Aesthetic medicine blog

Knowledge of Photodynamic Therapy helps to understand how light damages people with porphyrias and the importance of protecting themselves from it.

One afternoon, while I was in consultation, a young patient came to see me with his father. The patient had a porphyria, a strange disease, but after chatting with them, I realized that my years of dedication to photodynamic therapy could help these patients. And this is the reason why I write this text on my blog. I hope you find it useful.

Porphyrias are rare diseases and are characterized by a exaggerated photosensitivity (sun damage).

Dermatologists have “copied” this mechanism in Photodynamic therapy (PDT) to produce phototoxicity located in tumor and momentary lesions, which, by applying an adequate light source, allows us to destroy tumors selectively and without surgery.

We achieve this photosensitization by applying creams that produce accumulation of protoporphyrin IX (PpIX) in the selected cells. PpIX is the actor in question and the substance that causes intracellular damage in patients with porphyria.

These patients suffer in their cells from alteration in the porphyrin synthesis pathway, a pathway comprising several steps, which when altered at the end of the pathway, lead to accumulation of PpIX and nearby metabolites.

This accumulation causes pain in the skin with exposure to the sun (“freezing fire in the skin”), itching, redness, blisters, edema and even loss of substance in severe forms. These symptoms can also appear with artificial lights.

What are porphyrias and why do they occur?

The porphyrias are a group of at least nine genetic metabolic disorders described in the heme synthesis pathway. Heme is half of hemoglobin, along with globin. This molecule is responsible for transporting oxygen in the blood within the red blood cell or erythrocyte.

The heme group is synthesized partly in the liver and partly in the erythrocyte, which is why porphyrias are classified, depending on the mechanism that is altered, into hepatic and erythropoietic (erythrocytes or red blood cells).

In addition there are porphyrias not genetic, acquired due to liver failure or toxicity (1). A well-known one is the taking of oral tetracyclines (antibiotics) in some very susceptible patients.

Classification of porphyrias according to the organ in which abnormal porphyrins are synthesized

• Erythrepoietic
  • Congenital erythropoietic porphyria (CEP)
  • Erythropoietic protoporphyria (EPP)
• Hepatic
  • Preliminary cutaneous porphyria (PCT)
  • Hematoerythropoietic porphyria (HEP)
  • Porphyria variegata (PV)
  • Hereditary coproporphyria (CPH)
  • Acute intermittent porphyria (AIP)
  • Porphyria due to ALA dehydratase deficiency (Pd-ALAD)

How common are porphyrias?

Porphyrias are considered rare diseases. In the United States, they impact fewer than 200,000 people.

In Europe, the prevalence of the three most common forms of porphyria, cutaneous Tarta, acute intermittent and erythropoietic, is 1 in 10,000, 1 in 20,000 and 1 in 75,000, respectively.

Congenital erythropoietic porphyria, also called Günther's disease, is extremely rare, with an incidence of approximately 1 per million inhabitants.

the Nework European porphyria , a highly recommended page if you want to delve deeper into the topic and look for porphyria specialists in Europe, estimates about 335 patients diagnosed in 3 years in 11 countries (1,2).

How does a porphyria manifest?

Photosensitivity occurs in all porphyrias except acute intermittent porphyria and ALA dehydratase deficiency porphyria. This photosensitivity manifests itself in two ways (1):

• Acute photosensitivity syndrome: This is pain, burning sensation and itching with sun exposure. Then redness and edema of the skin appear, like a disproportionate sunburn. This image is due to the accumulation of PpIX in the cells.
• Skin fragility syndrome: It is not so acute, it is latent, and it is the appearance of erosions, blisters and cysts on the skin with minimal trauma or sun exposure.

Is there a common mechanism in porphyrias and photodynamic therapy?

Yes it exists. In a study made public in 2016 on neuron cultures, they discovered that the common mechanism is through ion channels (TRPA1 and TRPV1) that produce cellular damage through the activation of PpIX with ultraviolet and blue light (3).

They thus suggest the therapeutic opportunity of using medications that block these channels to prevent pain from sun exposure and skin damage

How is porphyria diagnosed?

The diagnosis is made under suspicion of symptom of the patient and determination of porphyrins in blood, urine or feces.

PpIX fluoresces when it accumulates in cells, and if we illuminate with a wood light or black light, widely used for diagnosis in dermatology, patients' teeth are fluorescent red (erythrodontics).

This is exactly the method we use to confirm that PpIX has accumulated in the cells we want when we do Photodynamic Therapy and we call it: “Fluorescence Diagnostics” (4). See next image:

This image shows a basal cell epithelioma and how after inducing protoporphyrin IX inside, when illuminated with Wood's light, red-pink fluorescence can be seen due to its accumulation.

