Bobyr I, Campanati A, Consales V, Martina E, Molinelli E, Diotallevi F, Brisigotti V, Giangiacomi M, Ganzetti G, Giuliodori K, Offidani A
Dermatological Unit, Department of Clinical and Molecular Sciences, Polytehnic Marche University, Ancona, Italy.
Institute of Pathological Anatomy and Histopathology, Polytechnic University Marche, Ancona, Italy.
J Eur Acad Dermatol Venereol. 2017 Feb;31(2):260-266. doi: 10.1111/jdv.13831. Epub 2016 Jul 25.
Actinic keratosis (AK) is a cutaneous intraepithelial neoplasm that typically develops on sun-damaged skin. The incidence of AK is increasing worldwide, and it is accepted as the most frequent pre-malignant lesion in humans.
To demonstrate that ingenol mebutate gel is effective in the treatment of actinic keratoses because of its clinical, dermoscopic, capillaroscopic, histopathological and immunohistochemical treatment outcomes.
Sixty individuals with multiple non-hypertrophic AKs were enrolled into this non-randomized, open-label, prospective, trial. Acquisition of clinical, dermoscopic and capillaroscopic images at baseline (T0), immediately after treatment on 3 (trunk and/or extremities) or 4 (scalp and/or face) day (T1), 14 days after the end of the treatment (T2) and at 60 days (T3). A subgroup of 20 patients received a cutaneous biopsy both at baseline and at T3 for histological and immunohistochemical evaluation.
Clinical improvement was observed in 100% of cases: total clearance in 41 patients (68.3%); partial clearance in 19 patients (32.7%). After treatment, dermoscopic improvement of all non-pigmented and pigmented AK lesions was observed. Most of the dermoscopic features disappeared with treatment. Total disappearance of specific vascular structures or significant reduction in the number and calibre of new blood vessels was capillaroscopically observed in all patients analysed (P ≤ 0.001). The immunohistochemical expression of p63 (P = 0.002), Ki-67 (P = 0.015) and VEGF (P = 0.016) significantly decreased.
The clinical efficacy of ingenol mebutate on AKs is confirmed by its effect on angiogenesis, stem cell activity and cell proliferation in vivo.
光化性角化病（AK）是一种皮肤上皮内肿瘤，通常发生在受阳光损伤的皮肤上。全球范围内AK的发病率正在上升，它被认为是人类最常见的癌前病变。
通过其临床、皮肤镜、毛细血管镜、组织病理学和免疫组织化学治疗结果，证明鬼臼毒素酯凝胶在治疗光化性角化病方面是有效的。
60例患有多个非肥厚性AK的个体被纳入这项非随机、开放标签、前瞻性试验。在基线（T0）、治疗后3天（躯干和/或四肢）或4天（头皮和/或面部）立即（T1）、治疗结束后14天（T2）和60天（T3）采集临床、皮肤镜和毛细血管镜图像。20例患者的亚组在基线和T3时均接受皮肤活检，用于组织学和免疫组织化学评估。
100%的病例观察到临床改善：41例患者（68.3%）完全清除；19例患者（32.7%）部分清除。治疗后，观察到所有非色素性和色素性AK病变的皮肤镜改善。大多数皮肤镜特征在治疗后消失。在所有分析的患者中，毛细血管镜观察到特定血管结构完全消失或新血管数量和管径显著减少（P≤0.001）。p63（P = 0.002）、Ki-67（P = 0.015）和VEGF（P = 0.016）的免疫组织化学表达显著降低。
鬼臼毒素酯对AK的临床疗效通过其对体内血管生成、干细胞活性和细胞增殖的作用得到证实。
