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AK management = TREATMENT + PHOTOPROTECTION
Physician-administered treatments
Curretage
Curettage (discrete, hyperkeratotic lesions)1,3
Possible cutaneous adverse reactions: infection, scarring, and dyspigmentation
Cryotherapy
Cryotherapy (especially for single lesions or multiple discrete lesions; not suitable for the treatment of field cancerization)1,2
Frequency: once, repeated up to 2 times
Possible cutaneous adverse reactions: blistering, hypopigmentation, hyperpigmentation, scarring, and infection as well as discomfort during the freezing cycle
Photodynamic therapy*
MAL-PDT1,2 (methylaminolevulinate photodynamic therapy)
Mode of application: different light sources and application modes
Incubation time: >2.5h
Possible cutaneous adverse reactions: pain, erythema, edema, stinging, crusting may last up to 4 weeks after treatment; must practice strict sun protection 24–48 hours after treatment.
ALA-PDT1,2 (5-aminolaevulinic acid photodynamic therapy)
Mode of application: different concentrations, light sources and application modes
Incubation time: >1h
Possible cutaneous adverse reactions: pain, erythema, edema, stinging, crusting may last up to 4 weeks after treatment; must practice strict sun protection 24–48 hours after treatment.
Patient-administered treatments
5-fluorouracil-based treatment
5% 5-FU1,2
Frequency: once or twice daily
Duration: for 2-4 weeks
Possible cutaneous adverse reactions: burning, pruritus, erythema, peeling, scaling, potential scarring.
Imiquimod-based treatment
5% imiquimod**1,2
Frequency: once daily at 2 or 3 days per week
Duration: for a time period of 4-16 weeks; continuously or intermittent
Possible cutaneous adverse reactions: erythema, crusting, pruritus, induration, scaling; rarely flu-like symptoms, fever, fatigue, angioedema.
Photoprotection
Protection from sunlight is an integral part of management of patients with AK
*PDT often included pretreatment of AK lesions, e.g. with curettage or other topical interventions.
**For immunosuppression, different clinical situations may exist, e.g. iatrogenic medical immunosuppression after organ transplantation, iatrogenic medical immunosuppression because of autoimmune disorders, immunosuppression due to other reasons (haematological disorders, AIDS etc.). Depending on the underlying disease, special care has to be given to the selection of the treatment to avoid (auto-) immunstimulation that may lead to a worsening of the underlying condition.
Going Further
International guidelines
Werner RN, et al. Evidence- and consensus-based (S3) guidelines for the treatment of actinic keratosis – International League of Dermatological Societies in cooperation with the European Dermatology Forum – Short version. J Eur Acad Dermatol Venereol 2015;29:2069–2079.
Download the free full text
Werner RN, et al. Methods and Results Report – Evidence and consensus-based (S3) guidelines for the treatment of actinic keratosis – International League of Dermatological Societies in cooperation with the European Dermatology Forum. J Eur Acad Dermatol Venereol 2015;29:e1–e66.
Download the guidelines
National guidelines
Due to national or regional specificities (regulatory approval, availability and treatment reimbursement policy), the international guidelines have recently been adapted.
Canada, 2015
Poulin Y, et al. for the Canadian non-melanoma skin cancer guidelines committee. Non-melanoma skin cancer in Canada. Management of actinic keratoses. J Cutan Med Surg. 2015;19(3): 227–38.
Download the free full text
UK, 2017
de Berker D, et al. British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017. Br J Dermatol 2017;176:20–43.
Download the free full text
France, 2019
Savary J, et al. Management and clinical practice of multiple face and scalp actinic keratosis in France. J Mark Access Health Policy 2019;7(1):1605787.
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References
- Werner RN, et al. Eur Acad Dermatol Venereol 2015;29:2069-2079.
- Uhlenhake EE. Clin Interv Aging 2013:8:29-35.
- Costa C, et al. J Dermatol Case Rep 2015;9(2):29-35.
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