Actinic keratosis (AK), due to its widespread prevalence, as well as the possibility of progression to an invasive form of squamous cell carcinoma, requires treatment regardless of the clinical stage. New imaging techniques, such as in vivo reflectance confocal microscopy (RCM), significantly increase the accuracy of diagnosis and allow noninvasive evaluation of the therapeutic efficacy of the ongoing treatment. Our objective was to evaluate the prevalence of specific (video)dermoscopy and RCM features of pigmented and classical subtypes of AK before and after photodynamic therapy (PDT) treatment. We included patients with facial grade II AKs (25 pigmented, 275 non-pigmented) were included in the study. Skin lesions were evaluated by (video)dermoscopy and RCM at the baseline and three months after PDT. In classic AK, the most frequent dermoscopic findings were fine wavy vessels (96%), scale (92%), microerosions (48%), and “strawberry” pattern (36%), while pigmented AK was characterized mostly by “rhomboidal pattern” (80%), scale (60%), white globules (48%), “jelly sign”, and superficial pigmentation (40%). RCM’s most characteristic classic AK findings were abnormal honeycomb pattern in the spinous layer, epidermal inflammatory infiltrate, and solar elastosis that were present in 96% of lesions. Pigmented AKs presented mostly with dark central areas of parakeratosis (72%), mottled pigmentation (72%), dermal inflammatory infiltrate (64%), solar elastosis (60%), and abnormal honeycomb pattern in the spinous layer (56%). Dermoscopically, PDT resulted in complete disappearance of the “rhomboidal pattern” in both classical and pigmented AKs, “starburst pattern” and “jelly sign” in classical AKs, and inner gray halo, “rosette sign” and central crust in pigmented AKs. Three months after one PDT session, RCM evaluation showed mostly solar elastosis in both classical and pigmented AK subtypes, epidermal inflammatory infiltrate in classical AKs, and dermal inflammatory infiltrate in pigmented AKs. New noninvasive imaging techniques such as RCM and (video)dermoscopy can help practitioners better visualize the efficacy of the ongoing PDT treatment in either classical or pigmented AK subtypes.
鉴于光化性角化病（AK）的广泛流行性及其可能进展为侵袭性鳞状细胞癌的风险，无论处于何种临床阶段均需进行治疗。新型成像技术，如活体反射式共聚焦显微镜（RCM），显著提高了诊断的准确性，并能无创评估当前治疗方案的疗效。本研究旨在评估光动力疗法（PDT）治疗前后，色素型与经典型AK亚型在（视频）皮肤镜及RCM下的特征性表现发生率。研究纳入了面部II级AK患者（其中色素型25例，非色素型275例）。在基线及PDT治疗后三个月，通过（视频）皮肤镜和RCM对皮损进行评估。在经典型AK中，最常见的皮肤镜表现为纤细波浪状血管（96%）、鳞屑（92%）、微糜烂（48%）和“草莓样”模式（36%）；而色素型AK则主要表现为“菱形模式”（80%）、鳞屑（60%）、白色球状结构（48%）、“果冻征”及浅表色素沉着（40%）。RCM下经典型AK最具特征性的发现是棘层异常蜂窝状模式、表皮炎症浸润和日光性弹力纤维变性，这些表现在96%的皮损中存在。色素型AK主要表现为角化不全的深色中央区域（72%）、斑驳状色素沉着（72%）、真皮炎症浸润（64%）、日光性弹力纤维变性（60%）以及棘层异常蜂窝状模式（56%）。皮肤镜下，PDT治疗后，经典型和色素型AK中的“菱形模式”、经典型AK中的“星爆模式”和“果冻征”，以及色素型AK中的内灰色晕、“玫瑰花结征”和中央结痂均完全消失。单次PDT治疗三个月后，RCM评估显示，经典型和色素型AK亚型均主要表现为日光性弹力纤维变性，经典型AK主要表现为表皮炎症浸润，而色素型AK则主要表现为真皮炎症浸润。RCM和（视频）皮肤镜等新型无创成像技术有助于临床医生更清晰地观察PDT治疗在经典型或色素型AK亚型中的疗效。
肿瘤(癌症)患者之家