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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old female was admitted with Brooke-Spiegler Syndrome &#40;BSS&#41;&#46; On dermatologic examination&#44; confluent&#44; infiltrated papules compatible with trichoepithelioma were detected &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Initially&#44; the prominent lesions on the left nasolabial sulcus skin were ablated by full-field erbium&#58; YAG laser applied at the setting of 3-mm spot-size&#44; 6&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 10&#8239;Hz with 100 &#956;sn pulse duration &#40;Fotona&#44; XS&#44; Dynamis&#41;&#46; Due to the requirement of sedoanalgesia for the remaining lesions&#44; she was offered fractional erbium&#58; YAG laser and topical imiquimod combination&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The pre-determined 4-week treatment cycles were repeated for 6-months as monthly Ablative Fractional Laser &#40;AFL&#41; applications immediately followed by imiquimod cream applied 5 consecutive days per week for the first 2-weeks&#46; This was followed by a treatment-free period of 2-weeks&#46; Severe irritation occurred that subsided during treatment-free periods&#46; On 6-months control&#44; her self-reported score changed from 10 to 0 for the part treated with full-field resurfacing and 10 to 2 for the parts treated with a combination of AFL and imiquimod &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; She has been under follow-up for 1&#46;5 years without recurrence &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">BSS is an autosomal dominant disorder characterized by progressive&#44; stigmatizing benign cutaneous neoplasms localized on the facial skin and the scalp&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical excision and alternative destructive modalities were reported for BSS skin neoplasms&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The ideal goal of interventions is to remove lesions without scarring and dyspigmentation&#44; still yet efficacious enough to prevent recurrences&#46; Recently&#44; topical sirolimus and imiquimod treatments were suggested as non-invasive approaches&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The first observation on the efficacy of imiquimod was reported in a case with Multiple Facial Trichoepitheliomas &#40;MFT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Topical tretinoin was introduced in the 6<span class="elsevierStyleSup">th</span> month to improve the penetration of imiquimod&#46; This combination was continued till 3<span class="elsevierStyleSup">rd</span> year&#46; A retrospective study reported partial response after 32-weeks of imiquimod treatment in two BSS patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These treatment durations are significantly longer when compared to the approved indications of imiquimod &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In a single-subject case study&#44; the efficacy of various treatments was evaluated&#46; Two sites received either imiquimod or the combination of AFL and imiquimod&#46; On the 3<span class="elsevierStyleSup">rd</span> month&#44; topical imiquimod wasn&#8217;t effective&#46; The treatment result of AFL and imiquimod was also similar to AFL alone&#46; An important difference from the combination design is that imiquimod wasn&#39;t applied immediately&#44; instead 2 days after AFL&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> AFL is shown to increase imiquimod flux 46 to 127-fold through multiple passes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Immediate application of the topical agent is central to treatment success of Laser-Assisted Delivery &#40;LAD&#41; which may explain discrepancies in treatment results&#46; A limitation of current observation is that AFL alone can provide similar results&#44; which cannot be compared to the combination therapy defined for this case&#46; However&#44; it should be emphasized that the lack of recurrence on long-term follow-up is extremely rare for Brooke-Spiegler syndrome and the detected results are remarkable&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">As imiquimod requires extended treatment durations for trichoepitheliomas&#44; LAD can assist in decreasing the duration&#46; Another important consideration about this regimen is the lack of recurrence on long-term follow-up&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#39; contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Aysenur Botsali&#58; Approval of the final version of the manuscript&#59; Critical literature review&#59; Data collection&#44; analysis&#44; and interpretation&#59; Effective participation in research orientation&#59; Intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; Preparation and writing of the manuscript&#59; Study conception and planning&#46;</p></span><p id="par0060" class="elsevierStylePara elsevierViewall">Ercan Caliskan&#58; Approval of the final version of the manuscript&#59; Critical literature review&#59; Effective participation in research orientation&#59; Intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; Manuscript critical review&#59; Study conception and planning&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41;&#44; A close-up image of the trichoepithelioma lesions located on the nasal dorsum&#46; &#40;B&#41;&#44; The same site at the last follow-up&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MFT&#44; Multiple Facial Trichoepithelioma&#59; BSS&#44; Brooke-Spiegler Syndrome&#59; IMI&#44; Imiquimod&#59; PDT&#44; Photodynamic Therapy&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&#44; year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type&#47;Patient number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration weeks &#40;wks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urquhart JL&#44; 2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MFT&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMI&#8239;&#43;&#8239;Tretinoin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37; clearance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alessi SS&#44; 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BSS&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Partial response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LoPiccolo MC&#44; 2011</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BSS&#47;1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient stated disease severity &#40;compared to baseline&#41; 10&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Er&#58; YAG laser&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Er&#58; YAG laser&#8239;&#43;&#8239;IMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Er&#58; YAG laser&#8239;&#43;&#8239;PDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tu JH et al&#46;&#44; 2016</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MFT&#47;2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CO2 laser&#8239;&#43;&#8239;Sirolimus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited re-growth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sirolimus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited disease progression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                      "titulo" => "Comparing ablative fractionated resurfacing&#44; photodynamic therapy&#44; and topical imiquimod in the treatment of trichoblastomas of Brooke-Spiegler Syndrome&#58; a case study"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Lopiccolo"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2011.01907.x"
