Clinical Management of Actinic Keratosis: Review and Update
Main Article Content
Keywords
Nonmelanoma skin cancer, actinic keratosis, squamous cell carcinoma, clinical management
Abstract
Actinic keratosis is commonly seen in dermatology clinics. Age and chronic sun exposure are the essential risk factors for its pathogenesis. It is regarded as a premalignant lesion; hence, aggressive treatment is warranted. Abundant research has been published about overall management, however, extensive knowledge about actinic keratosis prevention, the cost, safety profile, and mechanism of the existing therapeutics are pivotal in optimal clinical care. In this review article, we hereby present several commonly used approaches in office settings and the current guidelines. Finally, we will discuss the limitations of the available clinical evidence.
References
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2. Schmitt JV, Miot HA. Actinic keratosis: a clinical and epidemiological revision. An Bras Dermatol. 2012;87(3):425-434.
3. Cockerell CJ. Histopathology of incipient intraepidermal squamous cell carcinoma (“actinic keratosis”). J Am Acad Dermatol. 2000;42(1, Part 2):S11-S17.
4. Marques E, Chen TM. Actinic Keratosis. In: StatPearls. StatPearls Publishing; 2022.
5. Yaldiz M. Prevalence of actinic keratosis in patients attending the dermatology outpatient clinic. Medicine . 2019;98(28):e16465.
6. Madani S, Marwaha S, Dusendang JR, et al. Ten-Year Follow-up of Persons With Sun-Damaged Skin Associated With Subsequent Development of Cutaneous Squamous Cell Carcinoma. JAMA Dermatol. 2021;157(5):559-565.
7. Flohil SC, van der Leest RJT, Dowlatshahi EA, Hofman A, de Vries E, Nijsten T. Prevalence of actinic keratosis and its risk factors in the general population: the Rotterdam Study. J Invest Dermatol. 2013;133(8):1971-1978.
8. Banerjee S, Kaunelis D. Imiquimod for the Treatment of Actinic Keratosis: A Review of Clinical Effectiveness and Cost-Effectiveness. Canadian Agency for Drugs and Technologies in Health; 2018.
9. Filosa A, Filosa G. Actinic keratosis and squamous cell carcinoma: clinical and pathological features. G Ital Dermatol Venereol. 2015;150(4):379-384.
10. Cheng B, Veerabagu S, Miller CJ, et al. A comparison of invasive squamous cell carcinoma greater than 1 year after treatment with 5-Fluorouracil, Imiquimod, or Photodynamic Therapy with Aminolevulinic Acid. Journal of the American Academy of Dermatology. Published online 2022. doi:10.1016/j.jaad.2022.05.051
11. Jp. Bickers DR. Moy RL. Actinic keratoses. J Am Acad Dermatol.
12. Roewert-Huber J, Stockfleth E, Kerl H. Pathology and pathobiology of actinic (solar) keratosis - an update. British Journal of Dermatology. 2007;157:18-20. doi:10.1111/j.1365-2133.2007.08267.x
13. Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993;329(16):1147-1151.
14. Naylor MF, Boyd A, Smith DW, Cameron GS, Hubbard D, Neldner KH. High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol. 1995;131(2):170-175.
15. Actinic keratosis: Self-care. Accessed May 28, 2022. https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-self-care
16. Walker JL, Siegel JA, Sachar M, et al. 5-Fluorouracil for Actinic Keratosis Treatment and Chemoprevention: A Randomized Controlled Trial. J Invest Dermatol. 2017;137(6):1367-1370.
17. Pomerantz H, Hogan D, Eilers D, et al. Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis. JAMA Dermatology. 2015;151(9):952. doi:10.1001/jamadermatol.2015.0502
18. Gollnick H, Dirschka T, Ostendorf R, Kerl H, Kunstfeld R. Long-term clinical outcomes of imiquimod 5% cream vs. diclofenac 3% gel for actinic keratosis on the face or scalp: a pooled analysis of two randomized controlled trials. J Eur Acad Dermatol Venereol. 2020;34(1):82-89.
19. Jetter N, Chandan N, Wang S, Tsoukas M. Field Cancerization Therapies for Management of Actinic Keratosis: A Narrative Review. Am J Clin Dermatol. 2018;19(4):543-557.
