From the Guidelines
Actinic keratosis should be treated with field treatment using 5-fluorouracil or imiquimod, as these options have the strongest recommendations and moderate to good quality of evidence, according to the guidelines of care for the management of actinic keratosis 1.
Treatment Options
The following treatment options are recommended for actinic keratosis:
- Field treatment with 5-fluorouracil, which has a strong recommendation and moderate quality of evidence 1
- Field treatment with imiquimod, which also has a strong recommendation and moderate quality of evidence 1
- Cryosurgery, which is recommended for individual lesions and has a strong recommendation based on good practice statement 1
Photodynamic Therapy
Photodynamic therapy (PDT) is also a treatment option for actinic keratosis, particularly for cosmetically sensitive skin sites, multiple lesions, and large-area lesions 1.
- ALA-red light PDT and ALA-blue light PDT are conditionally recommended, with moderate quality of evidence 1
- Daylight PDT is considered a treatment option for people with mild or moderate AK lesions where pain is likely to be an issue 1
Prevention
Prevention is crucial in managing actinic keratosis, and includes:
- Daily use of broad-spectrum sunscreen (SPF 30+)
- Wearing protective clothing
- Avoiding peak sun hours (10am-4pm)
- Regular skin self-examinations Patients with actinic keratosis should have regular dermatology check-ups, typically every 6-12 months, as they have an increased risk of developing skin cancer.
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 recommended dosing is 2 times per week for a full 16 weeks.
- The treatment area should be washed with mild soap and water 8 hours following Imiquimod Cream application.
- Patients may experience local skin reactions, such as erythema, flaking/scaling/dryness, and scabbing/crusting, during treatment. 2 2
From the Research
Definition and Prevalence of Actinic Keratosis
- Actinic keratosis (AK) is a lesion that arises as a result of excessive exposure to solar radiation, predominantly on Fitzpatrick phototype I and II skin 3.
- AK lesions occur frequently on sun-exposed skin of Caucasians and become more prevalent with advancing age 4.
- They are considered premalignant in nature and may progress to squamous cell carcinoma, making treatment essential to prevent malignant transformation 3, 5.
Treatment Options for Actinic Keratosis
- Topical therapies, such as imiquimod and 5-fluorouracil, are useful alternatives to cryotherapy for treating diffuse actinic damage 4.
- Other treatment options include photodynamic therapy, cryosurgery, laser ablation, diclofenac, retinoids, and ingenol mebutate 3, 6, 5, 7.
- The combination of therapies has presented relevant results with the intention to reduce duration of therapy and side effects 3.
- Strong recommendations are presented for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery 6.
Efficacy of Treatment Options
- A meta-analysis showed that both imiquimod and 5-fluorouracil are effective methods for the treatment of actinic keratosis, with imiquimod having a higher efficacy rate (70 +/- 12%) compared to 5-fluorouracil (52 +/- 18%) 4.
- The choice of treatment modality depends on patient age, general health, and the thickness, size, and localization of the lesion 7.
- Education about sun exposure prevention remains the best and most cost-effective method for AK prevention 3.