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Treatment of actinic keratosis: a systematic review

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Abstract

Treatment of actinic keratoses (AKs) can help lower the risk of eventual skin cancer and address field pre-cancerization. This review compares the different therapeutic options for actinic keratosis. Databases used include Medline, EMBASE, Web of Science and the Cochrane Library from inception to December 2019. Randomized control trials that were related to any approved or recognized treatment for actinic keratosis were included. 1186 studies were found, of which 80 with 6748 patients were included in the analysis. A network meta-analysis was not possible due to interstudy heterogeneity. The greatest degree of improvement was seen with photodynamic therapy (PDT) used adjunctively with other modalities, but this was not significantly different compared to other treatments. PDT, cryotherapy, imiquimod, ingenol mebutate (IMB), 5-fluorouracil (5-FU), trichloroacetic acid (TCA), and ablative fractional laser (AFXL), were all non-inferior to one another in terms of percent clearance of AKs, but the lowest rates of clearance were seen with diclofenac sodium. When results were substratified by body site, 5-FU, combination PDT and combination 5-FU with calcipotriol were the most beneficial for AKs on the head and neck, although they often caused the highest proportion of initial side effects. Absence of randomized control trials for surgical treatments and non-ablative laser limits comparison of these treatments to other modalities. Limitations include the lack of standardized outcome reporting limited the comparability of results across trials. The results of this analysis do not account for individual patient risk or cumulative risk for development of skin cancer. At present, PDT, cryotherapy, imiquimod, IMB, 5-FU, TCA, AFXL, and combination treatments are similarly efficacious in reducing AKs in immunocompetent patients.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Northwestern University Department of Dermatology.

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Authors and Affiliations

  1. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Brandon Worley, Vishnu Harikumar, Kelly Reynolds, McKenzie A. Dirr, Rachel E. Christensen, Noor Anvery, Michael D. Yi, Emily Poon & Murad Alam

  2. Florida Dermatology and Skin Cancer Centers, Lake Wales, FL, USA

    Brandon Worley

  3. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Kelly Reynolds

  4. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Murad Alam

  5. Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Murad Alam

  6. Department of Dermatology, Northwestern Memorial Hospital, IL, 60611, Chicago, USA

    Murad Alam

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Worley, B., Harikumar, V., Reynolds, K. et al. Treatment of actinic keratosis: a systematic review. Arch Dermatol Res 315, 1099–1108 (2023). https://doi.org/10.1007/s00403-022-02490-5

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