From the Guidelines
Actinic keratosis should be treated with first-line therapies such as topical 5-fluorouracil or imiquimod to prevent progression to squamous cell carcinoma, as recommended by the most recent guidelines 1. The treatment of actinic keratosis is crucial to prevent the progression to squamous cell carcinoma, a type of skin cancer. According to the guidelines of care for the management of actinic keratosis, first-line treatments include topical medications such as 5-fluorouracil (Efudex, applied twice daily for 2-4 weeks) or imiquimod (Aldara, applied 2-3 times weekly for 4-16 weeks) 1. Some key points to consider in the treatment of actinic keratosis include:
- The use of UV protection is strongly recommended for patients with actinic keratosis 1
- Field treatment with 5-fluorouracil or imiquimod is recommended for patients with actinic keratosis 1
- Cryosurgery is an effective in-office procedure for isolated lesions 1
- Photodynamic therapy may be used for widespread lesions, involving application of a photosensitizing agent followed by light exposure 1
- Daily sunscreen use (SPF 30+), protective clothing, and avoiding peak sun hours (10am-4pm) are essential preventive measures 1
- Regular skin examinations are important as people with actinic keratosis have a higher risk of developing skin cancer 1 The condition develops due to UV radiation causing DNA damage in skin cells, leading to abnormal growth of keratinocytes in the epidermis, which is why sun protection is crucial for both prevention and after treatment 1.
From the FDA Drug Label
1.1 Actinic Keratosis Imiquimod Cream is indicated for the topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp in immunocompetent adults. 14. 1 Actinic Keratosis In two double-blind, vehicle-controlled clinical studies, 436 subjects with AK were randomized to treatment with either imiquimod cream or vehicle cream 2 times per week for 16 weeks.
Actinic Keratosis Treatment: Imiquimod cream is indicated for the topical treatment of actinic keratosis on the face or scalp in immunocompetent adults. The treatment involves applying the cream 2 times per week for 16 weeks.
- Key Points:
From the Research
Definition and Causes of Actinic Keratosis
- Actinic keratosis (AK) is a skin disease caused by chronic sun damage, typically arising on sun-exposed areas such as the face, scalp, neck, hands, and forearms 3.
- AK is characterized by intraepithelial keratinocyte dysplasia and molecular alterations shared with normal chronically sun-damaged skin and squamous cell carcinoma (SCC) 4.
- The main cause of AK in otherwise healthy Caucasians appears to be the sun 5.
Treatment Options for Actinic Keratosis
- Lesion-directed treatments include cryotherapy, laser therapy, surgery, and curettage 3.
- Field-directed treatments include 5-fluorouracil (5-FU), diclofenac 3% gel, chemical peeling, imiquimod, and photodynamic therapy (PDT) 3, 6.
- Prevention plays an important role in the treatment of AK, and it is based on the continuous use of sunscreen and protective clothing 3.
- Photodynamic therapy with topical aminolevulinic acid and light is a new therapy for AK, approved in the US to treat multiple individual AK on the face and scalp 5.
Progression and Risks of Actinic Keratosis
- AK can undergo spontaneous regression, stable existence, or malignant transformation to cutaneous SCC, with progression rates to SCC ranging from 0% to 0.5% per lesion-year 4.
- The conversion rate of AK to SCC is not accurately known, but appears to be in the range of 0.25 to 1% per year 5.
- AK is a marker for an increased rate of nonmelanoma skin cancer (NMSC), even in the absence of specific lesion progression 7.
- The risk for progression of AK to invasive SCC with the potential for metastasis provides the rationale for treatment 7.