From the Guidelines
Actinic keratosis (AK) is a precancerous skin lesion caused by chronic sun exposure, characterized by rough, scaly patches that can progress to squamous cell carcinoma, and is a marker of chronic sun damage, as noted in a study published in the British Journal of Dermatology 1. The condition typically appears on sun-exposed areas like the face, ears, scalp, neck, and hands, particularly in fair-skinned individuals over 40, and can range in color from skin-toned to reddish-brown, varying in size from a few millimeters to centimeters. Some key points to consider about AK include:
- AKs are precancerous lesions that can progress to keratinocyte carcinoma, as stated in the guidelines of care for the management of actinic keratosis published in the Journal of the American Academy of Dermatology 1.
- Treatment options are available, including topically applied creams, gels, and solutions, cryosurgery, and photodynamic therapy (PDT), with the selection of treatment based on AK features, treatment-related factors, and patient characteristics and preferences, as discussed in the guidelines of care for the management of actinic keratosis 1.
- The primary goal of treatment is to prevent the progression of AK to squamous cell carcinoma, and treatment should be individualized based on the patient's preferences, clinical circumstances, and quality of life, as recommended by the British Association of Dermatologists' guidelines for the care of patients with actinic keratosis 2017 1. Treatment options include:
- Cryotherapy (freezing with liquid nitrogen)
- Topical medications like 5-fluorouracil (Efudex, applied twice daily for 2-4 weeks), imiquimod (Aldara, applied 2-3 times weekly for 4-16 weeks), or ingenol mebutate (Picato, applied once daily for 2-3 days)
- Field therapy with photodynamic therapy for multiple lesions Prevention involves:
- Sun protection with broad-spectrum sunscreen (SPF 30+)
- Protective clothing
- Avoiding peak sun hours
- Regular skin examinations The development of AK results from UV radiation damaging skin cell DNA, causing abnormal cell growth in the epidermis, which is why sun protection is crucial for both prevention and after treatment, as noted in the guidelines of care for the management of actinic keratosis 1.
From the FDA Drug Label
The studies enrolled subjects with 4 to 8 clinically typical, visible, discrete, nonhyperkeratotic, nonhypertrophic AK lesions within a 25 cm2 contiguous treatment area on either the face or scalp.
Actinic Keratosis (AK) is a condition characterized by the presence of clinically typical, visible, discrete, nonhyperkeratotic, nonhypertrophic lesions on the face or scalp.
- Key characteristics of AK lesions include:
- Clinically typical
- Visible
- Discrete
- Nonhyperkeratotic
- Nonhypertrophic 2
From the Research
Definition and Characteristics of Actinic Keratosis
- Actinic keratosis (AK) is a common skin disease caused by chronic sun damage, typically arising on sun-exposed areas such as the face, scalp, neck, hands, and forearms 3, 4, 5, 6, 7.
- AK is considered a premalignant lesion, with the potential to progress to invasive squamous cell carcinoma (SCC) 3, 4, 5, 6, 7.
- The disease is more common in fair-skinned individuals, particularly those with Fitzpatrick phototype I and II skin 4.
Risk Factors and Prevention
- Chronic exposure to solar radiation is a major risk factor for the development of AK 3, 4, 5, 6, 7.
- Prevention plays a crucial role in the management of AK, with the continuous use of sunscreen and protective clothing recommended 3, 4, 6.
- Education about sun exposure prevention is essential, particularly in primary care settings 6.
Treatment Options
- Various treatment options are available for AK, including lesion-directed therapies (e.g., cryotherapy, laser therapy, surgery, curettage) and field-directed therapies (e.g., 5-fluorouracil, diclofenac 3% gel, chemical peeling, imiquimod, photodynamic therapy) 3, 4, 5, 7.
- The choice of treatment depends on the characteristics of the patient and the lesion, as well as the experience of the primary care physician 6.
- Combination therapy has shown promising results in reducing treatment duration and side effects 4.