Actinic keratoses (AKs), or solar keratoses, are pre-malignant cutaneous lesions that predominantly manifest in sun-exposed areas. They are one of the most common skin conditions seen by dermatologists, preceded only by acne vulgaris and dermatitis.
Actinic keratoses (AKs), or solar keratoses, are pre-malignant cutaneous lesions that predominantly manifest in sun-exposed areas. This article covers treatment regimens, sun protection, and the role that physicians play in improving patient awareness.
An actinic keratosis is a pre-malignant cutaneous lesion that frequently manifests in sun-exposed areas of the skin as a small, rough, scaly erythematous papule. Therapy choices are guided by efficacy, adverse effects, cosmetic results, and patient compliance.
Methyl aminolevulinate-hydrochloride cream (Metvix® [in Canada] and Metvixia® [in the US], Galderma) in combination with photodynamic therapy (PDT) provides an effective treatment option for actinic keratoses (AKs), superficial basal cell carcinoma (sBCC), and Bowen’s disease (BD).
Cutaneous concerns continue to be a significant part of family and specialty practices, as increasingly, patients are seeking medical consultation for the management of photodamage, actinic keratoses, and nonmelanoma skin cancer (NMSC), which is now a global epidemic.
The best approach is a pragmatic one. The patient with few AK lesions is most conveniently and cost effectively treated with a destructive technique (cryosurgery or curettage with light desiccation). Those with many AKs are candidates for medical therapy (such as 5-fluorouracil, imiquimod or diclofenac).
Actinic keratoses (AKs) are premalignant inflammatory skin lesions with the potential to transform into squamous cell carcinoma (SCC). There are several treatment options available for patients presenting with multiple AKs. Imiquimod is believed to stimulate and enhance host immune responses locally against skin tumors and viral infections.
Many of the treatment options available can cause discomfort, pain or skin irritation. Topical 3% diclofenac in 2.5% hyaluronan gel (Solaraze™, Bioglan Pharma) is a relatively new treatment that has been shown to be effective and well tolerated for the treatment of AKs.
The role of photodynamic therapy (PDT) in the treatment of in situ neoplasias and tumors of the skin is steadily increasing. Its principles of photodynamic action include an intratumoral enriched photosensitizer and light activation.
Carac® (5-fluorouracil 0.5% cream, Aventis Pharma) was approved by the US FDA in October 2000, for the treatment of multiple actinic or solar keratoses involving the face and anterior scalp.