How can PpIX activation and porphyrin skin damage be avoided?

To understand it better I explain it in the following image:

The top part shows the spectrum of electromagnetic radiation, where we can see as the wavelength increases:

A) Ultraviolet light

Which damages the skin and produces cancerous and precancerous lesions. It's divided in:

1. Ultraviolet A (UVA): the one that makes us brown. 400 to 315 nanometers (nm)

two. Ultraviolet B (UVB): the one that burns us and more related to skin cancer. From 315 to 280 nm.

3. Ultraviolet C (UVC): 280 to 100 nm. It is not good either, but due to its wavelength it reaches the ground little and penetrates the skin little.

B) Visible spectrum

What we see, the colors. It's a variety.

1. blue: 380 to 427 nm.

two. Green: from 497 to 570 nm.

3. Yellow: 570 to 580nm.

Four. Red: From 600 to 780 nm.

C) Infrared

1. Above 800 nm, it no longer acts as a source of photostimulant.

Below is the absorption spectrum of protoporphyrin IX (PpIX), which is divided into:

A) Soret Band

The most toxic, because it is the highest on the graph. In the ultraviolet range.

B) Four Q bands

Less toxic, ranging from blue to red.

When does light cause the most damage in people with porphyrias?

The damage that porphyrin causes to the skin when exposed to the sun occurs mainly when the PpIX matches (5,6):

• The ultraviolet range and the blue range: is the most toxic (around 400-420 nm)
• Red light: 600-630nm: Why else is he in a less toxic band? Because the longer the wavelength, the greater the penetration into the skin. Red light penetrates 1 to 2 mm into the skin and thus does more damage than green or yellow light when there is a buildup of ppIX.

Conclusions: importance of protection against sunlight and other sources

The last line shows how Sunscreens blocking the electromagnetic spectrum. With this we now reach the two main conclusions of how NOT to activate PpIX:

TO) You should use a physical-chemical sunscreen (most on the market) or pure physical, protects from the entire spectrum. It is essential to verify that we are not using a chemical-only filter.

B) Other light sources can promote the PpIX, with lower intensity but reminiscent of LED lights (television, lamps), the light that passes through the window (mostly UVA) or other light exposures. They are mild, but added together they can activate PpIX.

I hope I have not been too technical and have reached the readers. I understand that knowledge of the mechanism is essential, since in general dermatologists insist on protection against ultraviolet rays, but in the case of porphyrias it is somewhat more complicated.

References

1 Ramanujam V. Diagnosis of porphyria-Part 1: A brief description of the porphyrias. Protocols Curr Hum Genet 2015; 86: 1-26.

2 www.porphyria.eu

3 Babes et al. Photosensitization in porphyrias and photodynamic therapy involves TRPA1 and TRPV1. J Neurscience 2016; 36: 5264-5278.

4 Fernández-Guarino M. Retrospective, descriptive, observational study of the treatment of various actinic keratoses with topical methyl aminolevulinate and red light: results in clinical practice and correlation with fluorescence imaging. Actas Dermosifiliogr 2008; 10: 779-787.

5 Heerfort IM. Noninvasively measured skin protoporphyrin IX predicts photosensitivity in patients with erythropoietic protoporphyria. BJ Dermatol 2016; 175: 1284-1289.

6 Teramura T. Prevention of photosensitivity with protection adapted to the spectrum of action for erythropoietic protoporphyria. J Dermatol 2018; 45: 145-149.

Learn some tips on skin care during chemotherapy focused on addressing the most common skin side effects.

Cancer treatment is a medical and research challenge. The chemotherapy Traditionally, it works by inhibiting phases of the cell cycle of cancer cells, but it can also affect healthy cells. The skin is one of the organs most affected, with the possible appearance of dermatitis, rashes, canker sores, spots, nail alterations and other injuries.

Conventional or traditional chemotherapy continues to be used to control tumors. Advances in cancer treatment and patient survival make it necessary for clinicians to know how to manage chemotherapy reactions on the skin and advise patients. In the following text I present some guidelines for managing side effects and skin care during chemotherapy.

Skin Side Effects of Chemotherapy

The classification of cutaneous side effects of chemotherapy is standardized by the National Cancer Institute's Common Terminology Critherapy for Adverse Events (CTCAE) (1) in a common tool for all side effects of chemotherapy and that allows unifying the evaluation of performed by oncologists, dermatologists, nurses and other clinicians (available clicking here and summarized in Table I). These effects they do not always occur, this is a classification of all possible skin conditions when a patient is treated with chemotherapy (2).