20. Goldenberg G, Perl M. Actinic keratosis: update on field therapy. J Clin Aesthet Dermatol. 2014;7(10):28-31.
21. Prohaska J, Jan AH. Cryotherapy. In: StatPearls. StatPearls Publishing; 2022.
22. Nanda J, Bermudez R. Imiquimod. In: StatPearls. StatPearls Publishing; 2021.
23. Caperton C, Berman B. Safety, efficacy, and patient acceptability of imiquimod for topical treatment of actinic keratoses. Clin Cosmet Investig Dermatol. 2011;4:35-40.
24. Gupta AK, Paquet M, Villanueva E, Brintnell W. Interventions for actinic keratoses. Cochrane Database of Systematic Reviews. Published online 2012. doi:10.1002/14651858.cd004415.pub2
25. Lebwohl M, Dinehart S, Whiting D, et al. Imiquimod 5% cream for the treatment of actinic keratosis: results from two phase III, randomized, double-blind, parallel group, vehicle-controlled trials. Journal of the American Academy of Dermatology. 2004;50(5):714-721. doi:10.1016/j.jaad.2003.12.010
26. Szeimies RM, Gerritsen MJP, Gupta G, et al. Imiquimod 5% cream for the treatment of actinic keratosis: results from a phase III, randomized, double-blind, vehicle-controlled, clinical trial with histology. J Am Acad Dermatol. 2004;51(4):547-555.
27. Korman, Moy, Ling, Matheson. Dosing with 5% imiquimod cream 3 times per week for the treatment of actinic keratosis: results of two phase 3, randomized, double-blind, parallel-group, vehicle …. Arch nat conserv landsc res. https://jamanetwork.com/journals/jamadermatology/article-abstract/393884
28. Bhatia N. Local skin reactions and the onset of influenza-like signs and symptoms induced by imiquimod. JAAD Int. 2022;7:113-118.
29. Berman B, Ricotti CA Jr, Cazzaniga A, Davis SC. Determination of the area of skin capable of being covered by the application of 250 mg of 5% imiquimod cream. Dermatol Surg. 2004;30(5):784-786.
30. Blauvelt A, Kempers S, Lain E, et al. Phase 3 Trials of Tirbanibulin Ointment for Actinic Keratosis. N Engl J Med. 2021;384(6):512-520.
31. Dunn A, Han H, Gade A, Berman B. The Area Capable of Being Covered by the Application of 250mg of Tirbanibulin Ointment. J Clin Aesthet Dermatol. 2022;15(3):13-14.
32. Berman, Schlesinger, Bhatia. Complete clearance of actinic keratosis with tirbanibulin ointment 1% is not correlated with the severity of local skin reactions. SKIN J Cutan Med.
https://scholar.archive.org/work/hwrh24otqbchrff6owyeeki7ey/access/wayback/https://jofskin.org/index.php/skin/article/download/1542/pdf
33. Berman, Gual, Grada, Fumero. Efficacy of tirbanibulin ointment 1% across different patient populations: pooled results from two Phase 3 studies. SKIN J Cutan Med.
https://scholar.archive.org/work/b7co2q56sbdjdnygz447ibx4om/access/wayback/https://jofskin.org/index.php/skin/article/download/1544/pdf
34. Casale J, Patel P. Fluorouracil. In: StatPearls. StatPearls Publishing; 2022.
35. Schauder DM, Kim J, Nijhawan RI. Evaluation of the Use of Capecitabine for the Treatment and Prevention of Actinic Keratoses, Squamous Cell Carcinoma, and Basal Cell Carcinoma: A Systematic Review. JAMA Dermatol. 2020;156(10):1117-1124.
36. Gupta AK, Davey V, Mcphail H. Evaluation of the effectiveness of imiquimod and 5-fluorouracil for the treatment of actinic keratosis: Critical review and meta-analysis of efficacy studies. J Cutan Med Surg. 2005;9(5):209-214.
37. Wan MT, Lin JY. Current evidence and applications of photodynamic therapy in dermatology. Clin Cosmet Investig Dermatol. 2014;7:145-163.
38. Raizada K, Naik M. Photodynamic Therapy For The Eye. In: StatPearls. StatPearls Publishing; 2021.
39. Nestor MS, Berman B, Patel J, Lawson A. Safety and Efficacy of Aminolevulinic Acid 10% Topical Gel versus Aminolevulinic Acid 20% Topical Solution Followed by Blue-light Photodynamic Therapy for the Treatment of Actinic Keratosis on the Face and Scalp: A Randomized, Double-blind Study. J Clin Aesthet Dermatol. 2019;12(3):32-38.
