A new study published in Dermatologic Therapy aimed to reach an expert consensus on the management of patients with actinic keratosis (AK).

The present study entailed congregating two round tables of experts. In the first, seven clinical questions were selected and analyzed by a systematic literature review, using a Population, Intervention, Control and Outcomes (PICO) framework. In the second, the experts discussed relevant evidences and a consensus statement for each question was developed.

The findings revealed that:

• Lesion-directed treatments are preferred in patients with few AKs.
• Patients with multiple AKs are challenging, with more than one treatment usually needed to achieve complete lesion clearance or a high lesion response rate, therapy should be personalized, based on previous treatments, patient and lesion characteristics.
• Photodynamic therapy (PDT) is the most studied treatment for AKs on the arms.
• Oral nicotinamide 500 mg twice daily, systemic retinoids and regular sunscreen use reduced the number of new squamous cell carcinomas in patients with AKs.
• MAL (Methyl aminolevulinate)-PDT, DL (day light) PDT and imiquimod (IMQ) cream demonstrated to render the lowest percentage of new AKs, at post treatment follow up.
• Regular sunscreen use helps preventing new AKs. For IMQ 5% and 3.75% a higher intensity of skin reactions is associated with higher efficacy.
• Limited evidence is available for the treatment of AKs in organ transplant recipients (OTRs). While there is no evidence in favor or against the use of any of the available treatments in patients suffering from hematological cancer.

Hence, consensus was reached among experts on how to best treat AK in different clinical scenarios and among special populations.

Source: Dermatologic Therapy. 2020 Jul 10;e13992. doi: 10.1111/dth.13992.