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AK management = TREATMENT + PHOTOPROTECTION
Physician-administered treatments
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
0.5% 5-FU1,2
Frequency: once daily
Duration: for 1-4 weeks
Possible cutaneous adverse reactions: burning, pruritus, erythema, peeling, scaling, potential scarring.
Imiquimod-based treatment
3.75% imiquimod1,2
Frequency: once daily
Duration: for 2 weeks followed by a rest period of 2 weeks (1 or 2 treatment cycles)
Possible cutaneous adverse reactions: erythema, crusting, pruritus, induration, scaling; rarely flu-like symptoms, fever, fatigue, angioedema.
Ingenol mebutate-based treatment
0.015% ingenol mebutate1,2
Frequency: once daily
Duration: for 3 days
Location: for lesions on the face or scalp
Possible cutaneous adverse reactions: redness, scaling, vesiculation, dyspigmentation, swelling, pruritus, crusting.
0.05% ingenol mebutate1,2
Frequency: once daily
Duration: for 3 days
Location: for lesions on the trunk or extremities
Possible cutaneous adverse reactions: redness, scaling, vesiculation, dyspigmentation, swelling, pruritus, crusting.
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.
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.
Download the free full text
References
- Werner RN, et al. Eur Acad Dermatol Venereol 2015;29:2069-2079.
- Uhlenhake EE. Clin Interv Aging 2013:8:29-35.
Define a new AK management strategy