Treatment of actinic keratosis

INTRODUCTION

Actinic keratoses (AKs or solar keratoses) are cutaneous neoplasms that develop on sun-damaged skin. Multiple modalities have been used for the management of these lesions, including physical or chemical destruction, topical medication, and photodynamic therapy.

The treatment of AKs will be reviewed here. The epidemiology, clinical manifestations, and diagnosis of AKs are discussed separately. (See "Epidemiology, natural history, and diagnosis of actinic keratosis".)

OVERVIEW OF TREATMENT

AKs are increasingly considered lesions that are on a continuum with cutaneous squamous cell carcinoma (SCC) [1]. Although most AKs do not progress to SCC, AKs are a concern because the majority of cutaneous SCCs arise from preexisting AKs [2,3], and AKs which will progress to SCC cannot be distinguished from AKs that will spontaneously resolve or persist. Because of these factors, most clinicians routinely treat AKs [4]. Improvement in associated symptoms and cosmetic appearance can be additional benefits of treatment. (See "Epidemiology, natural history, and diagnosis of actinic keratosis", section on 'Clinical course'.)

The major treatment options for AK include destructive therapies (eg, cryotherapy, surgery, dermabrasion), topical medications (eg, 5-fluorouracil [5-FU], imiquimod, ingenol mebutate, diclofenac), chemical peels (eg, trichloroacetic acid), and photodynamic therapy (PDT). Given the multiple effective treatment options for AKs, the choice of therapy is influenced by factors such as the number and distribution of lesions, lesion characteristics, patient preference for the mode of treatment (eg, office-based versus home administered, duration of therapy), patient tolerance for side effects (eg, pain, inflammation, hypopigmentation, scarring), treatment cost, and treatment availability.

In general, lesion-directed treatments, such as cryotherapy and surgical intervention are the primary approach for isolated lesions [4]. Therapies that can be used to treat areas with multiple AKs (field-directed therapies), such as topical 5-FU, imiquimod, ingenol mebutate, diclofenac, and PDT, are particularly useful for treating patients with multiple lesions.

                 

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Literature review current through: Apr 2013. | This topic last updated: Feb 20, 2013.
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