Pharmacotherapy of actinic keratosis
- 19 November 2009
- journal article
- review article
- Published by Informa UK Limited in Expert Opinion on Pharmacotherapy
- Vol. 10 (18), 3015-3031
- https://doi.org/10.1517/14656560903382622
Abstract
Actinic keratosis (AK) represents the initial intraepidermal manifestation of abnormal keratinocyte proliferation with the potential of progression to squamous cell carcinoma (SCC). When in limited numbers, clinically visible AKs are treated individually with ablative and/or surgical procedures (lesion-directed treatment), while multiple and sublinical AKs are treated with field-directed therapies that use ablative, nonablating and other topically applied treatment modalities. Owing to difficulties in predicting which AK will progress to SCC, the general rule is to treat all AKs. The goals of treatment are to eliminate the AKs, minimizing their risk of progression to invasive SCC, while pursuing good cosmetic outcomes. Prevention is the most important treatment modality for AKs. Avoidance of sun and artificial sources of ultraviolet light, applying sunscreen and self-examination are among the most effective preventive measures. Chemopreventive modalities such as retinoids, 2-(Difluoromethyl)-dl-ornithine (DFMO), perillyl alcohol, T4 endonuclease V, and dl-α-tocopherol are described. Lesion-directed treatment modalities include cryotherapy, surgery and electrodessication with or without curettage. Field-directed treatment modalities include nonablative and ablative laser resurfacing, dermabrasion, chemical peels, topical immunomodulators (imiquimod, 5-fluorouracil and diclofenac) and photodynamic therapy. And, finally, newer and investigational treatment modalities such as ingenol mebutate, resiquimod and betulinic acid are also being discussed.Keywords
This publication has 134 references indexed in Scilit:
- Pharmacoeconomic Considerations in Treating Actinic KeratosisPharmacoEconomics, 2009
- A Preliminary Pharmacokinetic Study of Betulin, the Main Pentacyclic Triterpene from Extract of Outer Bark of Birch (Betulae alba cortex)Molecules, 2008
- Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patientsBritish Journal of Dermatology, 2007
- Imiquimod 5% cream for the treatment of actinic keratosis: Results from a phase III, randomized, double-blind, vehicle-controlled, clinical trial with histologyJournal of the American Academy of Dermatology, 2004
- Imiquimod 5% cream for the treatment of actinic keratosis: results from two phase III, randomized, double-blind, parallel group, vehicle-controlled trialsJournal of the American Academy of Dermatology, 2004
- Actinic damage and skin cancer in albinos in northern Tanzania: Findings in 164 patients enrolled in an outreach skin care programJournal of the American Academy of Dermatology, 1995
- Guidelines of care for actinic keratosesJournal of the American Academy of Dermatology, 1995
- Clinical evaluation of topical isotretinoin in the treatment of actinic keratosesJournal of the American Academy of Dermatology, 1994
- Reduction of Solar Keratoses by Regular Sunscreen UseNew England Journal of Medicine, 1993
- Topical treatment of multiple actinic keratoses of the face with arotinoid methyl sulfone (Ro 14-9706) cream versus tretinoin cream: A double-blind, comparative studyJournal of the American Academy of Dermatology, 1991