الفهرس 
Seborrheic KeratosisOnly 14 pages are availabe for public view
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Abstract
Seborrheic keratosis (SK) is one of the most common benign epidermal tumors that affects both sexes equally, and usually arises in individuals older than 50 years.
It presents as sharply demarcated, slightly raised brownish patches or plaques, usually on sun-exposed surfaces of the skin. The clinical presentation can be quite variable and includes clinical variants, such as stucco keratosis and dermatosis papulosa nigra. It can be divided into six major histopathological variants: acanthotic, hyperkeratotic, adenoid, irritated, clonal, and melanoacanthoma.
Photodynamic therapy (PDT) is a technique that utilizes reactive oxygen species produced by a nontoxic dye or photosensitizer molecule in the presence of low intensity visible light to kill mammalian or microbial cells. The advantages of PDT are numerous; it is a safe, noninvasive technique which yields effective therapeutic results.
Intense Pulsed Light (IPL) is a broadband visible light emitted from a non-coherent, filtered flash lamp. IPL sources emit light in the 500-1200 nm range and allows treatment of melanocytic lesions.
Methylene blue (MB) is a widely known histological dye that has been in use to stain living organisms for many years. It belongs to the phenothiazinium class of compounds. It is well known to be photo dynamically active. The characteristic color of MB is caused by the strong absorption band in the 550–700 nm regions. Methylene blue has shown in vivo activity against several types of tumors when locally injected and illuminated with red laser light.
In our study, we aimed to evaluate and investigate the efficacy and safety of topical carbon gel photo-enhancer assisted intense pulsed light versus methylene blue assisted intense pulsed light photodynamic therapy for treatment of Seborrheic Keratosis.
Thirty patients (21 males and 9 females) with Sks of different numbers and durations and their age ranged from 36-77 years were randomly selected from the outpatient clinic of Dermatology, Venereology and Andrology, Ain Shams University.
Patients were randomly subdivided into 3 subgroups:
10 patients that were subjected to methylene blue-mediated IPL therapy. 10 patients that were subjected to topical carbon gel photo-enhancer assisted IPL therapy. 10 patients that were subjected to IPL only.
At each visit, a sunscreen (SPF 50+) was applied to all light exposed areas.
Topical MB gel 10% or carbon suspension will be applied in a layer approximately 0.5-1mm thick over the lesion area
Assessments was done while facing the patients at baseline and at the end of the study (one week after last session).
In patients,treated with MB/IPL a detectable clinical response was achieved in 7 (70%) patients in the form of excellent response with the change of the dermoscopic picture and appearance of normal skin markings; 3 (30%) patients had very good response, while in patients treated with carbon gel /IPL 6 (60%) patients in the form of excellent response with the change of the dermoscopic picture and appearance of normal skin markings; 3 (30%) patients had very good response and only 1 (10%) patients showed poor response. In patients treated with IPL only 2 (20%) patients in the form of excellent response with the change of the dermoscopic picture and appearance of normal skin markings; 1 (10%) patients had very good response; 4 (40%) patients showed good response and 3 (30%) patients showed poor response
Regarding the number of received sessions five sessions were needed for the complete clinical response to be achieved.
There was no statistically significant difference found between the three studied group regarding age, gender, skin type and sun exposure among the studied cases.
No serious local or systemic side effects were noticed in both groups except for local skin reactions in the form of immediate burning pain at the time of the session with mild itching and irritation at the site of lesion with spontaneous resolution within the next few days.
Furthermore, none of the responding patients (complete and partial responses) developed relapse at the site of cleared lesions or any new lesions at other site within the period following the treatment.
Considering the advantages methylene blue-mediated photodynamic therapy and topical carbon gel photo-enhancer they can be considered as an effective and safe alternative therapeutic method in the treatment of Sk lesions with negligible side effects and with no recurrence.