Connect4IUC & 2030 Agenda in Vietnam

Intense Pulsed Light
Alone in the
Treatment of Actinic
Keratosis
Omeed Memar, MD, PhD
Clinical Instructor
Northwestern Memorial Hospital
Department of Dermatology
Chicago, IL
Actinic Keratosis
Prevalence in U.S.A is over 57 million
1-15% can progress to SCC
Cause is thought to be DNA mutation affecting p53,
viral DNA(HPV), RAS mutation
Diagnosis: Actinic
Keratosis: the cameleon
Dermoscopy
Clinically
Histologically
Confocal Microscopy
Bcc
Seb ker
Scc
Bowens disease
Wart
SLE
Porokeratosis
Rosacea
Melasma
Eczema
Psoriasis
Lichen Planus
Lentigo
Lentigo maligna
Normal skin
Appearance: Actinic
Keratosis
Dermoscopy:
"strawberry pattern”
prominent follicular openings surrounded by a white
halo
pigmented AK on the face include multiple slate-gray
to dark-brown dots and globules around the follicular
ostia, annular-granular pattern and brown to gray
pseudonetwork
Appearance: Actinic
Keratosis
Clinical
Pre-clinical AK
Classic AK: scaly with surrounding erythema
Hypertrophic AK
Atrophic AK
Cutaneous Horn
Lichenoid AK
Pigmented AK
Actinic Chelitis
Bowenoid AK
Treatment: Actinic Keratosis
Field Therapy
5-FU
Diclofenac
Imiquimod
Ingenol mebutate gel
Focal Destruction
Cryotherapy
Acid destruction
Laser destruction
PDT
Use of Levulan with different light sources, including IPL
Protoporphyrin IX absorption
Absorption
Intense Pulsed Light
Intense pulsed light (IPL) is a filtered flash lamp
device that emits a non-coherent polychromatic
radiation (420-1500 nm)
IPL has also been used to activate photosensitizers
in the treatment of photrejuvenation and actinic
keratosis
In studying the effectiveness of IPL in activating
different photosensitizers, a few split-face studies
were conducted: IPL alone VS IPL + Levulinic Acid
Question?
Did IPL alone
treat Actinic
Keratoses?
Method
A literature search was done to identify information
on IPL split-face photodynamic therapy studies in
the treatment of actinic keratosis up to April 2016.
The databases of Google Scholar and Ovid
MEDLINE were searched using the Boolean string:
(Intense pulsed light AND actinic keratosis).
The references were reviewed for split-face studies,
where IPL had been used as a control against the
contra-lateral IPL + topical aminolevulinic acid
(ALA). The references cited in the papers identified
were also reviewed.
Results
Gold et al
Gold et al
Supporting Data
Dovor et al Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of
photoaging. Arch Dermatol 2005;141:1247-1252
In treating “photoaging” IPL alone improves tactile
roughness equally to IPL +ALA
Demetriou C Reversig precancerous actinic damage by mixing wavelengths (1064nm, 532 nm). J
Cosmetic Laser Therapy 2011, 13:113-119
Reversed AK with combination of Q switched 532nm
and 1064nm lasers
Discussion
IPL is a device that targets red or brown lesions
Actinic keratoses initially present with redness and
some with pigmentation
IPL alone should be studied further for
effectiveness in treating actinic keratosis
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Delve into the implementation of Connect4IUC and the 2030 Agenda for Sustainable Development in Vietnam. Discover the country strategy approach, SDG-centered principles, and the focus on connecting Country Reference Frameworks. Learn how to connect with QNU and the key coordinators and managers involved in this initiative.

  • Connect4IUC
  • Sustainable Development
  • Vietnam
  • Multistakeholder Partnerships
  • Country Strategy

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  1. Intense Pulsed Light Alone in the Treatment of Actinic Keratosis Omeed Memar, MD, PhD Clinical Instructor Northwestern Memorial Hospital Department of Dermatology Chicago, IL

  2. Actinic Keratosis Prevalence in U.S.A is over 57 million 1-15% can progress to SCC Cause is thought to be DNA mutation affecting p53, viral DNA(HPV), RAS mutation

  3. Diagnosis: Actinic Keratosis: the cameleon Bcc Seb ker Scc Bowens disease Wart SLE Porokeratosis Rosacea Melasma Eczema Psoriasis Lichen Planus Lentigo Lentigo maligna Normal skin Dermoscopy Clinically Histologically Confocal Microscopy

  4. Appearance: Actinic Keratosis Dermoscopy: "strawberry pattern prominent follicular openings surrounded by a white halo pigmented AK on the face include multiple slate-gray to dark-brown dots and globules around the follicular ostia, annular-granular pattern and brown to gray pseudonetwork

  5. Appearance: Actinic Keratosis Clinical Pre-clinical AK Classic AK: scaly with surrounding erythema Hypertrophic AK Atrophic AK Cutaneous Horn Lichenoid AK Pigmented AK Actinic Chelitis Bowenoid AK

  6. Treatment: Actinic Keratosis Field Therapy 5-FU Diclofenac Imiquimod Ingenol mebutate gel Focal Destruction Cryotherapy Acid destruction Laser destruction PDT Use of Levulan with different light sources, including IPL

  7. Protoporphyrin IX absorption

  8. Absorption

  9. Intense Pulsed Light Intense pulsed light (IPL) is a filtered flash lamp device that emits a non-coherent polychromatic radiation (420-1500 nm) IPL has also been used to activate photosensitizers in the treatment of photrejuvenation and actinic keratosis In studying the effectiveness of IPL in activating different photosensitizers, a few split-face studies were conducted: IPL alone VS IPL + Levulinic Acid

  10. Question? Did IPL alone treat Actinic Keratoses?

  11. Method A literature search was done to identify information on IPL split-face photodynamic therapy studies in the treatment of actinic keratosis up to April 2016. The databases of Google Scholar and Ovid MEDLINE were searched using the Boolean string: (Intense pulsed light AND actinic keratosis). The references were reviewed for split-face studies, where IPL had been used as a control against the contra-lateral IPL + topical aminolevulinic acid (ALA). The references cited in the papers identified were also reviewed.

  12. Results (nm) Ref Site Light source Setting frequency # Tx Age # Pts Fitzp atr type Results Gold et al Face Vasculig ht IPL 550- 570 34j/cm2 Double pulsed 8x16mm spot Monthly 3 (judged 3 mo after) 37-63 13 I-IV 53% clearance vs 85% with ALA Tadiparthi et al Lumina IPL monthly 5 65-86 8 I-II 55% clearance vs 60% with methyl-ALA Haddad et al face Vasculig ht ESC Lumenis 515 20j (1 pt) 1 1 (judged results 8 weeks after) 3 I-IV 7% clearance 25j (2 pts)

  13. Gold et al

  14. Gold et al

  15. Supporting Data Dovor et al Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging. Arch Dermatol 2005;141:1247-1252 In treating photoaging IPL alone improves tactile roughness equally to IPL +ALA Demetriou C Reversig precancerous actinic damage by mixing wavelengths (1064nm, 532 nm). J Cosmetic Laser Therapy 2011, 13:113-119 Reversed AK with combination of Q switched 532nm and 1064nm lasers

  16. Discussion IPL is a device that targets red or brown lesions Actinic keratoses initially present with redness and some with pigmentation IPL alone should be studied further for effectiveness in treating actinic keratosis

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