The majority of chemotherapy reactions on the skin are managed in oncology services, who are aware of its effects and with nursing professionals specialized in them. Only occasionally they notify the dermatologist, when the skin lesions cause diagnostic doubts or when they are more severe or do not respond to the usual treatments. In the following text I will explain the most frequent effects and general advice for their management (3). Alopecia due to chemotherapy would be its own content due to its entity, so in this text I will only address the effects on the skin.

Dermatologists study these effects and skin care during chemotherapy, since the priority in these patients is the response of the tumor to the treatments received, which means that sometimes, we are “companions” during the process.

Side effects and skin care during chemotherapy

1. Dry skin or cutaneous xerosis

It is one of the most common side effects of chemotherapy on the skin. The creams that I usually recommend to alleviate it are emollients and fats, with soothing and anti-inflammatory substances (calamine, vitamin PP, oats, omegas, etc.). The prototype of creams would be those used for children with atopic dermatitis, although there are specific lines on the market studied for oncology patients.

Some moisturizing creams contain keratolytic agents, which are added to also treat peeling. Above all, urea is used in concentrations from 3 to 30%, and lactic acid, salicylic acid and even glycolic acid can also be used. I recommend trying them first in low concentrations, as they are especially useful on dry skin with slight peeling, but at high concentrations they can cause irritation and itching on sensitive skin.

It is also important to use anti-aging facial care with caution, since very common substances in these products can irritate, such as retinoic acid or retinol, glycolic acid and other alpha and beta-hydroxy acids. Perhaps the most appropriate thing is to use “anti-aging” substances such as vitamin C, vitamin B3 or B5, melatonin, hyaluronic acid, resveratrol or coenzyme Q10 for the face, which have a low potential to irritate.

Regarding washing the skin, you can opt for shower oils or “soapless soaps” or “syndet” that moisturize the skin during the shower.

2. Pruritus or itchy skin

Itchy skin during chemotherapy can be due to several causes, including the drugs it contains. I emphasize that in this case we are talking about itching without lesions on the skin, when itching appears on the skin with lesions the treatment is that of the lesions. The approach, in my opinion, is to achieve skin that is as comfortable and hydrated as possible, with the measures in the previous point.

In addition, you can use hydrating or soothing baths, effective at night, when the skin tends to itch the most, to facilitate a night's rest, and oral antihistamines. Antihistamines are simple treatments that serve to relieve itching, and if they are sedative, facilitate sleep. There are more powerful oral treatments (in pills) and also anti-itch creams and you can even apply corticosteroid creams to the most itchy areas.

3. Dermatitis and eczema

Intense dryness of the skin and other added factors, such as chemotherapy or some irritant, can produce true inflammation of the skin, in the form of dermatitis and eczema. Management is with emollients or moisturizing creams that do not sting; it may be necessary to use pure Vaseline for a few days to avoid stinging. Corticosteroids in cream are added twice a day, which are effective in controlling dermatitis. In severe or extensive cases, oral corticosteroids and oral antihistamines can be added to control itching.

The measures on skin care during chemotherapy in points 1 and 2 are applicable in patients with dermatitis as well.

4. Thrush or mucositis

The appearance of thrush or mucositis during chemotherapy cycles has a significant impact, since it causes a lot of discomfort and makes eating difficult, in these patients where maintaining general condition is important (5). The term mucositis refers to inflammation of the mucous membranes, the most frequently affected is the oral mucosa, and it can also occur in the genitals.

Mucositis subsides in a few days and in the meantime, it can be treated with mouthwashes with anti-inflammatories (tetracyclines, corticosteroids) and anesthetics. Its management consists of relieving the patient. Anesthetics in the mouth can also be applied before eating, to avoid pain and facilitate feeding. There are also mouthwashes that moisturize the mucosa, and hyaluronic acid gels and other components to apply directly to canker sores. They act by protecting the skin and promoting healing. The patient must be monitored and if it is more intense or does not resolve with treatment, it could be a fungal superinfection or, more rarely, a herpes virus.

There is clearly no way to prevent this adverse effect, keeping the mucosa hydrated and vitamin supplements, especially A, important for the mucosa, could be used.

5. Alterations in the nails

Fragmentation, lines and striations (onycholysis) may appear in the nails during chemotherapy. It has been described with chemotherapy drugs such as taxanes, cyclophosphamide, doxorubicin, capecitabine, etoposide and 5-fluorouracil (2,3,5). For its management, it is advisable to avoid irritants to the nails, such as frequent contact with water and trauma. To carry out household chores, you can use plastic gloves with cotton gloves underneath (they are special and are found in pharmacies).

