Insight into the management of actinic keratosis

Abstract

Summary Actinic keratoses (AK) are rough skin lesions (patches) caused by long‐term sun exposure in light skinned individuals, affecting 24‐60% of people above the age of 50. The current management of AK patients (meaning how they are diagnosed and treated and how long they are ‘followed up’ for) seems to vary within and between primary care (e.g. GPs) and secondary care (e.g. hospital dermatology departments). This Dutch study aimed to provide insight into underlying motives of current AK management. A study was conducted consisting of interviews with 22 general practitioners (GPs) and 18 dermatologists. GPs varied in their methods for diagnosing AK and in determining treatment and follow‐up schedules, due to a lack of knowledge and experience and low perceived value of AK care. Dermatologists indicated that they strived to provide AK care according to official guidelines, although patient preferences and other patient‐related factors influence treatment choices and often lead to extensive follow‐up regimens. For AK care to become more standardized and uniform in Dutch primary care, implementation of guidelines and continuing education are needed, to address the commonly reported barriers of lack of value, experience and knowledge among GPs. To help prevent extensive follow‐up in secondary care (and therefore to ensure efficient use of care), shared decision‐making tools along with adequate patient information may be useful to help dermatologists’ management of patient preferences.