From the Guidelines
Actinic keratosis is best treated with a combination of sun protection and medical interventions, with strong recommendations for the use of UV protection, cryosurgery, topical imiquimod, and 5-fluorouracil, as stated in the guidelines of care for the management of actinic keratosis 1. The treatment of actinic keratosis should prioritize methods that reduce morbidity, mortality, and improve quality of life.
Treatment Options
- For isolated lesions, cryotherapy with liquid nitrogen is a common first-line treatment, requiring 1-3 sessions to completely remove the lesion.
- Topical medications are effective for multiple lesions or field treatment, including:
- 5-fluorouracil (Efudex, Carac) applied twice daily for 2-4 weeks.
- Imiquimod (Aldara, Zyclara) applied 2-3 times weekly for 4-16 weeks.
Photodynamic Therapy
Photodynamic therapy is another option, involving application of aminolevulinic acid followed by light exposure, with conditional recommendations for its use 1.
Preventive Measures
Daily sunscreen use (SPF 30+), protective clothing, and avoiding peak sun hours are essential preventive measures as actinic keratoses develop from cumulative UV damage.
Regular Skin Examinations
Regular skin examinations are recommended for patients with a history of actinic keratosis, as these lesions have a small risk (approximately 0.1-10% per year) of progressing to squamous cell carcinoma 1. The guidelines of care for the management of actinic keratosis provide the most up-to-date recommendations for treatment, including the use of UV protection, cryosurgery, topical imiquimod, and 5-fluorouracil, as well as photodynamic therapy and diclofenac as part of combination therapy regimens 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. Table 11: Clearance Rates (AK) Complete Clearance Rates (100% AK Lesions Cleared) Study Imiquimod Cream Vehicle Study 46% (49/107) 3% (3/110) AK1 Study 44% (48/108) 4% (4/111) AK2 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 16 weeks.
- Complete clearance rates were 46% and 44% in two clinical studies. 2
From the Research
Treatment Options for Actinic Keratosis
- Topical medications such as 5-fluorouracil (5-FU), imiquimod, and diclofenac are commonly used to treat actinic keratosis 3, 4, 5.
- Photodynamic therapy, including methyl aminolevulinate photodynamic therapy (MAL-PDT), is also an effective treatment option 4, 5, 6.
- Cryosurgery and laser ablation are additional treatment options for actinic keratosis 5.
- Combination therapies, such as combining topical medications with photodynamic therapy, may also be effective in reducing treatment duration and side effects 4.
Efficacy of Treatment Options
- 5% fluorouracil cream has been shown to be the most effective treatment option, with a cumulative probability of remaining free from treatment failure of 74.7% at 12 months after the end of treatment 6.
- Imiquimod, MAL-PDT, and ingenol mebutate gel have been shown to be less effective than 5% fluorouracil cream, with cumulative probabilities of remaining free from treatment failure of 53.9%, 37.7%, and 28.9%, respectively 6.
- Lower concentrations of 5-FU, such as 0.5%, have also been shown to be effective in treating actinic keratosis, although efficacy may increase with increasing treatment duration 7.
Considerations for Treatment
- Patient factors, such as past medical history, lesion location, and tolerability of therapy, should be considered when selecting a treatment option 3.
- The potential for side effects, such as facial irritation, should also be considered when selecting a treatment option 7.
- Education about sun exposure prevention remains an important aspect of preventing actinic keratosis 4.