Adherence to topical therapies in actinic keratosis: A literature review

Abstract

The review highlighted a significant evidence gap regarding adherence and persistence to topical AK therapies. Combined, non-adherence and non-persistence may be as high as 88% in clinical practice, highlighting the importance of incorporating contributing factors to patient non-adherence into treatment decisions.

Phase IV head-to-head randomized controlled trial comparing ingenol mebutate 0·015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp

“…13 Effective field treatments may have a therapeutic advantage over lesiondirected therapies in that they can also address subclinical and emerging AK lesions. [12][13][14][15][16] Furthermore, timely intervention with follow-up field treatment has been shown to provide sustained clearance of AK lesions. 12 Diclofenac sodium (DS) in a 3% topical gel formulation with 2Á5% hyaluronic acid is used to treat AK.…”

“…Lesion‐directed therapies, such as cryotherapy, target visible AK lesions but leave subclinical lesions in the cancerized field untreated, from which new lesions may emerge . Effective field treatments may have a therapeutic advantage over lesion‐directed therapies in that they can also address subclinical and emerging AK lesions . Furthermore, timely intervention with follow‐up field treatment has been shown to provide sustained clearance of AK lesions …”

“…It may involve the inhibition of cyclooxygenase 2, reducing angiogenesis and cellular proliferation, as well as inducing apoptosis . The regimen for treating AK is twice daily for 90 days, which may reduce patients’ ability to tolerate local skin reactions (LSRs) and contribute to poor adherence …”

Field treatment of actinic keratosis on the scalp

“…Solaraze (topical diclofenac) causes little in the way of local reactions, but is limited by the need for patients to continue with use twice daily for a full 3 months to achieve maximum clinical efficacy. Combined nonadherence and nonpersistence is reported to be as high as 88% with topical treatments …”

“…Combined nonadherence and nonpersistence is reported to be as high as 88% with topical treatments. 6 Topical therapeutic options are limited by the area that the treatment can cover, and by licensing restrictions. Ingenol mebutate, 5% imiquimod (Aldara) and 5-FU 0Á5% + salicylic acid 10% (Actikerall) can be applied to an area of only 25 cm 2 .…”