Browsing by Author "Nguyen, Madalyn"
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Item Combination Therapy with Short-Contact Topical Calcipotriene and 5-FU For Actinic Keratosis(2018-03-14) Moore, Angela; Nguyen, MadalynBackground: Actinic keratoses (AKs) are precursor lesions to squamous cell carcinoma that arise from dysplasia of keratinocytes, which is enhanced by long-term ultraviolet radiation exposure. Treatment of actinic keratoses has traditionally involved cryotherapy, or various topical therapies such as topical 5-fluorouracil (5-FU) monotherapy, or combination therapy with cryotherapy. Because of irritation with use of topical 5-FU, short-contact therapy with 5-FU in combination with cryotherapy has been reported. Vitamin D derivatives have also been reported as systemic anti-cancer agents, though clinical data for usage is limited mainly due to hypercalcemia as an adverse effect and dose-limiting factor. Recent research has suggested that topical Vitamin D derivatives such as calcipotriene may be safe and efficacious agents for the treatment of AKs. Objective: The aim of this study was to evaluate efficacy and safety of short-contact topical treatment with calcipotriene and 5-FU with cryotherapy in the treatment of AKs. Combination short-contact calcipotriene and 5-FU with cryotherapy will be compared to short-contact 5-FU with cryotherapy and cryotherapy alone to determine differences in efficacy and safety between the treatment modalities. Methods: Subjects were identified as eligible for inclusion in this study based on a clinical diagnosis of actinic keratosis and treatment with cryotherapy, 5-FU, and/or topical calcipotriene between 2016 to 2018. The patients were divided into three treatment groups: 1) short-contact combination treatment with calcipotriene and 5-FU with cryotherapy, 2) short-contact 5-FU and cryotherapy, and 3) cryotherapy alone. Patients were assessed for baseline lesions in the face, scalp, upper extremities, chest, back, and lower extremities, and again at 1 month follow-up, 3 months follow-up, and 6 months follow-up. An analysis of covariance (ANCOVA) model with terms for treatment and baseline lesion count as covariate was used to compare post-treatment lesion count between treatment groups estimated at 95% confidence intervals (95% CI). Results: Data was collected on 50 patients in each subset. After adjusting for imbalances in baseline count, a statistically significant reduction in number of AK lesions occured after 6 months of treatment with short-contact combination treatment with calcipotriene and 5-FU with cryotherapy in comparison to short-contact 5-FU with cryotherapy and to cryotherapy. The mean total lesion count at month 6 in the short-contact combination treatment with calcipotriene and 5-FU with cryotherapy was significantly lower than in the other 2 subsets. Conclusions: Addition of topical calcipotriene to short-contact combination treatment of topical 5-FU with cryotherapy may result in improved long-term outcomes for patients with actinic keratoses. Larger series must be done to confirm increased efficacy and safety.Item Evaluating Safety and Efficacy of Combination Therapy with Short-Contact Topical 5-Fluorouracil 5% and Calcipotriene for Actinic Keratoses(2019-03-05) Moore, Angela; Nguyen, Madalyn; Hirapara, BhavikBackground: Actinic Keratoses (AKs) are precancerous lesions to squamous cell carcinomas of the skin, affecting roughly 35% of adults over the age of 40. The lesions are directly linked to the cumulative exposure to UV radiation and arise from keratinocyte dysplasia. Standard treatment includes liquid nitrogen (LN2), topical 5-Fluorouracil creams (5-FU), or combination therapy. Vitamin D derivatives have demonstrated anti-proliferative properties in cancer treatment via stimulation of the vitamin D3 receptor and, therefore, may be efficacious in the treatment of AKs. However, these treatments are limited by side effects such as pruritus, erythema, dryness, and irritation. Objective: The purpose of this study is to evaluate the safety and efficacy of short-contact combination therapy of topical 5-FU 5% cream and vit D foam after LN2. Methods: This was a retrospective study on adults diagnosed with AKs in a private clinical dermatology office setting. Charts from 139 patients, 49% males and 51% females, with a mean age of 57.4, were examined. All patients were first treated with LN2 at baseline. Short-contact therapy of topical 5-FU and/or vit D foam consisted of a thin application nightly to the face for 5 nights and to other treatment areas for 7 nights, and then no application for 2 weeks. The cycles were repeated every 3 weeks. The patients were divided into six treatment groups: 1) 5-FU 5% after LN2, 2) vit D foam after LN2, 3) 5-FU 1% after LN2, 4) 5-FU 5% and vit D foam after LN2, 5) 5-FU 1% and vit D foam after LN2, and 6) LN2 alone. AKs of the of the face, scalp, chest, upper extremities, back, and lower extremities for each patient were documented at baseline and follow up visits at 20-50, and 51-100 days. An analysis of covariance (ANCOVA) model was used to compare post-treatment lesion counts between treatment groups at 95% confidence intervals. Results/Conclusions: Greater irritation was observed with the 5-FU 5% cream compared to other treatment groups. Short-contact combination therapy with 5-FU cream and Vit D foam after LN2 demonstrates increased efficacy over LN2 alone. Studies with an increased sample size for a longer duration should be performed to evaluate efficacy and safety.