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                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1047"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21388481"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of cutaneous tumors with topical 5&#37; imiquimod cream"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;S&#46; Alessi"
                            1 => "J&#46;A&#46; Sanches"
                            2 => "W&#46;R&#46; Oliveira"
                            3 => "M&#46;C&#46; Messina"
                            4 => "E&#46;R&#46; Pimentel"
                            5 => "C&#46; Festa Neto"
                          ]
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                      ]
                    ]
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                    0 => array:1 [
                      "Revista" => array:5 [
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                      ]
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                      "titulo" => "Use of topical sirolimus in the management of multiple familial trichoepitheliomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;H&#46; Tu"
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                      "Revista" => array:3 [
                        "tituloSerie" => "Dermatol Ther"
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                      "titulo" => "Treatment of multiple trichoepitheliomas with topical imiquimod and tretinoin"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                    0 => array:2 [
                      "doi" => "10.1111/j.1525-1470.2005.22115.x"
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                        "tituloSerie" => "Pediatr Dermatol"
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                        "volumen" => "22"
                        "paginaInicial" => "67"
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                    0 => array:2 [
                      "titulo" => "Fractional laser as a tool to enhance the skin permeation of 5-aminolevulinic acid with minimal skin disruption&#58; a comparison with conventional erbium&#58;YAG laser"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
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                            3 => "H&#46;H&#46; Yang"
                            4 => "C&#46;Y&#46; Yuan"
                            5 => "J&#46;Y&#46; Fang"
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                      "doi" => "10.1016/j.jconrel.2010.03.017"
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                        "fecha" => "2010"
                        "volumen" => "145"
                        "paginaInicial" => "124"
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Case Letter
Laser-assisted delivery of imiquimod in Brooke-Spiegler syndrome
Aysenur Botsali
Autor para correspondência
abotsali@hotmail.com

Corresponding author.
, Ercan Caliskan
Department of Dermatology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old female was admitted with Brooke-Spiegler Syndrome &#40;BSS&#41;&#46; On dermatologic examination&#44; confluent&#44; infiltrated papules compatible with trichoepithelioma were detected &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Initially&#44; the prominent lesions on the left nasolabial sulcus skin were ablated by full-field erbium&#58; YAG laser applied at the setting of 3-mm spot-size&#44; 6&#8239;J&#47;cm<span class="elsevierStyleSup">2</span>&#44; 10&#8239;Hz with 100 &#956;sn pulse duration &#40;Fotona&#44; XS&#44; Dynamis&#41;&#46; Due to the requirement of sedoanalgesia for the remaining lesions&#44; she was offered fractional erbium&#58; YAG laser and topical imiquimod combination&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The pre-determined 4-week treatment cycles were repeated for 6-months as monthly Ablative Fractional Laser &#40;AFL&#41; applications immediately followed by imiquimod cream applied 5 consecutive days per week for the first 2-weeks&#46; This was followed by a treatment-free period of 2-weeks&#46; Severe irritation occurred that subsided during treatment-free periods&#46; On 6-months control&#44; her self-reported score changed from 10 to 0 for the part treated with full-field resurfacing and 10 to 2 for the parts treated with a combination of AFL and imiquimod &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; She has been under follow-up for 1&#46;5 years without recurrence &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">BSS is an autosomal dominant disorder characterized by progressive&#44; stigmatizing benign cutaneous neoplasms localized on the facial skin and the scalp&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical excision and alternative destructive modalities were reported for BSS skin neoplasms&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The ideal goal of interventions is to remove lesions without scarring and dyspigmentation&#44; still yet efficacious enough to prevent recurrences&#46; Recently&#44; topical sirolimus and imiquimod treatments were suggested as non-invasive approaches&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The first observation on the efficacy of imiquimod was reported in a case with Multiple Facial Trichoepitheliomas &#40;MFT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Topical tretinoin was introduced in the 6<span class="elsevierStyleSup">th</span> month to improve the penetration of imiquimod&#46; This combination was continued till 3<span class="elsevierStyleSup">rd</span> year&#46; A retrospective study reported partial response after 32-weeks of imiquimod treatment in two BSS patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These treatment durations are significantly longer when compared to the approved indications of imiquimod &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In a single-subject case study&#44; the efficacy of various treatments was evaluated&#46; Two sites received either imiquimod or the combination of AFL and imiquimod&#46; On the 3<span class="elsevierStyleSup">rd</span> month&#44; topical imiquimod wasn&#8217;t effective&#46; The treatment result of AFL and imiquimod was also similar to AFL alone&#46; An important difference from the combination design is that imiquimod wasn&#39;t applied immediately&#44; instead 2 days after AFL&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> AFL is shown to increase imiquimod flux 46 to 127-fold through multiple passes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Immediate application of the topical agent is central