الفهرس 
INTRODUCTION and Aim of the work.Only 14 pages are availabe for public view
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Abstract
Introduction: Solar keratosis is a hyperkeratotic lesion occurring in sun-exposed skin, which carries a low risk of progression to invasive squamous cell carcinoma. Solar lentigo is circumscribed brown pigmented macule occurring singly or as multiple lesions, on sun-exposed skin, after acute or chronic sun exposure. Solar keratosis or solar lentigo has various forms of treatment. Aim or work: The present work aims to compare different modalities for treatment of either solar keratosis or solar lentigines as regard their efficacy, side effects, and patient tolerability in order to determine the most preferable method of treatment for either solar keratosis or solar lentigines. Patients and Methods: This study was carried out on 39 patients of either sex (21 patients have solar keratosis and 18 patients have solar lentigines). Solar keratosis patients were randomly arranged in three groups: Group I: treated with 5-fluorouracil 5% cream applied twice daily for 4 weeks. Group II: treated with cryosurgery for one sitting for each patient. Group III: treated with dermabrasion, using diamond fraises, for one sitting for each patient. Solar lentigines patients were randomly selected and divided into two groups: Group IV: treated with topical tretinoin 0.05% cream applied once nightly for 6 months. Group V: treated with cryotherapy on some lesions on the back of right hand and localized dermabrasion on some lesions on the back of left hand. The patients were followed up for six months after starting the therapy. Results: As regard patients of group I, the following effects appeared at the sites of application of the treatment: Erythema, inflammation, erosions, pruritus and burning sensation. Complete cure of treated lesions was reported in 85.7% of patients and failure of therapy was reported in one patient (14.3% of treated patients). Regarding group II, pain, oedema, blisters formation, bacterial infection of the wound, transient hypopigmentation, permanent hypopigmentation and healing by bad atrophic scar appeared as complications of cryosurgery, cure rate was 100% and no recurrences were reported. In group III: cure rate without recurrences was 85.7% of treated patients and recurrence appeared in 14.3% of treated patients. In group IV: there was statistically significant hypopigmentation of the treated solar lentigines by the end of 1st month of treatment in 87.5% of treated patients. By the end of period of treatment, there was obvious hypopigmentation of the treated solar lentigines in 87.5% of treated patients while there was no change color of treated lesions in 12.5%. Regarding group V: serous crusts and erosions were significantly more after localized dermabrasion while blisters formation were reported only with cryotherapy. As regard other side effects observed during the follow-up period, erythema and infection, were non significantly more after localized dermabrasion while swelling, pain, and brown crustation were non significantly more with cryotherapy. Healing by bad scar was reported in 12.5% of treated patients following either localized dermabrasion or cryotherapy. Hyperpigmentation was considered as recurrence of the treated lesions. Rate of complete cure was 50% and the rate of recurrence was 50% with each of the dermabrasion and the cryotherapy. Conclusion: for treatment of the solar keratosis, cryosurgery may be more favorable due to its higher cure rate, absence of recurrence and most of its complications are tolerable and treatable. Dermabrasion proved that it can be a good alternative for cryosurgery if expert hands and facilities are available. Topical 5-FU is a good treatment for solar keratosis but it needs special type of patients who has multiple lesions, compliant and accepts relatively long term of treatment. As regard treatment of solar lentigines, cryotherapy may be preferable for treatment of solar lentigines. Its technique is simple, needs little time, needs no anesthesia, outpatient procedure, and economic. It has little temporary side effects and permanent complications were similar to that of localized dermabrasion and both were not of dangerous type. However, cryotherapy is more painful and pain may be severe but it is usually transient. Localized dermabrasion needs special preparation e.g. theater, operative suits, and relatively expensive devices. The complications of the procedure where more severe than that of cryotherapy especially infection of the treated areas. Serous crusts and erosions were significantly more with localized dermabrasion while blisters were significantly more with cryotherapy. Recurrence rate was the same with each procedure (50%). Topical tretinoin 0.05% cream is a non-invasive method to induce just lightening of the treated solar lentigines in a safe and quite manner. It is preferable for patients who do not want to undergo invasive maneuvers and get satisfaction from just lightening of the treated solar lentigines. Localized dermabrasion and cryotherapy carried better results than topical tretinoin as they led to complete disappearance of the treated solar lentigines. However, both are considered invasive methods and carry a risk of many complications.