Pharmacotherapeutic Management of Actinic Keratosis: Focus on Newer Topical Agents
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Actinic (solar) keratoses (AK) have the potential for malignant transformation and are the second most common diagnosis in dermatologic practices. No well-established clinical criteria are available to determine which AK are more likely to undergo malignant transformation; therefore, many dermatologists utilize field-directed approaches to treat all visible and subclinical AK on an affected skin surface. Current topical therapeutic agents require lengthy treatment regimens and are less well tolerated than many newer and investigational agents. We review and compare the efficacy and tolerability of well-established topical agents for the management of AK in the United States including 5-fluorouracil, imiquimod 5 % cream as well as the newer 2.5 and 3.75 % formulations, diclofenac 3 % gel, photodynamic therapy, and the recently approved ingenol mebutate gel and discuss the therapeutic potential of investigational agents. Cryotherapy and 5-fluorouracil are efficacious at treating AK but less tolerable than imiquimod cream, particularly at its lower concentrations. The newer agents, diclofenac gel and ingenol mebutate, appear to be more tolerable than cryotherapy and 5- fluorouracil; however, comparative studies regarding efficacy are not available.
- Berman B, Cohen DE, Amini S. What is the role of field-directed therapy in the treatment of actinic keratosis? Part 1: overview and investigational topical agents. Cutis. 2012;89(5):241–50.
- Berman B, Cohen DE, Amini S. What is the role of field-directed therapy in the treatment of actinic keratosis? Part 2: commonly used field-directed and lesion-directed therapies. Cutis. 2012;89(6):294–301.
- Quaedvlieg PJ, Tirsi E, Thissen MR, et al. Actinic keratosis: how to differentiate the good from the bad ones? Eur J Dermatol. 2006;16:335–9.
- Krawtchenko N, Roewert-Huber J, Ulrich M, et al. A randomised study of topical 5% imiquimod vs. topical 5-fluorouracil vs. cryosurgery in immunocompetent patients with actinic keratoses: a comparison of clinical and histological outcomes including 1-year follow-up. Br J Dermatol. 2007;157(suppl 2):34–40. CrossRef
- Yentzer B, Hick J, Williams L, et al. Adherence to a topical regimen of 5-fluorouracil 0.5% cream for the treatment of actinic keratosis. Arch Dermatol. 2009;145:203–5. CrossRef
- Jorizzo J, Weiss J, Furst K, et al. Effect of a 1-week treatment with 0.5% topical fluorouracil on occurrence of actinic keratosis after cryosurgery: a randomized, vehicle-controlled clinical trial. Arch Dermatol. 2004;140:813–6. CrossRef
- Stockfleth E, Sterry W, Carey-Yard M, et al. Multicentre, open-label study using imiquimod 5% cream in one or two 4-week courses of treatment for multiple actinic keratoses on the head. Br J Dermatol. 2007;157(suppl 2):41–6. CrossRef
- Swanson N, Abramovits W, Berman B, Kulp J, Rigel DS, Levy S. Imiquimod 2.5% and 3.75% for the treatment of actinic keratoses: results of two placebo-controlled studies of daily application to the face and balding scalp for two 2-week cycles. J Am Acad Dermatol. 2010;62(4):582–90. CrossRef
- Foley P, Merlin K, Cumming S, Campbell J, et al. A comparison of cryotherapy and imiquimod for treatment of actinic keratoses: lesion clearance, safety, and skin quality outcomes. J Drugs Dermatol. 2011;10(12):1432–8.
- Tan JK, Thomas DR, Poulin Y, et al. Efficacy of imiquimod as an adjunct to cryotherapy for actinic keratoses. J Cutan Med Surg. 2007;11:195–201.
- Martin GM, Stockfleth E. Diclofenac sodium 3% gel for the management of actinic keratosis: 10 + years of cumulative evidence of efficacy and safety. J Drugs Dermatol. 2012;11(5):600–8.
- de Berker D, McGregor JM, Hughes BR. British Association of Dermatologists Therapy Guidelines and Audit Subcommittee. Guidelines for the management of actinic keratoses [published correction in Br J Dermatol. 2008;158:873]. Br J Dermatol. 2007;156:222–30. CrossRef
- Mastrolonardo M. Topical diclofenac 3% gel plus cryotherapy for treatment of multiple and recurrent actinic keratoses. Clin Exp Dermatol. 2009;34(1):33–5. CrossRef
- Smith SR, Morhenn VB, Piacquadio DJ. Bilateral comparison of the efficacy and tolerability of 3% diclofenac sodium gel and 5% 5-fluorouracil cream in the treatment of actinic keratoses of the face and scalp. J Drugs Dermatol. 2006;5:156–9.
- Ogbourne SM, Suhrbier A, Jones B, et al. Antitumor activity of 3-ingenyl angelate: plasma membrane and mitochondrial disruption and necrotic cell death. Cancer Res. 2004;64(8):2833–9. CrossRef
- Siller G, Gebauer K, Welburn P, et al. PEP005 (ingenol mebutate) gel, a novel agent for the treatment of actinic keratosis: results of a randomized, double-blind, vehicle-controlled, multicentre, phase IIa study. Australas J Dermatol. 2009;50(1):16–22. CrossRef
- Stockfleth E, Kerl H, Zwingers T, Willers C. Low-dose 5-fluorouracil in combination with salicylic acid as a new lesion-directed option to treat topically actinic keratoses: histological and clinical study results. Br J Dermatol. 2011;165(5):1101–8. CrossRef
- Szeimies RM, Bichel J, Ortonne JP, et al. A phase II dose-ranging study of topical resiquimod to treat actinic keratosis. Br J Dermatol. 2008;159(1):205–10. CrossRef
- Campione E, Diluvio L, Paternò EJ, et al. Topical treatment of actinic keratoses with piroxicam 1% gel: a preliminary open-label study utilizing a new clinical score. Am J Clin Dermatol. 2010;11:45–50. CrossRef
- Huyke C, Reuter J, Rödig M, et al. Treatment of actinic keratoses with a novel betulin-based oleogel. A prospective, randomized, comparative pilot study. J Dtsch Dermatol Ges. 2009;7(2):128–33.
- Pharmacotherapeutic Management of Actinic Keratosis: Focus on Newer Topical Agents
American Journal of Clinical Dermatology
Volume 14, Issue 4 , pp 273-277
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- Springer International Publishing
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- Author Affiliations
- 1. Division of Dermatology, University of California-Habor Medical Center, Torrance, CA, USA
- 2. Department of Dermatology, University of Texas, Southwestern, Dallas, TX, USA
- 3. Department of Pathology, University of Texas, Southwestern, Dallas, TX, USA
- 4. Dermpath Diagnostics, 2330 Butler St, Suite 115, Dallas, TX, 75235, USA