40. Martin GM. In-office Painless Aminolevulinic Acid Photodynamic Therapy: A Proof of Concept Study and Clinical Experience in More Than 100 Patients. J Clin Aesthet Dermatol. 2016;9(2):19-26.
41. Kaw U, Ilyas M, Bullock T, et al. A regimen to minimize pain during blue light photodynamic therapy of actinic keratoses: Bilaterally controlled, randomized trial of simultaneous versus conventional illumination. J Am Acad Dermatol. 2020;82(4):862-868.
42. Wulf HC. Photodynamic Therapy in Daylight for Actinic Keratoses. JAMA Dermatol. 2016;152(6):631-632.
43. Rubel DM, Spelman L, Murrell DF, et al. Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: a randomized controlled trial. Br J Dermatol. 2014;171(5):1164-1171.
44. Lacour JP, Ulrich C, Gilaberte Y, et al. Daylight photodynamic therapy with methyl aminolevulinate cream is effective and nearly painless in treating actinic keratoses: a randomized, investigator-blinded, controlled, phase III study throughout Europe. Journal of the European Academy of Dermatology and Venereology. 2015;29(12):2342-2348. doi:10.1111/jdv.13228
45. Kellner C, Bauriedl S, Hollstein S, Reinhold U. Simulated-daylight photodynamic therapy with BF-200 aminolaevulinic acid for actinic keratosis: assessment of the efficacy and tolerability in a retrospective study. Br J Dermatol. 2015;172(4):1146-1148.
46. Ulrich M, Reinhold U, Dominicus R, Aschoff R, Szeimies RM, Dirschka T. Red light photodynamic therapy with BF-200 ALA showed superior efficacy in the treatment of actinic keratosis on the extremities, trunk, and neck in a vehicle-controlled phase III study. J Am Acad Dermatol. 2021;85(6):1510-1519.
47. Dirschka T, Radny P, Dominicus R, et al. Photodynamic therapy with BF-200 ALA for the treatment of actinic keratosis: results of a multicentre, randomized, observer-blind phase III study in comparison with a registered methyl-5-aminolaevulinate cream and placebo. Br J Dermatol. 2012;166(1):137-146.
48. Pirard D, Vereecken P, Mélot C, Heenen M. Three percent diclofenac in 2.5% hyaluronan gel in the treatment of actinic keratoses: a meta-analysis of the recent studies. Arch Dermatol Res. 2005;297(5):185-189.
49. 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(2):156-159.
50. Lesiak A, Maćkowska A, Bednarski IA, et al. Ingenol mebutate treatment in actinic keratosis - clinical effectiveness and potential side effects. Postepy Dermatol Alergol. 2019;36(4):468-471.
51. Lebwohl M, Swanson N, Anderson LL, Melgaard A, Xu Z, Berman B. Ingenol mebutate gel for actinic keratosis. N Engl J Med. 2012;366(11):1010-1019.
52. Steeb T, Wessely A, Petzold A, et al. How to Assess the Efficacy of Interventions for Actinic Keratosis? A Review with a Focus on Long-Term Results. J Clin Med Res. 2021;10(20). doi:10.3390/jcm10204736
53. Jansen MHE, Kessels JPHM, Nelemans PJ, et al. Randomized Trial of Four Treatment Approaches for Actinic Keratosis. N Engl J Med. 2019;380(10):935-946.
54. Gupta AK, Paquet M. Network meta-analysis of the outcome “participant complete clearance” in nonimmunosuppressed participants of eight interventions for actinic keratosis: a follow-up on a Cochrane review. Br J Dermatol. 2013;169(2):250-259.
55. Vegter S, Tolley K. A network meta-analysis of the relative efficacy of treatments for actinic keratosis of the face or scalp in Europe. PLoS One. 2014;9(6):e96829.
56. Werner RN, Stockfleth E, Connolly SM, et al. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version. Journal of the European Academy of Dermatology and Venereology. 2015;29(11):2069-2079. doi:10.1111/jdv.13180
57. Eisen DB, Dellavalle RP, Frazer-Green L, Schlesinger TE, Shive M, Wu PA. Focused update to the Guidelines of Care for the Management of Actinic Keratosis: Executive Summary. J Am Acad Dermatol. Published online April 16, 2022. doi:10.1016/j.jaad.2022.04.013
2. Schmitt JV, Miot HA. Actinic keratosis: a clinical and epidemiological revision. An Bras Dermatol. 2012;87(3):425-434.