Manicures should be avoided and nails should be kept short. Moisturizing the nails and the periungual area benefits the nails, and you can use general moisturizing creams or specific nail care creams, also in the form of specific polishes (not coloring nail lacquer polishes). This side effect can be prevented by using cold gloves during the chemotherapy infusion, which produce vasoconstriction and reduce the arrival of the chemotherapy to the nail matrix.

Sometimes what occurs is a darkening of the nail (hyperpigmentation), as occurs with 5-Fluorouracil, taxanes, cyclophosphamide, doxorubicin and capecitabine (1,2). This pigmentation can appear in bands or diffusely on the nail plate. This is a side effect that does not require treatment and does not cause discomfort. It persists months after finishing chemotherapy and disappears with the progressive growth of the nail.

Rarely, the alterations produced by chemotherapy in the nails predispose to infection of the nail itself or the surrounding area (perionyxis). In this case, management by a dermatologist may be required and sometimes a culture may be performed to identify the infectious agent and be able to treat it.

6. Hyperpigmentation or appearance of spots on the skin

The appearance of spots on the skin and mucous membranes secondary to chemotherapy has a very varied clinical expression. It may be diffuse, with a tanned appearance, mottled, flagellated (lashed), serpentine, only in areas of flexion, or on the palms and soles (2,3).

It does not require treatment and subsides only months after finishing treatment. As general measures, within skin care during chemotherapy, sun protection is indicated in these patients and anti-blemish cosmetics can be used to treat and prevent their appearance. Hypothetically, pigment lasers could also be useful, and there is little about this use, remember that it is to treat an asymptomatic dermatosis that resolves on its own.

7. Photosensitivity

This is an exaggerated reaction to ultraviolet light from the sun and has been infrequently described with 5-Fluorouracil, Tegafur or Capecitabine (3). Erythema (redness) and intense inflammation occur in the area exposed to the sun. By default and to also avoid hyperpigmentation (spots), patients undergoing chemotherapy are protected from the sun and are encouraged to use sunscreen.

The recommended sunscreens are a factor 30 or higher, and use them before sun exposure. Let us remember that the sun protection index (SPF) measures only protection against ultraviolet radiation, which is responsible for phototoxic reactions. If we also want to protect ourselves from spots (hyperpigmentation), we must choose a filter that includes UVA protection, and if it also includes visible light, we protect ourselves from all light options that can darken the skin.

9. Palmar-plantar erythrodysesthesia

Also called hand-foot syndrome or acral erythema (4). It has been described with Capecitabine, doxorubicin, cytarabine, 5-fluorouracil and taxols (2,3,5). It consists of the appearance of a tingling sensation that can progress to burning in the palms and soles. Sensitivity to temperature and pain may be decreased and is accompanied by redness and swelling of the hands, and sometimes peeling. Erythrodysesthesia affects the palms more frequently than the soles and its severity varies.

To prevent the appearance of erythrodysesthesia, the way chemotherapy is administered is controlled by oncologists, and urea creams, non-steroidal anti-inflammatory drugs (NSAIDs) and hand cooling can be used during the chemotherapy infusion.

When it appears, treatment with powerful corticosteroids, local cold water compresses, and anti-inflammatories can be used. Other options are oral or topical calcium antagonists, anti-inflammatory COX-2 inhibitors, oral pyridoxine or topical heparin (2-4).

10. Maculopapular rash

This is a generalized rash from the treatment. It is common to any drug, and is treated according to its severity. Emollient creams, oral corticosteroid creams and oral antihistamines can be used for itching. In general, they are temporary and do not require discontinuation of treatment.

As part of skin care during chemotherapy, you can try to prevent these reactions by administering premedication before receiving the chemotherapy cycle, which includes antihistamines and oral corticosteroids (3).

To end and again, I would like to emphasize that this text is a transversal approach to all the possible effects of chemotherapy treatments and that They do not all occur at the same time with the same treatment. Prevention and treatment of chemotherapy side effects is essential in patients to avoid avoidable changes in administration protocols.

*On the other hand, if you are receiving radiotherapy, I recommend reading this article.

I hope it is useful to you.

References

1. https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm

2. Cury-Martins J, Eris APM, Abdalla CMZ, Silva GB, Moura VPT, Sanches JA. Management of dermatologic adverse events from cancer therapies: recommendations of an expert panel. An Bras Dermatol. 2020; 95:221-237.

