Treatment of Actinic Keratosis

Introduction to Treatment Options

The British Journal of Dermatology recommends cryotherapy as a flexible and effective method for individual lesions, particularly for thicker lesions, although scarring may occur 1, 2
The British Journal of Dermatology suggests curettage for grade 3 (thick) actinic keratoses resistant to topical treatments or when there is suspicion of early squamous cell carcinoma 1
Application of 100% phenol once a month for up to 8 months has shown no recurrence at 12 months, as reported in the British Journal of Dermatology 3

The British Journal of Dermatology recommends 5-fluorouracil (5-FU) at 5%: applied twice daily for 3-4 weeks, effective in reducing about 70% of actinic keratoses for up to 12 months 4, 2
Imiquimod at 5%: applied three times a week for 16 weeks, with a complete response rate of 47%, according to the British Journal of Dermatology 5, 2
Diclofenac gel at 3%: moderate efficacy with low morbidity for mild actinic keratoses, applied for 60-90 days, as stated in the British Journal of Dermatology 2, 6
Photodynamic therapy (PDT): particularly effective for confluent actinic keratoses of the scalp and difficult-to-treat areas, as reported in the British Journal of Dermatology 1, 7

For the ear, a frequent site with a higher risk of transformation into squamous cell carcinoma, histological biopsy is recommended for thick lesions, according to the British Journal of Dermatology 3
For the periorbital area, special precaution is needed to avoid contact of products with the eye; cryotherapy with a contact probe is preferable, as stated in the British Journal of Dermatology 3
For the legs, there is a risk of poor healing; PDT presents less risk of unfavorable scarring compared to other physical therapies, as reported in the British Journal of Dermatology 1
For the backs of hands, topical treatments may require longer periods, and pretreatment with 5% salicylic acid can improve results, according to the British Journal of Dermatology 8

Regular use of high-index sunscreen reduces the appearance of new actinic keratoses, as reported in the British Journal of Dermatology 9
Application of sunscreen with a protection factor of 17 twice daily for 7 months is superior to emollient in reducing the total number of actinic keratoses, according to the British Journal of Dermatology 9

Diclofenac at 3% as a pretreatment for 5-FU at 0.5% in 10% salicylic acid is effective as a sequential treatment, as stated in the British Journal of Dermatology 3
Pretreatment with 5-FU at 5% for 5-7 days can be effective in combination with cryotherapy or PDT, according to the British Journal of Dermatology 3
PDT followed by imiquimod twice a week for 16 weeks is more beneficial than PDT alone, as reported in the British Journal of Dermatology 3

Patient education on potential side effects is essential, as many treatments cause redness, pain, and sometimes crusts, according to the British Journal of Dermatology 8
Failure of an individual lesion to respond to physical therapy indicates a need for further evaluation, which may include formal excision, as stated in the British Journal of Dermatology 1
Actinic keratosis lesions can spontaneously regress in 15-25% of cases over a period of one year, as reported in the British Journal of Dermatology 9
The rate of malignant transformation is low, less than 1 in 1000 per year, but for an individual with an average of 7.7 actinic keratoses, the probability that at least one will transform over a period of 10 years is about 10%, according to the British Journal of Dermatology 9