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Which Modalities are Effective for AKs?

A recent study published in the Journal of Drugs in Dermatology found certain lesion-directed and field-directed treatments were safe and effective for actinic keratoses (AKs), particularly among patients with multiple lesions.

“For a disease such as actinic keratosis that is associated with high rates of nonadherence and nonpersistence to treatment, real-world evidence is crucial to confirm clinical efficacy,” the researchers wrote. To better understand the real-world treatment of AKs by type and modality, they analyzed clinical and outcome data from the medical charts of 429 patients with AKs.

They found that the first treatment after diagnosis was a procedure, followed by a topical therapy. Treatment with 5-fluorouracil (5-FU), ingenol mebutate (IngMeb), imiquimod (IMQ), cryotherapy alone, or cryotherapy plus one topical was associated with 66%, 69.3%, 72.5%, 72.9%, and 73% reductions in AKs, respectively. They also found that a 75% or greater clearance of AKs was achieved by 57.1%, 72.7%, 57.1%, 62.4%, and 62% of patients treated with 5-FU, IngMeb, IMQ, cryotherapy alone, or cryotherapy plus one topical, respectively.

In addition, the researchers found that treatment effectiveness was positively correlated with the number of AKs at baseline for topical and for procedural plus topical combination treatments, but not for procedural treatments alone. Specifically, patients with six or more AKs were treated with topicals or with a combination of a procedure plus a topical, which was associated with higher rates of complete clearance compared with a procedure alone.

Cryotherapy was associated with more adverse reactions (9.7%), whereas field-directed treatment (18.5%-43.1%) and combination cryotherapy plus topical treatment (21.3%) were associated with more local skin reactions.

“This study highlights the greater utility and benefits of field-directed topical treatments for AKs, such as IngMeb, 5-FU, and IMQ, especially when a greater number of AKs over a larger field size are involved,” the researchers concluded. “Future large-scale, long-term, real-world studies may further our understanding of the most effective management.”

The limitations of this retrospective study were the limited duration and small population size.


Hansen JB, Larsson T, Dunkelly-Allen N, Veverka KA, Feldman SR. Real-world effectiveness and safety of field- and lesion-directed treatments for actinic keratosis. J Drugs Dermatol. 2020;19(8):756-762. doi:10.36849/JDD.2020.5123

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