Treatment-Refractory Actinic Keratoses Successfully Treated Using Simultaneous Combination Topical 5-Fluorouracil Cream and Imiquimod Cream: A Case–Control Study

Ondo, Andrew L.; Padilla, R. Steven; Miedler, John D.; Cockerell, Clay J.; Kerner, James D.; Steiner, Robert L.; Mings, Steven M.; Shanler, Stuart D.

doi:10.1111/j.1524-4725.2012.02480.x

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…In a recent study, a combination of imiquimod and 5-FU once daily for up to 12 weeks led to the complete resolution of AK in ten out of ten patients [124], and a similar study found that 5-FU in the morning and imiquimod 5% at night for 1 week, repeated monthly for up to 3 months, gave >90% complete clearance [125]. It was noted that 17% of patients withdrew due to adverse side effects in this study.…”

Section: Discussionmentioning

confidence: 99%

Actinic Keratosis: Rationale and Management

Dodds

Chia

Shumack

2014

Dermatol Ther (Heidelb)

105

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Actinic keratoses (AKs) are common skin lesions heralding an increased risk of developing squamous cell carcinoma (SCC) and other skin malignancies, arising principally due to excessive ultraviolet (UV) exposure. They are predominantly found in fair-skinned individuals, and increasingly, are a problem of the immunosuppressed. AKs may regress spontaneously, remain stable or transform to invasive SCC. The risk of SCC increases for those with more than 5 AKs, and the majority of SCCs arise from AKs. The main mechanisms of AK formation are inflammation, oxidative stress, immunosuppression, impaired apoptosis, mutagenesis, dysregulation of cell growth and proliferation, and tissue remodeling. Human papilloma virus has also been implicated in the formation of some AKs. Understanding these mechanisms guides the rationale behind the current available treatments for AKs. One of the main principles underpinning the management of AKs is that of field cancerization. Wide areas of skin are exposed to increasing amounts of UV light and other environmental insults as we age. This is especially true for the head, neck and forearms. These insults do not target only the skin where individual lesions develop, but also large areas where crops of AKs may appear. The skin between lesions is exposed to the same insults and is likely to contain as-yet undetectable preclinical lesions or areas of dysplastic cells. The whole affected area is known as the ‘field’. Management is therefore divided into lesion-directed and field-directed therapies. Current therapies include lesion-directed cryotherapy and/or excision, and topical field-directed creams: 5-fluorouracil, imiquimod, diclofenac, photodynamic therapy and ingenol mebutate. Combining lesion- and field-directed therapies has yielded good results and several novel therapies are under investigation. Treatment is variable and tailored to the individual making a gold standard management algorithm difficult to design. This literature review article aims to describe the rationale behind the best available therapies for AKs in light of current understanding of pathophysiology and epidemiology. A PubMed and MEDLINE search of literature was performed between January 1, 2000 and September 18, 2013. Where appropriate, articles published prior to this have been referenced. This is not a systematic review or meta-analysis, but aims to highlight the most up to date understanding of AK disease and its management.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0049-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Actinic Keratosis: Rationale and Management

Dodds

Chia

Shumack

2014

Dermatol Ther (Heidelb)

105

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“…Thickened/hyperkeratotic and pigmented AKs occur, and diameters can range to >1 cm; patients occasionally report pain. 7…”

mentioning

confidence: 99%

“…Thickened/ hyperkeratotic and pigmented AKs occur, and diameters can range to >1 cm; patients occasionally report pain. 7 Authorities debate whether AKs should be regarded as SCC in situ or as premalignant precursors to invasive SCC. 8 However, it is clear that they represent an intermediate stage in a multistep evolution of SCC (see chapter 4).…”

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confidence: 99%

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

et al. 2015

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Background Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). Objective To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Methods Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Results Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Conclusions Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the longterm immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.

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“…Topical therapies can also be combined together especially in cases of recalcitrant lesions. Once daily application of imiquimod and 5-FU for an average of 1–12 weeks histologically resolved AK lesions in ten out of ten patients in a recent study of treatment-refractory AKs 43. A similar study showed topical 5-FU in the morning and imiquimod 5% applied at night for 1 week of therapy, repeated monthly for up to 3 months, achieved greater than 90% complete clearance; however, 17% patients withdrew due to adverse effects 44…”

Section: Combining Therapeutic Modalitiesmentioning

confidence: 86%

Optimal treatment of actinic keratoses

Uhlenhake¹

2013

CIA

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The most compelling reason and primary goal of treating actinic keratoses is to prevent malignant transformation into invasive squamous cell carcinoma, and although there are well established guidelines outlining treatment modalities and regimens for squamous cell carcinoma, the more commonly encountered precancerous actinic lesions have no such standard. Many options are available with variable success and patient compliance rates. Prevention of these lesions is key, with sun protection being a must in treating aging patients with sun damage as it is never too late to begin protecting the skin.

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Treatment-Refractory Actinic Keratoses Successfully Treated Using Simultaneous Combination Topical 5-Fluorouracil Cream and Imiquimod Cream: A Case–Control Study

Cited by 14 publications

References 25 publications

Actinic Keratosis: Rationale and Management

Actinic Keratosis: Rationale and Management

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses

Optimal treatment of actinic keratoses

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