How to treat actinic keratosis? An update

Abstract

Actinic keratosis (AKs) is one of the most common skin lesions leading to an increased risk of developing squamous cell carcinoma and other skin malignancies. The lesions principally arise as a result of excessive ultraviolet (UV) exposure. AKs may regress spontaneously, remain stable or evolve to invasive squamous cell carcinoma. The risk of squamous cell carcinoma is significantly increased patients with more than 5 AKs. The main mechanisms involved in the formation of AK are inflammation, mutagenesis, oxidative stress, impaired apoptosis, immunosuppression, disregulation of cell growth and proliferation, and tissue remodeling. Human papilloma virus has also been correlated with the formation of some AKs. As an individual ages, his skin is exposed to increasing cumulative amounts of UV light and other environmental insults. This is especially true for the head, neck and forearms. These insults do not target only the skin where individual lesions develop, but also the surrounding area. In this area undetectable preclinical AK lesions or dysplastic cells may be present. The whole affected area is known as the 'field'. Therefore, management is divided into lesion-directed and field-directed therapies. Currently, the therapies in use are lesion-directed cryotherapy and/or excision, and field-directed topical agents: 5-fluorouracil, diclofenac, photodynamic therapy, imiquimod, and ingenol mebutate. Combining lesion-and field-directed therapies showed good results and several novel therapies are under investigation. Treatment is variable and personalized, what makes a gold standard management algorithm difficult to design. This review aims to describe the rationale behind the available treatment options for AKs based on current understanding of pathophysiology and epidemiology. (J Dermatol Case Rep. 2015; 9(2): 29-35)

In vivo Confocal Laser Microscopy for monitoring of actinic keratosis treatment: a comparison with histopathologic assessment after treatment with topical 5% 5‐fluorouracil

“…3,56 On the other hand, its effectiveness is patient-dependent and patient compliance may be impaired by adverse effects, such as pain, erythema, pruritus, irritation and contact dermatitis. 57,58 In fact, 2 subjects in our study presented contact dermatitis and 7 dropped out. The long treatment and need for frequent clinical assessments justify losing seven participants.…”

“…5‐FU has the advantage of being able to treat clinical and subclinical lesions with minimal scarring . On the other hand, its effectiveness is patient‐dependent and patient compliance may be impaired by adverse effects, such as pain, erythema, pruritus, irritation and contact dermatitis . In fact, 2 subjects in our study presented contact dermatitis and 7 dropped out.…”

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

“…Recurrence of the disease may include partial elimination of the initial lesion, subclinical lesion progression to visible status, or development of new lesions [7]. On top of this, an AK may progress to invasive SCC, the second-most common form of skin cancer [8,9]. The actual percentage of progress to invasive SCC remains unknown, and estimates vary from 5 to 20% within 10 to 25 years with reported annual transformation rates varying greatly from as low as 0.25% to as high as 16% [10].…”

Cells to Surgery Quiz: April 2019

“…a. The clinical clearance achieved with ingenol mebutate appears to be correlated with histologic clearance: Ingenol mebutate gel was approved by the US Food and Drug Administration (FDA) in 2012 as a new topical field therapy treatment for AK (Costa et al, 2015;Lebwohl et al, 2012). Clinical studies have proven its efficiency in treating AK, due to its ability to induce cell death (Lebwohl et al, 2012) of tumor cells and induce an immune response by the activation of the protein kinase C (Martin and Swanson, 2013).…”