Acta Dermato-Venereologica 98-10CompleteContent | Page 12

963 CLINICAL REPORT Assessment of the Effect of 3% Diclofenac Sodium on Photodamaged Skin by Means of Reflectance Confocal Microscopy Gonzalo SEGURADO-MIRAVALLES 1 , Natalia JIMÉNEZ-GÓMEZ 1 , Oscar MUÑOZ MORENO-ARRONES 1 , Ivette ALARCÓN- SALAZAR 1 , Adrián ALEGRE-SÁNCHEZ 1 , David SACEDA-CORRALO 1 , Pedro JAÉN-OLASOLO 1 and Salvador GONZÁLEZ- RODRÍGUEZ 1–3 Dermatology Department, Ramon y Cajal Hospital, 2 Department of Medicine and Medical Specialities, Universidad de Alcalá de Henares, Madrid, Spain, and 3 Dermatology Service, Memorial Sloan-Kettering Cancer Centre, New York, USA 1 Treatment of actinic keratosis with 3% diclofenac sodium w/w in hyaluronic acid is associated with a concomitant improvement in signs of photodamaged skin. However this effect has not yet been examined in depth. Twenty patients with actinic keratosis and signs of photodamaged skin were studied. They recei- ved treatment with diclofenac sodium w/w in hyalu- ronic acid for 2 months. Clinical and reflectance confo- cal microscopy assessment on signs of photodamaged skin were performed. Regarding reflectance confocal microscopy, the most common descriptors were: ir- regular honeycomb pattern in 18/20 patients (90%), mottled pigmentation in 17/20 (85%), coarse collagen structures in all patients, and huddled collagen and curled bright structures in 16/20 (77.8%). After treat- ment, significant improvement in clinical parameters: irregular pigmentation and coarseness, and confocal parameters: irregular honeycomb pattern and mottled pigmentation, were noted. Reflectance confocal mi- croscopy is a useful tool in monitoring changes in pho- todamaged skin after treatment. The use of diclofenac sodium w/w in hyaluronic acid is associated with an improvement in some clinical and reflectance confocal microscopy parameters of photodamaged skin. Key words: actinic keratosis; diclofenac sodium; honeycomb pattern; mottled pigmentation; photodamaged skin; reflectan- ce confocal microscopy. Accepted May 29, 2018; Epub ahead of print Jun 1, 2018 Acta Derm Venereol 2018; 98: 963–969. Corr: Gonzalo Segurado-Miravalles, Dermatology Department, Ramon y Cajal Hospital, Carretera Colmenar Viejo km 9.100, ES-28034 Madrid, Spain. E-mail: [email protected] C hronic ultraviolet (UV) exposure leads to changes in keratinocytes, melanocytes and connective tissue of the skin on sun-exposed areas. These modifications in- clude keratinocyte atypia, increased melanocyte density, increased epidermal melanin and deposition of elastotic material in the superficial dermis. This photodamage results in wrinkling, pigment irregularities, coarseness and skin neoplasms (1, 2). Actinic keratosis (AK) is commonly treated with 3% diclofenac sodium w/w in hyaluronic acid (DSHA) (3). It has been proven to be an effective and safe therapy over the years (4). In addition, an improvement has been reported in the cosmetic appearance of the surrounding SIGNIFICANCE Chronic ultraviolet exposure causes changes over kera- tinocytes, melanocytes and connective tissue of the skin on sun-exposed areas, including keratinocyte atypia, in- creased melanocyte density, increased epidermal melanin and, deposition of elastotic material in superficial dermis. This photodamage results in wrinkling, pigment irregulari- ties, coarseness and skin neoplasms. Treatment with 3% diclofenac sodium w/w in hyaluronic acid is associated with an improvement in irregular pigmentation, coarseness, keratinocyte atypia and mottled pigmentation. Therefore, treatment with 3% diclofenac sodium associates an impro- vement in signs of photodamaged skin. skin after treating AK (5). This is probably in relation to a decrease in photoaged skin signs. In vivo reflectance confocal microscopy (RCM) is a non-invasive technique that enables real-time imaging of superficial layers of the skin at a quasi-histologic re- solution. By means of RCM, the different skin structures can be visualised up to a depth of 300 µm, that usually encompasses the epidermis and superficial part of the dermis (6). Thus, we were able to assess these layers at a cellular level without performing an invasive biopsy. Confocal features of AK have been widely studied (6–10) and photodamaged skin and skin ageing have also been characterised (11–14). In addition, it has also turned out to be useful for monitoring the effectiveness of several treatments in AK (15–20) due to its non-invasive nature. Nevertheless, to the best of our knowledge, it has never been used in characterising the effect of a treatment on the signs of photodamaged skin. The purpose of this study is to determine whether RCM is able to characterise the clinical changes induced by DSHA in photodamaged skin in patients with AK. MATERIAL AND METHODS Study population This single-centre prospective study enrolled patients with at least one clinical and dermoscopically diagnosed AK on the forehead or bald scalp and clinical signs of photodamage surrounding AK (irregular pigmentation, fine surface lines or coarseness). The study was conducted from June 2016 to October 2016. The Clinical Research Ethics Committee at Ramón y Cajal University Hospital This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2984 Acta Derm Venereol 2018; 98: 963–969