3. Reyes-Habito CM, Roh EK. Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: part I. Conventional chemotherapeutic drugs. J Am Acad Dermatol. 2014;71: 203. e1-203.e12; perhaps 215-6.

4. Miller KK, Gorcey L, McLellan BN. Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management. J Am Acad Dermatol. 2014; 71:787-94.

5. Balagula Y, Rosen ST, Lacouture ME. The emergence of supportive oncodermatology: the study of dermatologic adverse events to cancer therapies. J Am Acad Dermatol. 2011 Sep; 65:624-635.

Conozca varios consejos sobre el cuidado de la piel durante la radioterapia, basados ​​en la literatura científica, que pueden ayudarlo.

the radiotherapy es un tratamiento aplicado en cáncer. Usa los rayos X del espectro electromagnético para tratar tumores. Su intensidad se mide en grises (Gy), que es la radiación necesaria para depositar 1 Joule de energía en 1 kilo de materia.

La oncología radioterápica ha experimentado una gran evolución en los últimos años y cada vez es menos habitual que se produzcan reacciones cutáneas graves o que el propio radioterapeuta no maneje (1,2). No obstante, su prevención y su tratamiento es un reto para el médico.

Las reacciones cutáneas a la radioterapia o radiodermatitis son un efecto secundario muy común del tratamiento y aparecen hasta en el 95% de los pacientes tratados (1,2). Este tipo de reacciones se dividen en agudas, que aparecen durante el tratamiento, y crónicas, que se manifiestan como secuelas. En el siguiente texto sobre el cuidado de la piel durante la radioterapia, abordo las reacciones cutáneas a esta terapia oncológica, así como su tratamiento y prevención.

1. Tipos de reacciones cutáneas a la radioterapia o radiodermatitis, ¿qué le hace la radioterapia a la piel?

the quemaduras agudas La radioterapia o radiodermatitis aguda se produce en los primeros días o semanas de tratamiento. Al comienzo de la irradiación de la piel, la zona tratada se torna eritematosa (“enrojecida”), y es a partir de la segunda semana que, al mismo tiempo de la eritema, xerosis cutánea (sequedad), hiperpigmentación (piel oscura) descamación y caída del cabello (1,2).

A veces, el daño puede ser más profundo y afectar la dermis, produciendo úlceras y ampollas que necesitan pausar el tratamiento.

La radiodermatitis se clasifica según su gravedad en grados que van del 1 al 3, siendo el 3 el más grave y en el que aparecen ulceraciones en la piel (2). Los carcinomas en los que aparece con mayor frecuencia son en madre, en el de vulva o en los de cabeza y cuello.

La llamada, radiodermatitis crónica, incluye el daño provocado por la radioterapia más allá de los 90 días. Estos cambios incluyen adelgazamiento de la piel (atrofia dérmica), endurecimiento (fibrosis), pigmentación y cambios vasculares (telangiectasias).

2. ¿Por qué ocurren las quemaduras en la piel?

Cada vez es menos habitual Dejemos que los dermatólogos veamos radiodermatitis. La mayoría de los pacientes tratados con radioterapia moderna reciben a diario dosis bajas de radiación, el objetivo del tratamiento es dañar el tumor y tratar de respetar el tejido sano (2).

Podemos decir que el riesgo de quemadura por radioterapia depende de la dosis radiación utilizada (mayor riesgo en dosis altas) y factores de la propio paciente. Al mismo tiempo, cuando el tumor diana de la radiación está más cerca de la piel, más superficial, es más probable que se dañe la piel (2). El uso de radiación superior a 2 Gy, utilizar creams Antes de recibir radioterapia, el uso concomitante de chemotherapy o su aplicación en piel delgada (cara, cuello, escote), puede incrementar el riesgo de radiodermatitis (1).

3. Cuidado de la piel durante la radioterapia: ¿Cómo prevenir quemaduras?

Las medidas generales sobre el cuidado de la piel durante la radioterapia se resumen en la Tabla I. La prevención de quemaduras por radioterapia es difícil y no existe un protocolo establecido (4). Las recomendaciones generales incluyen llevar ropa suelta y aireada en el área tratada y hidratar la piel con cremas emolientes o regeneradoras.

Tambien es conveniente evitar el calor o el frío extremos en el área de radioterapia y exposición solar. De especial interés es el melatonina tópica, tema de una entrada completa en Madriderma. La melatonina puede formularse en concentraciones del 0,5% y aplicarse desde días antes de que se haya descubierto que la radioterapia es capaz de disminuir la intensidad de la radiodermatitis.

the Trolamina es un antiinflamatorio no esteroideo que además se ha utilizado para tratar la radiodermatitis de forma eficaz, que es equivalente en estudios al cremas calmantes (dos). los corticosteroides tópicos Son un tratamiento clásico para disminuir la inflamación de la piel y seguro que son eficaces, aún cuando apenas existen estudios en radiodermatitis.

