Ulrich C, Hackethal M, Ulrich M, Howorka A, Forschner T, Sterry W, Stockfleth E
Department of Dermatology, Charité, Skin Cancer Center Charité, University Hospital of Berlin, Berlin, Germany.
Br J Dermatol. 2007 May;156 Suppl 3:40-2. doi: 10.1111/j.1365-2133.2007.07864.x.
Non-melanoma skin cancer (NMSC) represents a significant cause of morbidity in organ transplant patients; the relative risk of squamous cell carcinoma and actinic keratosis (AK) is 100 and 250 times higher, respectively, compared with immunocompetent patients.
The aim of this study was to investigate the effects of 3% diclofenac gel on the clearance rates of multiple AKs in organ transplant recipients (OTRs).
PATIENTS/METHODS: An open-label study was conducted in six patients (three kidney, one liver and two heart transplant patients) with histories of multiple NMSCs and extensive actinic keratoses (AKs). Patients were treated with diclofenac 3% gel, twice daily for 16 weeks. Complete and partial clearance rates of AKs were assessed after 16 weeks and biopsies were performed 4 weeks post-therapy on clinically typical AKs identified prior to the start of treatment.
Three out of six patients showed complete clinical and histological clearance after 16 weeks of treatment with diclofenac 3% gel. Two further patients showed a marked (> or = 75% lesion reduction) improvement in their overall AK lesion count in the treatment area. One patient showed a 30% lesion reduction in the area treated. Local adverse events at the site of application were very mild and included mild erythema and marginal erosion. No systemic side effects were reported.
Results suggest that diclofenac 3% gel may be useful in the treatment and control of multiple AK lesions in OTRs. Further studies are needed to investigate the efficacy and safety of this therapy for the local treatment of AK in greater numbers of immunosuppressed patients.
非黑色素瘤皮肤癌（NMSC）是器官移植患者发病的一个重要原因；与免疫功能正常的患者相比，鳞状细胞癌和光化性角化病（AK）的相对风险分别高出100倍和250倍。
本研究旨在调查3%双氯芬酸凝胶对器官移植受者（OTR）中多个AK清除率的影响。
患者/方法：对6例有多个NMSC病史和广泛光化性角化病（AK）的患者（3例肾移植、1例肝移植和2例心脏移植患者）进行了一项开放标签研究。患者使用3%双氯芬酸凝胶治疗，每日两次，共16周。16周后评估AK的完全和部分清除率，并在治疗开始前确定的临床典型AK治疗后4周进行活检。
6例患者中有3例在使用3%双氯芬酸凝胶治疗16周后显示出完全的临床和组织学清除。另外2例患者治疗区域的AK病变总数有显著改善（病变减少≥75%）。1例患者治疗区域的病变减少了30%。用药部位的局部不良事件非常轻微，包括轻度红斑和边缘糜烂。未报告全身副作用。
结果表明，3%双氯芬酸凝胶可能对OTR中多个AK病变的治疗和控制有用。需要进一步研究以调查该疗法在更多免疫抑制患者中局部治疗AK的疗效和安全性。
