Letter - Therapy
Darier’s disease: treatment with topical sodium diclofenac 3% gel
Marcella Oliveira Menezes Quitete de Campos
, Giovanna Abrantes Pimenta de Figueiredo, Allyson Capobiango Evangelista, Alexander Richard Bauk
Corresponding author
Department of Dermatology, Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Therapy</span>" "titulo" => "Darier’s disease: treatment with topical sodium diclofenac 3% gel" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "882" "paginaFinal" => "884" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marcella Oliveira Menezes Quitete de Campos, Giovanna Abrantes Pimenta de Figueiredo, Allyson Capobiango Evangelista, Alexander Richard Bauk" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Marcella Oliveira Menezes Quitete de" "apellidos" => "Campos" "email" => array:1 [ 0 => "marcellamqcampos@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Giovanna Abrantes Pimenta de" "apellidos" => "Figueiredo" ] 2 => array:2 [ "nombre" => "Allyson Capobiango" "apellidos" => "Evangelista" ] 3 => array:2 [ "nombre" => "Alexander Richard" "apellidos" => "Bauk" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1840 "Ancho" => 3008 "Tamanyo" => 436156 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Dorsal region, four months after starting treatment. (B) Detail of the dorsal region, right scapular region after treatment</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 32-year-old male patient came to the authors outpatient clinic with a previous history of epilepsy and cognitive impairment, using carbamazepine and a clinical and histopathological diagnosis of Darier's disease for eight years. On physical examination, he had multiple erythematous-brown, keratotic papules, some of them crusted, located on the dorsal region, shoulders and anterior thorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He had previously used topical keratolytics, corticosteroids and retinoids, in addition to systemic antibiotics, without achieving lesion control. Systemic retinoids were avoided due to possible drug interactions (carbamazepine).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">After reviewing the literature, the authors found some reports on the use of topical sodium diclofenac in Darier's disease. They chose to start with 3% sodium diclofenac and 2.5% hyaluronic acid in natrosol gel, applied twice a day only on the affected areas on the left side of the body, for eight weeks. After significant improvement of the lesions, the patient was instructed to apply it on all affected areas, twice a day. He denied local or systemic adverse reactions during medication use and no laboratory changes were observed during this period. After four months of treatment, he showed significant lesion regression, with post-inflammatory hypo- and hyperchromic macules and the presence of a few residual keratotic papules (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Medication use was reduced to once a day for another four weeks and the treatment was discontinued, with good clinical control maintained since then.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Darier's disease occurs due to a mutation in the ATP2A2 gene, which encodes a protein involved in epidermal differentiation and intercellular communication called SERCA2B, leading to impaired SERCA21 function.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It manifests as erythematous-brown, keratotic-crusted papules, in seborrheic areas of the trunk, scalp, face, and neck associated with a foul odor and pruritus.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Ungual changes may also be observed, such as erythematous and white longitudinal bands, longitudinal fissures, subungual keratosis, and brittleness, forming “V”-shaped notches.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment of Darier's disease includes general measures such as wearing light clothing and sunscreen protection; use of topical medications, such as keratolytics, corticoids, retinoids, tacrolimus, and 5-fluorouracil; and systemic drugs such as acitretin, isotretinoin, or cyclosporine. Surgical and photodynamic therapy can also be performed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Sodium diclofenac 3% was recently described as a therapeutic option in Darier's disease.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> Its mechanism of action occurs by inhibiting cyclooxygenase-2, resulting in the suppression of prostaglandin E2 activity, which in turn downregulates the ATP2A2 gene. This leads to the normalization of SERCA2 levels in keratinocytes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its use is combined with hyaluronic acid 2.5%, which acts by maintaining the drug on the epidermis and superficial dermis, with better local action and less systemic absorption.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Marcella Oliveira Menezes Quitete de Campos: Drafting and editing of the manuscript; critical review of the literature.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Giovanna Abrantes Pimenta de Figueiredo: Drafting and editing of the manuscript; critical review of the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Allyson Capobiango Evangelista: Drafting and editing of the manuscript; critical review of the literature.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Alexander Richard Bauk: Approval of the final version of the manuscript; design and planning of the case report; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-12-29" "fechaAceptado" => "2022-01-31" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the General Outpatient Clinic of the Dermatology Service, Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1840 "Ancho" => 3008 "Tamanyo" => 504468 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Dorsal region ‒ before treatment. (B) Right scapular region, before treatment</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1840 "Ancho" => 3008 "Tamanyo" => 436156 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Dorsal region, four months after starting treatment. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 23 | 4 | 27 |
| 2024 October | 163 | 80 | 243 |
| 2024 September | 151 | 93 | 244 |
| 2024 August | 164 | 114 | 278 |
| 2024 July | 146 | 115 | 261 |
| 2024 June | 161 | 78 | 239 |
| 2024 May | 132 | 81 | 213 |
| 2024 April | 143 | 104 | 247 |
| 2024 March | 125 | 79 | 204 |
| 2024 February | 127 | 110 | 237 |
| 2024 January | 194 | 71 | 265 |
| 2023 December | 641 | 87 | 728 |
| 2023 November | 227 | 129 | 356 |
| 2023 October | 276 | 112 | 388 |
| 2023 September | 91 | 75 | 166 |
| 2023 August | 58 | 31 | 89 |
| 2023 July | 75 | 60 | 135 |
| 2023 June | 7 | 11 | 18 |
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