Acta Dermato-Venereologica 98-10CompleteContent | Page 12
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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