QUERATOSIS ACTINICA PDF

Actinic keratoses AKs are common skin lesions associated with an increased risk of developing squamous cell carcinoma. Few studies in Europe have focused on AK prevalence.. To determine the point prevalence of AKs in a dermatology outpatient population in Spain, to describe the clinical characteristics of these lesions and to characterise the profile of AK patients.. Observational, cross-sectional, multicentre study conducted in 19 hospitals dermatology outpatient services around Spain. Prevalence was significantly higher in men than women

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The diagnosis of pigmented actinic keratosis PAK is often challenging because of overlapping features with lentigo maligna.. To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients..

Descriptive and analytical study of PAK. Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications..

Actinic keratosis is considered to be an in situ epidermal dysplasia that develops in sunexposed areas in individuals having a fair skin phototype. The primary objective of the present study was to describe the dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients in order to emphasize the usefulness of this imaging technique in the diagnosis of PAK.

The age, sex, skin phototype, and site of the lesions were recorded for each patient. The evolutionary stages of PAK were determined as follows: thin patches with thin or without scales; scaly plaque and hyperkeratotic plaque. Clinical and dermoscopic images were taken and then evaluated by three examiners experienced in dermoscopy independently of the histology results if the lesion was excised; and then the correlation dermoscopy-histopathology was done after the dermoscopic analysis.

Dermoscopic patterns were divided into two categories. Classification and definitions of the dermoscopic patterns examined in our study. Newly described dermoscopic signs were used in our study, namely, the prominent central hyperkeratosis and the double white clod. The prominent central hyperkeratosis in the follicular opening gives an appearance of a dermoscopic horn. This sign is the evolution of the central keratin surrounded by the inner gray halo described by Nascimento et al.

Other signs such as the rosette sign, 6,7 the jelly sign 1 with a superficial pigmentation appearance, white globules and circles 7 and the inner gray halo IGH 5 around the yellowish keratin were examined based on recent literature.

In addition, other known signs, such as rhomboidal structures, globules and dots, annular—granular pattern and scales 8,9 were also examined. Statistical analysis was performed using the SPSS 20 software. Two kinds of analysis were performed, namely descriptive and univariate analysis. A p value less than 0. Ethical approval was obtained from the ethics committees in the Department of Dermatology of the Hospital Center Hassan II in Fez-Morocco, and all the patients were informed of the conditions related to the study and gave their written, informed consent.

In total, lesions in patients were included in our study. The other epidemiological and clinical characteristics of lesions were summarized in Table 2 and the dermoscopic patterns described in our study were resumed in Table 3 Figs. The presence of 2 or more dermoscopic signs in both the follicule's surroundings and keratosis was noticed in Rhomboidal pattern, the annular granular pattern, the gray halo, the jelly sign, the white globule, the rosette sign, the white circle and the presence of grayish areas were significantly related to male sex.

No dermoscopic sign was significantly related to the female gender Table 3. Rhomboidal pattern, the annular granular pattern, the gray halo, the jelly sign and the white circle sign were significantly related to fair skin phototype III Table 3.

Rhomboidal pattern, the annular granular pattern, the gray halo, the white circle, the double circle and the double clods were the dermoscopic patterns significantly related to Xeroderma pigmentosum. The jelly sign with a superficial pigmentation was significantly related to the thin patches of PAK. The star like appearance of the lesion was present especially in hypertrophic PAK Table 3. The epidemiological and the clinical characteristics of the patients. C,E: the rosette sign black arrow.

B and D: the annular granular pattern blue arrow , the inner gray halo around the yellowish central keratin D: green arrow. F: the dermoscopic horn black arrow , the gray halo around the yellowish central keratin red arrow , the rosette sign blue arrow , the double white clods green arrow. G: Central crusts black arrow , the white globule red arrow , the rosette sign blue arrow , the double white clods attached against each other green circle.

H: the superficial pigmentation with the jelly sign, the double white clods green circle , the white globule black arrow. Clinical and dermoscopic images of PAK. A: the rhomboidal pattern with the dermoscopic horn black arrow , the gray halo around the yellowish central keratin blue arrow , the rosette sign violet circle , the double white clods red circle , grayish area and scales red arrow.

B: the rhomboidal pattern with the presence of white circles black arrow , the gray halo around the yellowish central keratin green arrow , the rosette sign violet circle , the double white clods red circle. C: the annular granular pattern with the dermoscopic horn blue arrow , globules green arrow , the rosette sign violet circle.

D: the rhomboidal pattern, the gray halo around the yellowish central keratin blue arrow , the double white clods red circle , the white circle blue circle. E and F: the superficial pigmentation with the jelly sign with white globules arrows , the rosette sign circles.

