From the Guidelines
Treatment options for actinic keratosis include both topical medications and procedural interventions, with 5-fluorouracil (5-FU) cream and imiquimod 5% cream being first-line topical treatments, as recommended by the most recent guidelines 1. The choice of treatment depends on the number and location of lesions, patient preference, and previous treatment response.
- Topical treatments:
- 5-fluorouracil (5-FU) cream applied once or twice daily for 2-4 weeks
- imiquimod 5% cream applied 2-3 times weekly for 4-16 weeks
- diclofenac 3% gel applied twice daily for 60-90 days, which has fewer side effects but is conditionally recommended due to lower quality of evidence 1
- Procedural treatments:
- cryotherapy with liquid nitrogen for individual lesions
- photodynamic therapy (PDT) for multiple lesions, involving application of aminolevulinic acid followed by light exposure, which is conditionally recommended 1
- curettage and electrodesiccation or surgical excision for thicker lesions Sun protection is essential during and after treatment to prevent recurrence, as UV radiation is the primary cause of these precancerous lesions, and patients should be advised to use UV protection as a good practice statement 1. Most treatments cause temporary inflammation, redness, and discomfort as the abnormal cells are destroyed. The benefits of 5-FU treatment for AK were assessed as moderate or large, based on studies assessed field treatment with 5-FU 1. It is also important to consider the patient's quality of life and preferences when choosing a treatment option, as treatment of AK is likely to be an ongoing process for most patients, and one that is usually accompanied by some level of discomfort 1.
From the FDA Drug Label
- INDICATIONS AND USAGE AMELUZ, in combination with photodynamic therapy (PDT) using BF-RhodoLED® or RhodoLED® XL lamp, a narrowband, red light illumination source, is indicated for lesion-directed and field-directed treatment of actinic keratoses (AKs) of mild-to-moderate severity on the face and scalp.
The treatment options for actinic keratosis include:
- Photodynamic therapy (PDT) using aminolevulinic acid (TOP) in combination with a narrowband, red light illumination source, such as BF-RhodoLED® or RhodoLED® XL lamp, for lesion-directed and field-directed treatment of mild-to-moderate severity AKs on the face and scalp 2.
From the Research
Treatment Options for Actinic Keratosis
The treatment options for actinic keratosis include:
- Individual lesion-based treatments, such as cryotherapy 3
- Field-directed treatments, such as topical treatments, including 3% diclofenac in 2.5% hyaluronic acid, 0.5% 5-fluorouracil, 5% imiquimod, and 0.025% to 0.05% ingenol mebutate 3
- Photodynamic therapy (PDT) with photosensitisers such as aminolevulinic acid (ALA) and methyl aminolevulinate (MAL) 3
- Sequential combination of 5-fluorouracil and photodynamic therapy 4
- Sequential use of photodynamic therapy and imiquimod 5% cream 5
Efficacy of Treatment Options
The efficacy of these treatment options varies, with:
- 3% diclofenac in 2.5% hyaluronic acid showing a significant improvement in participant complete clearance rates compared to vehicle or placebo (RR 2.46,95% CI 1.66 to 3.66) 3
- 0.5% 5-fluorouracil showing a significant improvement in participant complete clearance rates compared to placebo (RR 8.86,95% CI: 3.67 to 21.44) 3
- 5% imiquimod showing a significant improvement in participant complete clearance rates compared to placebo (RR 7.70,95% CI 4.63 to 12.79) 3
- Photodynamic therapy with ALA or MAL showing a significant improvement in participant complete clearance rates compared to placebo-PDT (RR 6.22,95% CI 2.88 to 13.43 for ALA with blue light; RR 5.94,95% CI 3.35 to 10.54 for ALA with red light; RR 4.46,95% CI 3.17 to 6.28 for MAL with red light) 3
- Sequential combination of 5-fluorouracil and photodynamic therapy showing a 90% resolution of treated actinic keratoses at 1 month and 1 year post-treatment 4
- Sequential use of photodynamic therapy and imiquimod 5% cream showing a median lesion reduction of 89.9% at month 12 5
Safety and Cosmetic Outcomes
The safety and cosmetic outcomes of these treatment options also vary, with:
- Imiquimod treatment and photodynamic therapy resulting in better cosmetic outcomes than cryotherapy and 5-fluorouracil 3
- A significant number of participants withdrawing due to adverse events, such as erythema and flaking/scaling/dryness, with 3% diclofenac in 2.5% hyaluronic acid and 5% imiquimod 3
- Most patients experiencing mild to moderate facial irritation with 0.5% fluorouracil cream 6