to treatment success of Laser-Assisted Delivery &#40;LAD&#41; which may explain discrepancies in treatment results&#46; A limitation of current observation is that AFL alone can provide similar results&#44; which cannot be compared to the combination therapy defined for this case&#46; However&#44; it should be emphasized that the lack of recurrence on long-term follow-up is extremely rare for Brooke-Spiegler syndrome and the detected results are remarkable&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">As imiquimod requires extended treatment durations for trichoepitheliomas&#44; LAD can assist in decreasing the duration&#46; Another important consideration about this regimen is the lack of recurrence on long-term follow-up&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors&#39; contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Aysenur Botsali&#58; Approval of the final version of the manuscript&#59; Critical literature review&#59; Data collection&#44; analysis&#44; and interpretation&#59; Effective participation in research orientation&#59; Intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; Preparation and writing of the manuscript&#59; Study conception and planning&#46;</p></span><p id="par0060" class="elsevierStylePara elsevierViewall">Ercan Caliskan&#58; Approval of the final version of the manuscript&#59; Critical literature review&#59; Effective participation in research orientation&#59; Intellectual participation in propaedeutic and&#47;or therapeutic management of studied cases&#59; Manuscript critical review&#59; Study conception and planning&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&#44; year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type&#47;Patient number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration weeks &#40;wks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urquhart JL&#44; 2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MFT&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMI&#8239;&#43;&#8239;Tretinoin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#37; clearance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alessi SS&#44; 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BSS&#47;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Partial response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LoPiccolo MC&#44; 2011</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BSS&#47;1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient stated disease severity &#40;compared to baseline&#41; 10&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Er&#58; YAG laser&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Er&#58; YAG laser&#8239;&#43;&#8239;IMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Er&#58; YAG laser&#8239;&#43;&#8239;PDT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tu JH et al&#46;&#44; 2016</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MFT&#47;2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CO2 laser&#8239;&#43;&#8239;Sirolimus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited re-growth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sirolimus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Limited disease progression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Literature data on the topical treatment options of BSS&#47;MFT&#46;</p>"
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      "titulo" => "References"
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                    0 => array:2 [
                      "titulo" => "Comparing ablative fractionated resurfacing&#44; photodynamic therapy&#44; and topical imiquimod in the treatment of trichoblastomas of Brooke-Spiegler Syndrome&#58; a case study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Lopiccolo"
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                            2 => "D&#46;J&#46; Kouba"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2011.01907.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1050"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21388481"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Treatment of cutaneous tumors with topical 5&#37; imiquimod cream"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;S&#46; Alessi"
                            1 => "J&#46;A&#46; Sanches"
                            2 => "W&#46;R&#46; Oliveira"
                            3 => "M&#46;C&#46; Messina"
                            4 => "E&#46;R&#46; Pimentel"
                            5 => "C&#46; Festa Neto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:5 [
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                        "volumen" => "64"
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                      ]
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                  ]
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            ]
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of topical sirolimus in the management of multiple familial trichoepitheliomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;H&#46; Tu"
                            1 => "J&#46;M&#46;C&#46; Teng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Dermatol Ther"
                        "fecha" => "2017"
                        "volumen" => "30"
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              "identificador" => "bib0020"
              "etiqueta" => "4"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treatment of multiple trichoepitheliomas with topical imiquimod and tretinoin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;L&#46; Urquhart"
                            1 => "W&#46;L&#46; Weston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1525-1470.2005.22115.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Dermatol"
                        "fecha" => "2005"
                        "volumen" => "22"
                        "paginaInicial" => "67"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15660902"
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fractional laser as a tool to enhance the skin permeation of 5-aminolevulinic acid with minimal skin disruption&#58; a comparison with conventional erbium&#58;YAG laser"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46;R&#46; Lee"
                            1 => "S&#46;C&#46; Shen"
                            2 => "M&#46;H&#46; Pai"
                            3 => "H&#46;H&#46; Yang"
                            4 => "C&#46;Y&#46; Yuan"
                            5 => "J&#46;Y&#46; Fang"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1016/j.jconrel.2010.03.017"
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                        "tituloSerie" => "J Control Release"
                        "fecha" => "2010"
                        "volumen" => "145"
                        "paginaInicial" => "124"
                        "paginaFinal" => "133"
                        "link" => array:1 [
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
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Idiomas
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