3. Cockerell CJ. Histopathology of incipient intraepidermal squamous cell carcinoma (“actinic keratosis”). J Am Acad Dermatol. 2000;42(1, Part 2):S11-S17.
4. Marques E, Chen TM. Actinic Keratosis. In: StatPearls. StatPearls Publishing; 2022.
5. Yaldiz M. Prevalence of actinic keratosis in patients attending the dermatology outpatient clinic. Medicine . 2019;98(28):e16465.
6. Madani S, Marwaha S, Dusendang JR, et al. Ten-Year Follow-up of Persons With Sun-Damaged Skin Associated With Subsequent Development of Cutaneous Squamous Cell Carcinoma. JAMA Dermatol. 2021;157(5):559-565.
7. Flohil SC, van der Leest RJT, Dowlatshahi EA, Hofman A, de Vries E, Nijsten T. Prevalence of actinic keratosis and its risk factors in the general population: the Rotterdam Study. J Invest Dermatol. 2013;133(8):1971-1978.
8. Banerjee S, Kaunelis D. Imiquimod for the Treatment of Actinic Keratosis: A Review of Clinical Effectiveness and Cost-Effectiveness. Canadian Agency for Drugs and Technologies in Health; 2018.
9. Filosa A, Filosa G. Actinic keratosis and squamous cell carcinoma: clinical and pathological features. G Ital Dermatol Venereol. 2015;150(4):379-384.
10. Cheng B, Veerabagu S, Miller CJ, et al. A comparison of invasive squamous cell carcinoma greater than 1 year after treatment with 5-Fluorouracil, Imiquimod, or Photodynamic Therapy with Aminolevulinic Acid. Journal of the American Academy of Dermatology. Published online 2022. doi:10.1016/j.jaad.2022.05.051
11. Jp. Bickers DR. Moy RL. Actinic keratoses. J Am Acad Dermatol.
12. Roewert-Huber J, Stockfleth E, Kerl H. Pathology and pathobiology of actinic (solar) keratosis - an update. British Journal of Dermatology. 2007;157:18-20. doi:10.1111/j.1365-2133.2007.08267.x
13. Thompson SC, Jolley D, Marks R. Reduction of solar keratoses by regular sunscreen use. N Engl J Med. 1993;329(16):1147-1151.
14. Naylor MF, Boyd A, Smith DW, Cameron GS, Hubbard D, Neldner KH. High sun protection factor sunscreens in the suppression of actinic neoplasia. Arch Dermatol. 1995;131(2):170-175.
15. Actinic keratosis: Self-care. Accessed May 28, 2022. https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-self-care
16. Walker JL, Siegel JA, Sachar M, et al. 5-Fluorouracil for Actinic Keratosis Treatment and Chemoprevention: A Randomized Controlled Trial. J Invest Dermatol. 2017;137(6):1367-1370.
17. Pomerantz H, Hogan D, Eilers D, et al. Long-term Efficacy of Topical Fluorouracil Cream, 5%, for Treating Actinic Keratosis. JAMA Dermatology. 2015;151(9):952. doi:10.1001/jamadermatol.2015.0502
18. Gollnick H, Dirschka T, Ostendorf R, Kerl H, Kunstfeld R. Long-term clinical outcomes of imiquimod 5% cream vs. diclofenac 3% gel for actinic keratosis on the face or scalp: a pooled analysis of two randomized controlled trials. J Eur Acad Dermatol Venereol. 2020;34(1):82-89.
19. Jetter N, Chandan N, Wang S, Tsoukas M. Field Cancerization Therapies for Management of Actinic Keratosis: A Narrative Review. Am J Clin Dermatol. 2018;19(4):543-557.
20. Goldenberg G, Perl M. Actinic keratosis: update on field therapy. J Clin Aesthet Dermatol. 2014;7(10):28-31.
21. Prohaska J, Jan AH. Cryotherapy. In: StatPearls. StatPearls Publishing; 2022.
22. Nanda J, Bermudez R. Imiquimod. In: StatPearls. StatPearls Publishing; 2021.
23. Caperton C, Berman B. Safety, efficacy, and patient acceptability of imiquimod for topical treatment of actinic keratoses. Clin Cosmet Investig Dermatol. 2011;4:35-40.