G: the star like appearance with the presence of white globules green arrow , the rosette sign violet circle and the double white clods red circle. H: the star like appearance with the presence of central crusts with peripheral white globules green arrow , the rosette sign violet circle , the double white clods red circle , white circle around the follicular opening black arrow and the dermoscopic horn red arrow. Univariate analysis showing the patients characteristics significantly related to the dermoscopic features.

The dermoscopic horn was not related to a special epidemiological or clinical characteristic of PAK in our patients. The primary objective of the present study was to describe different dermoscopic patterns of PAK and to correlate the pattern with clinical characteristics of the patient and the evolutionary stage of the lesion. Only few previous studies 1,5,8,9—14 focused on the pigmented form of AK, reporting the dermoscopic signs of PAK, without information about clinical characteristics of the patients.

The most challenging form of PAK is the flat or thin patch, as already highlighted by Tschandl et al. In our study, the jelly sign was the dermoscopic pattern significantly related to thin patches, in contrast to the study of Ciudad et al.

An other dermoscopic pattern found in our study and recently reported is the inner gray halo IGH. White structures clods and circles are the signature sign of keratinization, 14,15 and may be present in SCC and keratoacanthoma as well, yet if present, they are a very good feature that could allow to rule out the diagnosis of LM.

The star-like appearance at the periphery of the lesion was significantly related to hypertrophic PAK. This sign must lead the clinician to the necessity of the excision of the lesion in order to rule out a pigmented squamous cell carcinoma in situ. The dermoscopic horn is a new term that we have used in our study to describe the prominent central keratosis organized in the follicular openings.

This feature was present in 9. We think that this sign would be of great help not only in the differential diagnosis of PAK, but also a good sign of keratinization and the benignity of the disease. Based on the evolutionary stages of PAK, the jelly sign with a superficial pigmentation was significantly related to the thin plates of AK. The star-like appearance of the lesion was present especially in rough hypertrophic AK.

This correlation is particularly useful for the prognostic and the therapeutic choice according to the degree of infiltration of PAK. As described in previous studies, 2 these dermoscopic features were significantly more noticed in males than in females while the dermoscopic horn and grayish areas were not related to any special epidemiological or clinical characteristic of PAK in our patients. The description of significance of these dermoscopic features, their relationship with the phototype, the gender and the clinical form of PAK or in special types of skin like in xerodema pigmentusum XP patients is very important, because it may limit the unnecessary biopsies and excisions.

Although it was not the aim of our study, and a control population is mandatory to talk about the diagnostic accuracy of PAK in comparison with LM, it seems that the diagnosis of PAK should be based on 2 or more dermoscopic signs in both the FSA and FkA. Notably, This theory of combination was already reported for the dermoscopic diagnosis of malignant pigmented skin lesions. In conclusion, we emphasize the importance of the dermoscopic analysis according to the gender, the phototype, the type of skin and the clinical forms of PAK.

All the subjects agreed to participate in the study prospectively or to use their materials or data for research purposes retrospectively. All the subjects were informed of the conditions related to the study and gave their informed consent for publication. The authors declare that they have no conflicts of interest. ISSN: Descargar PDF. Kelati a ,. Autor para correspondencia. Contenido relaccionado. Actas Dermosifiliogr. Table 1. Classification and definitions of the dermoscopic patterns examined in our study..

Table 2. The epidemiological and the clinical characteristics of the patients.. Table 3. Univariate analysis showing the patients characteristics significantly related to the dermoscopic features..

The diagnosis of pigmented actinic keratosis PAK is often challenging because of overlapping features with lentigo maligna. Objective To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients.

Methods Descriptive and analytical study of PAK. Conclusions The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications. Pigmented actinic keratosis. Palabras clave:. Texto completo. Introduction Actinic keratosis is considered to be an in situ epidermal dysplasia that develops in sunexposed areas in individuals having a fair skin phototype. Figure 1. Figure 2. Ciudad, J. Diagnostic utility of dermoscopy in pigmented actinic keratosis.

Actas Dermosifiliogr, , pp. Huerta-Brogeras, O. Olmos, J. Borbujo, et al. Validation of dermoscopy as a real-time noninvasive diagnostic imaging technique for actinic keratosis.

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Aka: Actinic Keratoses , Actinic Keratosis. These images are a random sampling from a Bing search on the term "Actinic Keratoses. Search Bing for all related images. Started in , this collection now contains interlinked topic pages divided into a tree of 31 specialty books and chapters. Content is updated monthly with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers.

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