{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T03:11:53Z","timestamp":1771902713612,"version":"3.50.1"},"reference-count":64,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,1,23]],"date-time":"2018-01-23T00:00:00Z","timestamp":1516665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Histological examination is the gold standard for actinic keratosis diagnosis; however, it is not always a feasible approach. Reflectance confocal microscopy (RCM) is a non\u2010invasive technique that may be an alternative for monitoring actinic keratoses treatment response. Topical 5\u2010fluorouracil is indicated for actinic keratosis multiple lesions and for field cancerization treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the RCM accuracy, sensibility and specificity for actinic keratosis, considering as a gold standard the histopathological examination; as well as to evaluate the efficacy of 5% 5\u2010fluorouracil treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a prospective study in actinic keratosis patients between August 2014 and November 2015. RCM analyses were performed in one randomly selected actinic keratosis lesion of the upper limbs by two independent observers before and after 5% 5\u2010fluorouracil treatment. At the end of treatment and with clinical bleaching of treated lesions, histological examination was performed by two pathologists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 50 lesions were enroled, and 40 lesions presented complete clinical bleaching after treatment and were included in the final analysis. Accuracy, sensibility and specificity means among observers were 83.8%, 84.6% and 83.3%, respectively. After 5\u2010fluorouracil treatment, actinic keratosis was diagnosed in 45.0% (observer 1) and 32.5% (observer 2) of subjects according to RCM and in 32.5% of subjects according to histological examination. Considering RCM observers diagnosis, the concordance was substantial (<jats:italic>k<\/jats:italic> 0.637, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). 5\u2010fluorouracil led to a reduction in 55.0%\u201367.5% of actinic keratoses according to RCM analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study allows to validate RCM as a non\u2010invasive method capable of monitoring actinic keratosis therapeutic response to 5\u2010fluorouracil, presenting efficacy comparable to histological examination. Additionally, the results suggest that 5\u2010fluorouracil may be a satisfactory option for therapeutic control of this condition.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.14716","type":"journal-article","created":{"date-parts":[[2017,11,25]],"date-time":"2017-11-25T01:46:39Z","timestamp":1511574399000},"page":"1155-1163","source":"Crossref","is-referenced-by-count":18,"title":["In vivo Confocal Laser Microscopy for monitoring of actinic keratosis treatment: a comparison with histopathologic assessment after treatment with topical 5% 5\u2010fluorouracil"],"prefix":"10.1111","volume":"32","author":[{"given":"P.","family":"Ishioka","sequence":"first","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo S\u00e3o Paulo SP Brazil"},{"name":"Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Maia","sequence":"additional","affiliation":[{"name":"Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.B.","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.F.","family":"Lellis","sequence":"additional","affiliation":[{"name":"Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.H.","family":"Hirata","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo S\u00e3o Paulo SP Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,1,23]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"CD004415","article-title":"Interventions for actinic keratoses","volume":"12","author":"Gupta AK","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2000.103342"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14852"},{"key":"e_1_2_6_5_1","unstructured":"Neittaanmaki\u2010PerttuN.Diagnosis and treatment of premalignant changes of photodamaged skin: Novel hyperspectral imaging and new therapeutical aspects University of Helsink;2015."},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0102-311X2009000500003"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.08267.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2012.09.052"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2000.103343"},{"key":"e_1_2_6_10_1","first-page":"1727","article-title":"A genetic explanation of Slaughter's concept of field cancerization: evidence and clinical implications","volume":"63","author":"Braakhuis BJ","year":"2003","journal-title":"Can Res"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2000.103339"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2009.02.022"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-0972"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2007.34117.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.141.4.507"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.1994.tb08544.x"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199310143291602"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-0960.1983.tb00256.x"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2012.1060"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.12282"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14516"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2013.2301"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000370148"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1159\/000254893"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14517"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2000.105565"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.07865.x"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-3083.2009.03410.x"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-1860"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.13445"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1590\/abd1806-4841.20153437"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.12434"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.12343"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.12.045"},{"key":"e_1_2_6_35_1","first-page":"330","article-title":"5\u2010fluorouracil: mechanisms of action and clinical strategies. Nature reviews","volume":"3","author":"Longley DB","year":"2003","journal-title":"Cancer"},{"issue":"2","key":"e_1_2_6_36_1","first-page":"4","article-title":"The use of topical fluorouracil to treat actinic keratosis","volume":"70","author":"Robins P","year":"2002","journal-title":"Cutis"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.3109\/09546634.2010.507704"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.3109\/09546630902789326"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(81)80196-X"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(01)80077-1"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(02)80012-1"},{"key":"e_1_2_6_42_1","first-page":"335","article-title":"Randomized trial evaluating a new 0.5% fluorouracil formulation demonstrates efficacy after 1\u2010, 2\u2010, or 4\u2010week treatment in patients with actinic keratosis","volume":"70","author":"Jorizzo J","year":"2002","journal-title":"Cutis"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.13180"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.08271.x"},{"key":"e_1_2_6_45_1","first-page":"651","article-title":"Development of a treatment algorithm for actinic keratoses: a European Consensus","volume":"18","author":"Stockfleth E","year":"2008","journal-title":"Eur J Dermatol"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-2539"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/1523-1747.ep12606215"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1747.1999.00690.x"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2014.04.067"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-016-2043-3"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2016.4354"},{"key":"e_1_2_6_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.13304"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.4103\/0301-4738.37595"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2077.172206"},{"key":"e_1_2_6_56_1","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2009.134"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-013-0023-y"},{"key":"e_1_2_6_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2007.01079.x"},{"key":"e_1_2_6_59_1","doi-asserted-by":"publisher","DOI":"10.3315\/jdcr.2015.1199"},{"key":"e_1_2_6_60_1","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2008.562"},{"key":"e_1_2_6_61_1","doi-asserted-by":"publisher","DOI":"10.1586\/14737167.2015.995171"},{"key":"e_1_2_6_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-016-0462-4"},{"key":"e_1_2_6_63_1","first-page":"1","article-title":"The cost\u2010effectiveness of 5\u2010FU\u2010SA in the treatment of actinic keratoses of the face and scalp in the UK secondary care setting","volume":"20","author":"Wojcik R","year":"2016","journal-title":"J Medical Econ"},{"key":"e_1_2_6_64_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra022137"},{"key":"e_1_2_6_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2009.04045.x"}],"container-title":["Journal of the European Academy of Dermatology and Venereology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjdv.14716","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdv.14716","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T20:58:20Z","timestamp":1694984300000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jdv.14716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,23]]},"references-count":64,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1111\/jdv.14716"],"URL":"https:\/\/doi.org\/10.1111\/jdv.14716","archive":["Portico"],"relation":{},"ISSN":["0926-9959","1468-3083"],"issn-type":[{"value":"0926-9959","type":"print"},{"value":"1468-3083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,23]]}}}