24. Gupta AK, Paquet M, Villanueva E, Brintnell W. Interventions for actinic keratoses. Cochrane Database of Systematic Reviews. Published online 2012. doi:10.1002/14651858.cd004415.pub2
25. Lebwohl M, Dinehart S, Whiting D, et al. Imiquimod 5% cream for the treatment of actinic keratosis: results from two phase III, randomized, double-blind, parallel group, vehicle-controlled trials. Journal of the American Academy of Dermatology. 2004;50(5):714-721. doi:10.1016/j.jaad.2003.12.010
26. Szeimies RM, Gerritsen MJP, Gupta G, et al. Imiquimod 5% cream for the treatment of actinic keratosis: results from a phase III, randomized, double-blind, vehicle-controlled, clinical trial with histology. J Am Acad Dermatol. 2004;51(4):547-555.
27. Korman, Moy, Ling, Matheson. Dosing with 5% imiquimod cream 3 times per week for the treatment of actinic keratosis: results of two phase 3, randomized, double-blind, parallel-group, vehicle …. Arch nat conserv landsc res. https://jamanetwork.com/journals/jamadermatology/article-abstract/393884
28. Bhatia N. Local skin reactions and the onset of influenza-like signs and symptoms induced by imiquimod. JAAD Int. 2022;7:113-118.
29. Berman B, Ricotti CA Jr, Cazzaniga A, Davis SC. Determination of the area of skin capable of being covered by the application of 250 mg of 5% imiquimod cream. Dermatol Surg. 2004;30(5):784-786.
30. Blauvelt A, Kempers S, Lain E, et al. Phase 3 Trials of Tirbanibulin Ointment for Actinic Keratosis. N Engl J Med. 2021;384(6):512-520.
31. Dunn A, Han H, Gade A, Berman B. The Area Capable of Being Covered by the Application of 250mg of Tirbanibulin Ointment. J Clin Aesthet Dermatol. 2022;15(3):13-14.
32. Berman, Schlesinger, Bhatia. Complete clearance of actinic keratosis with tirbanibulin ointment 1% is not correlated with the severity of local skin reactions. SKIN J Cutan Med.
https://scholar.archive.org/work/hwrh24otqbchrff6owyeeki7ey/access/wayback/https://jofskin.org/index.php/skin/article/download/1542/pdf
33. Berman, Gual, Grada, Fumero. Efficacy of tirbanibulin ointment 1% across different patient populations: pooled results from two Phase 3 studies. SKIN J Cutan Med.
https://scholar.archive.org/work/b7co2q56sbdjdnygz447ibx4om/access/wayback/https://jofskin.org/index.php/skin/article/download/1544/pdf
34. Casale J, Patel P. Fluorouracil. In: StatPearls. StatPearls Publishing; 2022.
35. Schauder DM, Kim J, Nijhawan RI. Evaluation of the Use of Capecitabine for the Treatment and Prevention of Actinic Keratoses, Squamous Cell Carcinoma, and Basal Cell Carcinoma: A Systematic Review. JAMA Dermatol. 2020;156(10):1117-1124.
36. Gupta AK, Davey V, Mcphail H. Evaluation of the effectiveness of imiquimod and 5-fluorouracil for the treatment of actinic keratosis: Critical review and meta-analysis of efficacy studies. J Cutan Med Surg. 2005;9(5):209-214.
37. Wan MT, Lin JY. Current evidence and applications of photodynamic therapy in dermatology. Clin Cosmet Investig Dermatol. 2014;7:145-163.
38. Raizada K, Naik M. Photodynamic Therapy For The Eye. In: StatPearls. StatPearls Publishing; 2021.
39. Nestor MS, Berman B, Patel J, Lawson A. Safety and Efficacy of Aminolevulinic Acid 10% Topical Gel versus Aminolevulinic Acid 20% Topical Solution Followed by Blue-light Photodynamic Therapy for the Treatment of Actinic Keratosis on the Face and Scalp: A Randomized, Double-blind Study. J Clin Aesthet Dermatol. 2019;12(3):32-38.
40. Martin GM. In-office Painless Aminolevulinic Acid Photodynamic Therapy: A Proof of Concept Study and Clinical Experience in More Than 100 Patients. J Clin Aesthet Dermatol. 2016;9(2):19-26.