En estudios experimentales se ha comprobado la capacidad de algunas enzimas hidrolíticas para disminuir la inflamación producida por la radioterapia y que los inhibidores del factor transformante beta (FG-beta), implicados en el procedimiento de curación, son capaces de disminuir la fibrosis (1).

4. ¿Cómo puedo lavar mi piel tratada con radioterapia?

La mayoría de los autores recomiendan lavar la zona con jabón suave y agua tibia (1,2,3). Estos lavados se usan para disminuir la picazón o el malestar en el área tratada. El jabón recomendado debe tener un PH neutro o ser hidratante, como los aceites de ducha o syndet.

5. ¿Qué cremas puedo utilizar para tratar la radiodermatitis?

Cremas emolientes, hidratantes, calmantes, antiinflamatorias y repetitivas o regeneradoras. Deben evitarse las cremas hidratantes que contengan principios activos como urea, ácido salicílico o láctico que puedan irritar la piel. Tampoco se recomiendan las cremas que contengan retinoles, alfa o beta hidroxiácidos, presentes a modo de ejemplo en cremas anti-envejecimiento o anti-envejecimiento. No se deben aplicar exfoliantes ni peelings en el área.

Rosenthal y Cols (3) hacen público un buen resumen de los principios que se pueden usar en las cremas en la revista de la Academia Estadounidense de Dermatología, que resumo a continuación:

Verduras, naturales

• Caléndula: planta con propiedades cicatrizantes y antiinflamatorias.

• Catequinas: un grupo de compuestos fenólicos que se encuentran en el coco, el té y los arándanos.

• Aloe vera: una hierba antiinflamatoria natural que se usa para proteger la piel de las irritaciones, incluida la radiodermatitis.

• Manzanilla: un clásico como tratamiento a pesar de que no existen estudios que demuestren su eficacia en la radiodermatitis.

Vitaminas en crema

• Vitamina C, ácido pantoténico (vitamina B5).

Agentes endógenos (propios del organismo)

• Ácido hialurónico, preparado con factor de crecimiento epidérmico (EGF) o con melatonina.

6. Cuidado de la piel durante la radioterapia: ¿Cómo se trata la radiodermatitis?

El objetivo del tratamiento de la radiodermatitis aguda es fomentar un entorno óptimo para la cicatrización y repetición de la piel dañada. los limpieza de la herida es imprescindible y debe ser diario, con suero o agua y jabón.

En quemaduras agudas, con solución de continuidad, apósitos hidrocoloides o hidrogeles han probado ser útiles. Promueven la cicatrización de la piel sin dañarla y alivian el dolor al proporcionar una capa protectora sobre ella (1).

Existe el riesgo de que la quemadura se sobreinfecte con bacterias, aún cuando no está indicada la prevención rutinaria de la infección. Cuando se sospecha, se pueden utilizar antibióticos en crema en las curas o cambiar los apósitos por parches plateados que sean antibacterianos.

7. Reacciones dermatológicas a la radioterapia que no son radiodermatitis.

Volver a llamar o volver a llamar fenómeno

Este curioso fenómeno puede aparecer en la piel años luego de recibir radioterapia y puede pasarse por alto. Se trata de que en la zona tratada, la inflamación vuelve a aparecer al exponerse a algún fármaco. El tratamiento se trata de suspender la medicación y prescribir corticosteroides tópicos (2).

Morfea inducida por radiación

Ocurre en raras ocasiones y se trata de la aparición de una placa de morfea en la zona tratada meses o años luego de recibir el tratamiento. La morfea es una dermatosis que se trata de la aparición de una placa eritematosa (“roja”, que después se endurece ligeramente con un aspecto fibroso.

Cancer

En el campo tratado se puede aumentar el riesgo de padecer un carcinoma basocelular, carcinoma epidermoide o angiosarcoma años luego.

Conclusiones sobre el cuidado de la piel durante la radioterapia

En la actualidad, no existe una pauta homogénea para el tratamiento y prevención de la radiodermatitis, pero no obstante, son cada vez menos graves y menos frecuentes debido a los avances de la oncología radioterápica.

Por otra parte, si está recibiendo quimioterapia, le recomiendo que lea este post.

