From the Guidelines
Actinic keratosis is best treated with a combination of sun protection and specific therapies based on the extent of lesions, with 5-fluorouracil (5-FU) cream 5% applied twice daily for 2-4 weeks being a highly effective option, as recommended by the guidelines of care for the management of actinic keratosis 1. The treatment options for actinic keratosis can be categorized into several approaches, including:
- Topical treatments, such as 5-FU cream 5% applied twice daily for 2-4 weeks, imiquimod 5% cream applied 2-3 times weekly for 4-16 weeks, ingenol mebutate gel, or diclofenac sodium 3% gel applied twice daily for 60-90 days
- Cryotherapy with liquid nitrogen, typically requiring a 5-15 second freeze per lesion with possible repeat treatments every 2-3 weeks until resolved
- Photodynamic therapy, involving application of aminolevulinic acid followed by light activation, which is effective for widespread lesions
- Combination therapy, such as the combined use of 5-FU and cryosurgery, which has been conditionally recommended by the guidelines 1 The choice of treatment should be based on the extent of lesions, patient preference, and the potential for side effects, as well as the strength of evidence supporting each option, with strong recommendations made for the use of UV protection, cryosurgery, topical imiquimod, and 5-FU 1. It is essential to note that daily sunscreen use (SPF 30+), protective clothing, and regular skin examinations are crucial components of management, as actinic keratoses are caused by cumulative UV exposure and can progress to squamous cell carcinoma if left untreated 1. In terms of specific treatment regimens, the guidelines recommend:
- For patients with AK, the use of UV protection is strongly recommended 1
- For patients with AKs, field treatment with 5-fluorouracil is strongly recommended 1
- For patients with AKs, field treatment with imiquimod is strongly recommended 1
- For patients with AKs, the use of diclofenac is conditionally recommended, based on lower quality of evidence than that of the evidence supporting strong recommendations for the use of 5-FU or imiquimod 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:
- Ablative (destructive) therapies such as cryosurgery, curettage with electrosurgery, and photodynamic therapy 3, 4
- Topical therapies, including:
Efficacy of Treatment Options
Studies have shown that:
- 3% diclofenac in 2.5% hyaluronic acid, 0.5% 5-fluorouracil, 5% imiquimod, and 0.025% to 0.05% ingenol mebutate are effective field-directed treatments for actinic keratosis 3
- Photodynamic therapy is an effective treatment for individual lesions, with better cosmetic outcomes than cryotherapy 3
- Sequential use of photodynamic therapy and imiquimod 5% cream is a well-tolerated and effective treatment for actinic keratosis 7
Adverse Events and Cosmetic Outcomes
Adverse events and cosmetic outcomes vary between treatments, with: