Non-melanoma Skin Cancer Pigmentary Disorders & Vitiligo

Non-melanoma Skin Cancer

Pigmentary Disorders & Vitiligo

P681

P683

THE USE OF TOPICAL IMIQUIMOD FOR CUTANEOUS EPITHELIAL MALIGNANCIES: CLINICAL EXPERIENCE, OPTIMAL APPLICATION REGIMENS, PATIENT FOLLOW-UP AND TOLERABILITY ASSESSMENTS James Q. Del Rosso, DO; Department of Dermatology, University of Las Vegas, Las Vegas, NV Topical imiquimod is an immune response modifier approved in the US for treatment of external genital warts. Imiquimod induces its therapeutic activity by enhancing innate and acquired immunity. The compound has been shown to augment migration of antigen-presenting cells and activate cytokines including TNF-alpha, several interleukins, IFN-alpha and IFN-gamma. Other mechanisms, such as facilitation of apoptosis may also play a role. Multiple studies and case reports have demonstrated efficacy with imiquimod for the treatment of superficial basal cell carcinoma, some nodular basal cell carcinomas, intraepithelial squamous cell carcinoma and actinic keratoses. Although a variety of approaches have been used, available evidence suggests that initial regimens and responses correlate with frequency of application, the type of disease being treated, and to some extent, interpatient variability in the degree of inflammatory response. This poster provides follow-up information presented by the author in a poster presentation at the 2003 Annual AAD meeting and a subsequent publication. Additional data from literature review, new observational cases from a private practice setting and extended follow-up of previously treated patients will be included. Emphasis is placed on discussion of optimal treatment regimens, rational use of rest periods where applicable, efficacy, tolerability, extended follow-up and overall comparison with other available treatment options.

A SMALL OPEN-LABEL STUDY OF A 2% 4-HYDROXYANISOLE AND 0.01% TRETINOIN SOLUTION FOR THE TREATMENT OF POST-INFLAMMATORY HYPERPIGMENTATION Valerie D. Callender, MD; Department of Dermatology, Howard University College of Medicine and Callender Skin & Laser Center, Washington, DC Post-inflammatory hyperpigmentation (PIH) is a frequent sequel to inflammatory eruptions in the skin. PIH is particularly common in dark complected individuals with a relatively higher level of melanin production whose melanocytes overreact to cutaneous injury. PIH may persist for months to years after resolution of the initial lesion and is, to most patients, of great concern. Topical hydroquinone has been a mainstay of therapy for PIH, however, in many hyperpigmentation disorders, combination products or treatments appear to be more useful than single agents. Some studies suggest that prolonged use of hydroquinone may result in the development of exogenous ochronosis. This poster will present the results of a small study utilizing a dual agent topical solution containing 2% 4-hydroxyanisole and 0.01% tretinoin in patients with PIH from various skin disorders and conditions, including acne, burn scars, post-electrodessication, and others. Efficacy evaluations were made by means of photography and mexameter reading to assess hyperpigmented macules and safety parameters were noted. Animal studies have shown this combination to be effective in lightening skin without causing irreversible depigmentation and with minimal local irritation. 4-HA has no known cytotoxicity to human melanocytes

Disclosure not available at press time. 100 percent sponsored by 3M Pharmaceuticals

Disclosure not available at press time. 100 percent sponsored by Galderma Laboratories, L.P.

P682 A COMPARISON OF AMINOLEVULINIC ACID TOPICAL SOLUTION AND BLUE LIGHT, AMINOLEVULINIC ACID TOPICAL SOLUTION AND A LASER LIGHT SOURCE OR TOPICAL 5-FLUOROURACIL IN BROAD AREA TREATMENT OF ACTINIC KERATOSES OF THE FACE AND SCALP Stacy R Smith, MD; Therapeutics, Inc, La Jolla, CA; Daniel Piacquadio, MD; Therapeutics, Inc, La Jolla, CA; Deborah Aiken, MD; Dermatology Associates, Encinitas, CA; Richard Fitzpatrick, MD; Dermatology Associates, Encinitas, CA Background: Topical 20% aminolevulinic acid HCL (ALA) in conjunction with noncoherent blue light has been approved and marketed as a lesion-specific treatment for actinic keratoses. Since its introduction, the use of broad area photodynamic therapy (PDT), where entire affected areas as opposed to individual lesions are treated, has gained in popularity. Prior to the use of such broad area PDT, the standard of care for treating large areas of actinic keratoses has been topical 5-fluorouracil. Additionally, various light sources have been used and reported to be valuable in activating the sensitized tissue during PDT. The objective of this study is to compare the efficacy and tolerability of broad area PDT therapy with two different light sources as well as treatment with topical 5-fluoruracil. Methods: 36 patients with at least 4 actinic keratoses of the face and/or scalp were randomized to receive one of three treatments: topical ALA followed by noncoherent blue light activation, topical ALA followed by activation with a variable pulse duration dye laser or topical 5-fluorouracil. Response was evaluated by grading of target AK lesions for efficacy and evaluation of signs of inflammation (erythema, swelling, crusting etc). Patients selected for PDT therapy received up to two treatments, 30 days apart, depending upon their response. Patents selected for topical 5-FU therapy were to apply the medication for 28 days. Results: Differences in proportions of patients treated with total lesion clearing will be compared along with proportions sustaining less than complete clearing for patients treated with ALA PDT with non-coherent blue light, ALA PDT with laser light and with topical 5-fluorouracil. Similarly, proportions of patients with significant signs of irritation (erythema, crusting and pain) will be compared between each modality Disclosure not available at press time. Study and poster supported by Dusa Pharmaceuticals

MARCH 2004

P684 COST-EFFECTIVENESS ANALYSIS OF CURRENT THERAPIES FOR MELASMA Daniel J. Piacquadio, MD; Division of Dermatology, University of California and Therapeutics, Inc., San Diego, CA; Stacy Smith, MD; University of California and Therapeutics, Inc., San Diego, CA Melasma is an extremely common acquired hyperpigmentation disorder with an incidence of approximately 5-6 million among women in the United States. Many types of therapy are utilized for melasma treatment, including hydroquinone, tretinoin, topical corticosteroids, azelaic acid, and kojic acid. Laser treatments and dermabrasion are also used. In 2002, a triple combination therapy, based on a depigmenting formulation proposed by Kligman and Willis in 1975, became commercially available to treat melasma. This therapy combines tretinoin 0.05%, hydroquinone 4% and fluocinolone acetonide 0.01%. While hydroquinone has been the mainstay of treatment for melasma, monotherapy with hydroquinone often requires a prolonged treatment course and is often inadequate for some patients. Tretinoin monotherapy has also been used, but improvement may not be visible for a period of up to or more than six months. Because of the requirements of managed care organizations, it is increasingly important to be able to demonstrate the cost-effectiveness of a proposed course of treatment. Cost-effectiveness analysis is useful for comparing alternative therapies for achieving a defined outcome– in this case, improvement or resolution of hyperpigmentation. In such analysis, benefits are defined as the extent to which a particular therapy affects clinically relevant outcomes. This poster will compare the cost-effectiveness of several current therapies for melasma based on an average course of treatment. Disclosure not available at press time. 100 percent sponsored by Galderma Laboratories, L.P.

J AM ACAD DERMATOL

P175