photoprotection in order to minimize recurrence of AK.
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Syntheses, biological evaluation and SAR of ingenol mebutate analogues for treatment of actinic keratosis and non-melanoma skin cancer. Ingenol mebutate类似物用于治疗光化性角化病和非黑色素瘤皮肤癌的合成、生物学评价及构效关系。
Ingenol mebutate is the active ingredient in Picato® a new drug for the treatment of actinic keratosis. A number of derivatives related to ingenol mebutate were prepared by chemical synthesis from ingenol with the purpose of investigating the SAR and potency in assays relating to pro-inflammatory effects (induction of PMN oxidative burst and keratinocyte cytokine release), the potential of cell death induction, as well as the chemical stability. By modifications of the ingenol scaffold several prerequisites for activity were identified. The chemical stability of the compounds could be linked to an acyl migration mechanism. We were able to find analogues of ingenol mebutate with comparable in vitro properties. Some key features for potent and more stable ingenol derivatives have been identified.
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Transition to Medicare Does Not Contribute to Rise in Outpatient Visits for Nonmelanoma Skin Cancer, Actinic Keratosis, or Actinic Cheilitis in the US Population. 向Medicare的过渡并未导致美国人群中非黑色素瘤皮肤癌、光化性角化病或光化性唇炎门诊就诊量的增加。
Outpatient visits for nonmelanoma skin cancer (NMSC) and actinic keratoses (AK) have risen steadily in the United States, notably among Medicare beneficiaries. Individuals may delay seeking care for minimally symptomatic conditions until they qualify for Medicare coverage, indicating potential delay of nonurgent screening interventions for uninsured or underinsured patients younger than 65 years. This study investigates whether an atypical increase in outpatient visits for NMSC, AK, or actinic cheilitis (AC) occurs at the age of Medicare transition by utilizing the National Ambulatory Care Survey from 1993 to 2019. The National Ambulatory Care Survey data were analyzed for patients aged within 5 years of 65 years. Diagnoses were identified using International Classification of Diseases codes. Linear regression and outlier detection were used to identify a relationship between Medicare eligibility and outpatient visits for NMSC and AK/AC. Predicted visits for AK/AC and NMSC increased with age. However, there was no evidence of a disproportionate increase in outpatient visits for NMSC and AK/AC at the age of Medicare eligibility. Outside evidence indicates health care utilization increases after Medicare transition. This study's data do not support a corresponding rise in outpatient visits for NMSC and AK/AC at the age of Medicare eligibility.