References

1. Hegedus F, Mathew LM, Schwartz RA. Dermatitis por radiación: una descripción general. Int J Dermatol. 2017 Sep; 56 (9): 909-914. doi: 10.1111 / ijd.13371. Publicación electrónica 6 de agosto de 2016 PMID: 27496623.

2. Leventhal J, joven señor. Dermatitis por radiación: acreditación, prevención y manejo. Oncología (Williston Park). 15 de diciembre de 2017; 31 (12): 885-7, 894-9. PMID: 29297172. Disponible en el siguiente link: https://www.cancernetwork.com/view/radiation-dermatitis-recognition-prevention-and-management

3. Rosenthal A, Israilevich R, Moy R. Manejo de la dermatitis aguda por radiación: revisión de la literatura y iniciativa de algoritmo de tratamiento. J Am Acad Dermatol. 2019 agosto; 81 (2): 558-567. doi: 10.1016 / j.jaad.2019.02.047. Publicación electrónica 22 de febrero de 2019 PMID: 30802561.

4. Ferreira EB, Vasques CI, Gadia R, Chan RJ, Guerra EN, Mezzomo LA, De Luca Canto G, Dos Reis PE. Intervenciones tópicas para prevenir la dermatitis aguda por radiación en pacientes con cáncer de cabeza y cuello: una revisión sistemática. Atención de apoyo al cáncer. 2017 Mar; 25 (3): 1001-1011. doi: 10.1007 / s00520-016-3521-7. Publicación electrónica del 12 de diciembre de 2016 PMID: 27957620.

Conoce en qué se diferencian los cosméticos japoneses de los occidentales, qué concepto de belleza disponen en Japón, cuáles son sus productos estrella y qué seguridad ofrecen.

Los cosméticos que utilizamos forman parte de nuestro cuidado personal. Son sobre todo utilizados por las mujeres para cuidarse y verse mejor.

Hábitos japoneses en cosmética, ¿en qué se diferencian de los occidentales?

Parece que los hábitos japoneses con respecto al uso de cremas son bastante correctos. En un estudio que se realizó mediante encuestas a la población femenina, se encontró que prácticamente todas usaban lociones o emulsiones limpiadoras y la mayoría de ellos al menos tres productos para el cuidado facial (1).

Su conocimiento del uso de protección solar, diariamente por prácticamente todas las mujeres japonesas encuestadas, inclusive varias veces al día. Recordemos que las geishas se han pintado el rostro de blanco durante siglos para alcanzar una apariencia de porcelana en sus rostros. Las mujeres japonesas además usan a menudo otros productos como mascarillas, bases en polvo, maquillaje, rímel, espumas limpiadoras y brillo de labios.

¿Cuál es el concepto de belleza en Japón? ¿Qué buscan en su piel?

El concepto de belleza es subjetivo y se ha intentado medir en numerosos estudios, intentando establecer qué se contempla atractivo en caucásicos, asiáticos o africanos. En general, el caras proporcionales y ovaladas, que disponen rasgos étnicos (2). En el sudeste asiático, el piel facial extremadamente pálida y los cosméticos que usan reflejan ese deseo con el uso de cremas anti-imperfecciones y protección solar.

En cuanto a los procedimientos cosméticos como mínimo invasivos (toxina botulínica, rellenos de ácido hialurónico o láser), en Japón y Asia, del mismo modo que en Occidente, se buscan armonizar el rostro, mejorar la calidad de la piel y mejorar las líneas de transición áspero en el rostro manteniendo sus rasgos étnicos (3).

¿Cuáles son los productos faciales estrella de la cosmética japonesa?

Máscaras tipo “hoja impregnada”

En varias capas o en una, con productos hidratantes, antioxidantes, son muy característicos de la cosmética japonesa y se han extendido a Occidente. Se aplican dejándolas actuar unos minutos posteriormente de la limpieza o masaje.

Masaje facial vertical o masaje Kobido

Existen algunos trabajos publicados de esta costumbre tradicional de las mujeres japonesas de realizar automasaje y masajes al aplicar cremas de tratamiento facial. Se ha descubierto que estos masajes estimulan el sistema nervioso parasimpático produciendo un efecto relajante en los músculos de la cara (4). Estudios “in vitro” en piel humana (“ex vivo”) han demostrado que masajear el rostro con cremas de tratamiento cosmético aumenta su eficacia (5).

La cuestión de si los masajes faciales verdaderamente inducen cambios en la forma del rostro es razonable, y para esto Nishimura et al (6) desarrollaron un sistema de tomografía tridimensional que aplicaron para estudiar los efectos del masaje facial en 12 mujeres sanas.