41. Kaw U, Ilyas M, Bullock T, et al. A regimen to minimize pain during blue light photodynamic therapy of actinic keratoses: Bilaterally controlled, randomized trial of simultaneous versus conventional illumination. J Am Acad Dermatol. 2020;82(4):862-868.
42. Wulf HC. Photodynamic Therapy in Daylight for Actinic Keratoses. JAMA Dermatol. 2016;152(6):631-632.
43. Rubel DM, Spelman L, Murrell DF, et al. Daylight photodynamic therapy with methyl aminolevulinate cream as a convenient, similarly effective, nearly painless alternative to conventional photodynamic therapy in actinic keratosis treatment: a randomized controlled trial. Br J Dermatol. 2014;171(5):1164-1171.
44. Lacour JP, Ulrich C, Gilaberte Y, et al. Daylight photodynamic therapy with methyl aminolevulinate cream is effective and nearly painless in treating actinic keratoses: a randomized, investigator-blinded, controlled, phase III study throughout Europe. Journal of the European Academy of Dermatology and Venereology. 2015;29(12):2342-2348. doi:10.1111/jdv.13228
45. Kellner C, Bauriedl S, Hollstein S, Reinhold U. Simulated-daylight photodynamic therapy with BF-200 aminolaevulinic acid for actinic keratosis: assessment of the efficacy and tolerability in a retrospective study. Br J Dermatol. 2015;172(4):1146-1148.
46. Ulrich M, Reinhold U, Dominicus R, Aschoff R, Szeimies RM, Dirschka T. Red light photodynamic therapy with BF-200 ALA showed superior efficacy in the treatment of actinic keratosis on the extremities, trunk, and neck in a vehicle-controlled phase III study. J Am Acad Dermatol. 2021;85(6):1510-1519.
47. Dirschka T, Radny P, Dominicus R, et al. Photodynamic therapy with BF-200 ALA for the treatment of actinic keratosis: results of a multicentre, randomized, observer-blind phase III study in comparison with a registered methyl-5-aminolaevulinate cream and placebo. Br J Dermatol. 2012;166(1):137-146.
48. Pirard D, Vereecken P, Mélot C, Heenen M. Three percent diclofenac in 2.5% hyaluronan gel in the treatment of actinic keratoses: a meta-analysis of the recent studies. Arch Dermatol Res. 2005;297(5):185-189.
49. 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(2):156-159.
50. Lesiak A, Maćkowska A, Bednarski IA, et al. Ingenol mebutate treatment in actinic keratosis - clinical effectiveness and potential side effects. Postepy Dermatol Alergol. 2019;36(4):468-471.
51. Lebwohl M, Swanson N, Anderson LL, Melgaard A, Xu Z, Berman B. Ingenol mebutate gel for actinic keratosis. N Engl J Med. 2012;366(11):1010-1019.
52. Steeb T, Wessely A, Petzold A, et al. How to Assess the Efficacy of Interventions for Actinic Keratosis? A Review with a Focus on Long-Term Results. J Clin Med Res. 2021;10(20). doi:10.3390/jcm10204736
53. Jansen MHE, Kessels JPHM, Nelemans PJ, et al. Randomized Trial of Four Treatment Approaches for Actinic Keratosis. N Engl J Med. 2019;380(10):935-946.
54. Gupta AK, Paquet M. Network meta-analysis of the outcome “participant complete clearance” in nonimmunosuppressed participants of eight interventions for actinic keratosis: a follow-up on a Cochrane review. Br J Dermatol. 2013;169(2):250-259.
55. Vegter S, Tolley K. A network meta-analysis of the relative efficacy of treatments for actinic keratosis of the face or scalp in Europe. PLoS One. 2014;9(6):e96829.
56. Werner RN, Stockfleth E, Connolly SM, et al. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version. Journal of the European Academy of Dermatology and Venereology. 2015;29(11):2069-2079. doi:10.1111/jdv.13180
57. Eisen DB, Dellavalle RP, Frazer-Green L, Schlesinger TE, Shive M, Wu PA. Focused update to the Guidelines of Care for the Management of Actinic Keratosis: Executive Summary. J Am Acad Dermatol. Published online April 16, 2022. doi:10.1016/j.jaad.2022.04.013
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Jul 7, 2022
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Han, H., & Berman, B. . (2022). Clinical Management of Actinic Keratosis: Review and Update. SKIN The Journal of Cutaneous Medicine, 6(4), 274–285. https://doi.org/10.25251/skin.6.4.1
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Clinical Management Recommendations
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