Current Guidelines for Treating Facial Actinic Keratosis

Introduction to Treatment Options

• The American Academy of Dermatology strongly recommends field treatment with 5-fluorouracil (5-FU) or imiquimod as first-line therapies for facial actinic keratosis, with cryosurgery recommended for isolated lesions 1

Treatment Selection Approach

• Treatment selection should be based on lesion characteristics, such as location, thickness, and number of lesions, as well as treatment factors like efficacy, tolerability, and treatment burden, and patient factors including symptoms, risk of progression, and cosmetic concerns 1

Field-Directed Treatments

• The American Academy of Dermatology recommends 5-fluorouracil (5-FU) with moderate quality evidence, which reduces approximately 70% of actinic keratoses for up to 12 months 1
• The American Academy of Dermatology also recommends imiquimod with moderate quality evidence 1
• Diclofenac 3% gel is conditionally recommended with low quality evidence, and has moderate efficacy with low morbidity for mild actinic keratoses 1

Lesion-Directed Treatments

• Cryosurgery is strongly recommended for individual lesions, particularly thicker ones, but may cause scarring 1

Combination Therapies

• Combination therapy of 5-FU and cryosurgery is conditionally recommended over cryosurgery alone 1
• Combination therapy of imiquimod and cryosurgery is also conditionally recommended over cryosurgery alone 1

Prevention

• The American Academy of Dermatology strongly recommends UV protection for all patients with actinic keratosis 1
• Regular sunscreen use reduces the appearance of new actinic keratoses 2

Risk of Progression

• The rate of malignant transformation is low, less than 1 in 1000 per year 2
• For an individual with an average of 7.7 actinic keratoses, the probability of at least one transforming over 10 years is about 10% 2

Spontaneous Regression

• Actinic keratosis lesions can spontaneously regress in 15-25% of cases over one year 2