Estos autores encontraron que el masaje facial era capaz de producir cambios morfológicos en diversos localizaciones del rostro, sobre todo en el tercio inferior del rostro, sugiriendo que la zona de tejido subcutáneo alrededor de la mandíbula es sobre todo sensible a este tipo de terapia.

Algunos dermatólogos, a pesar de todo, no están a favor de estos tratamientos de “cabina”, aludiendo a que los beneficios son subjetivos y que pueden aparecer problemas retardados como dermatitis (irritación cutánea) o acné (7).

Seguridad de los cosméticos japoneses, ¿disponen la misma legislación?

Los parámetros que evalúan la seguridad de las cremas o cosméticos se basan en su capacidad para provocar dermatitis o irritación. En Europa y en Estados Unidos existen agencias estatales para velar por los cosméticos. Japón, a pesar de todo, no realizó esta verificación en sus cosméticos, que se basan en datos de Europa.

Con la globalización, donde los productos cosméticos se intercambian fácilmente entre países, era necesario que Japón proporcionara datos de tolerancia en el origen y un etiquetado correcto, puesto que los componentes permitidos en algunos países pueden no estar permitidos en otros (1). A tal efecto, la ley avanza, pero detrás del europeo donde, al mismo tiempo, a diferencia de Japón, la experimentación en animales con cosméticos está prohibida desde 2013 (8).

Podemos concluir que la cosmética japonesa se adapta progresivamente a la ley mundial más exigente con los mismos objetivos de preservar la piel de aspecto joven, sobre todo la piel de aspecto claro y sin imperfecciones. De especial interés es su uso de cremas cosméticas, con la característica aplicación de mascarillas y masajes faciales como parte de su rutina cosmética diaria.

References

1. Yamaguchi M, Araki D, Kanamori T, Okiyama Y, Seto H, Uda M, Usami M, Yamamoto Y, Masunaga T, Sasa H. Cantidad de consumo real de productos de cuidado personal que reflejan los hábitos cosméticos japoneses. J Toxicol Sci 2017; 42 (6): 797-814. doi: 10.2131 / jts.42.797. PMID: 29142178.

two. Chan IL, Cohen S, da Cunha MG, Maluf LC. Características y manejo de la piel asiática. Int J Dermatol. 2019 Feb; 58 (2): 131-143. doi: 10.1111 / ijd.14153. Publicación electrónica 24 de julio de 2018. PMID: 30039861.

3. Liew S, Wu WT, Chan HH, Ho WW, Kim HJ, Goodman GJ, Peng PH, Rogers JD. Consenso sobre tendencias, actitudes y conceptos cambiantes de la belleza asiática. Estética Plast Surg. 2016 Abr; 40 (2): 193-201. doi: 10.1007 / s00266-015-0562-0. Publicación electrónica 25 de septiembre de 2015. PMID: 26408389; PMCID: PMC4819477.

Four. Sakai S, Takatori R, Nomura M, Uehara K. Parámetros útiles para el análisis del movimiento del cuidado de la piel facial en mujeres japonesas. J Physiol Anthropol. 2020 24 de agosto; 39 (1): 22. doi: 10.1186 / s40101-020-00234-w. PMID: 32831147; PMCID: PMC7507946.

5. Caberlotto E, Ruiz L, Miller Z, Poletti M, Tadlock L.Efectos de un dispositivo de masaje cutáneo sobre la expresión ex vivo de proteínas de la dermis humana y arrugas faciales in vivo. Más uno. 2017 1 de marzo; 12 (3): e0172624. doi: 10.1371 / journal.pone.0172624. PMID: 28249037; PMCID: PMC5383004

6. Nishimura H, Okuda I, Kunizawa N, Inoue T, Nakajima Y, Amano S. Análisis de cambios morfológicos posteriormente del masaje facial a través de un enfoque disruptivo a través de tomografía computarizada tridimensional. Skin Res Technol. 2017 agosto; 23 (3): 369-375. doi: 10.1111 / srt.12345. Publicación electrónica del 22 de noviembre de 2016 PMID: 27878850.

7. Khanna N, Datta Gupta S. Masaje facial rejuvenecedor: ¿una perdición o una bendición? Int J Dermatol. 2002 julio; 41 (7): 407-10. doi: 10.1046 / j.1365-4362.2002.01511.x. PMID: 12121555.

8. Inomata S. Garantía de seguridad de los cosméticos en Japón: situación actual y perspectivas futuras. J Oil Sci. 2014; 63 (1): 1-6. doi: 10.5650 / jos.ess13501. PMID: 24389794.