Actinic Keratosis (AK): Treatment and Prevention

Treat an individual lesion and/or the area where they appear (=field treatment)

Treatments more suitable for individual lesions:
-Imiquimod (Aldara)
-Fluoruracil (Efudix)
-Ingenol mebutate (Picato): only 2 or 3 days application
-Diclofenac (Solaraze)
all cause local reaction

-Cryotherapy

Treatments more indicated for field therapy
-PDT (Photodynamic Therapy)
-Daylight PDT
-Treatments can be combined with Ablative lasers (Co2, erbium)

What is the best treatment ?
-Out of a Cochrane review of 83 studies gathering 10000 individuals, PDT was Superior to cryotherapy for treatment of individual lesions.
-For field treatment, all of them are effective but none are compared with each other

Prevention of Actinic Keratosis (AK)
–Photoprotection (behavioral and sunscreens): sunscreens have been found to be effective in a Randomized Control Trial (RCT)
-For organ transplant population reduction in AK and SCC (Squamous Cell Carcinoma) over a 2 year period

–Oral nicotinamide (amide form of vitamin D3 (niacin)): some efficacy
–Celecoxib: some evidence (click HERE to read more)
–Systemic retinoids: no evidence  (to read a free review by the NIH, click HERE)
–Capecitabine: some evidence
–Afamelanotide (alpha MSH analogue) : a  phase 2 study is ongoing at the time of publication

Sy52 Update ok AK, BCC and SCC. World Congress of Dermatology 2015 –  Vancouver, Canada