Managing Actinic Keratosis: An Expert Consensus

actinic keratosis
actinic keratosis
Consensus was reached by experts on how to best treat patients with actinic keratosis with respect to different clinical scenarios and special populations.

Researchers have issued an expert consensus for managing patients with actinic keratosis (AK), as published in Dermatologic Therapy.

A panel of dermatologists in Italy selected 7 common clinical questions regarding AK treatment and analyzed the evidence for each one after conducting a systematic literature review. The study group then developed the following 7 consensus statements:

· Statement 1: There is scarce available literature on interventions for patients with few AKs. Lesion-directed treatments are preferred in patients with few AKs.

· Statement 2: Patients with multiple AKs are challenging, and more than 1 treatment is usually needed to achieve complete lesion clearance or a high lesion response rate. Therapy should be personalized, based on previous treatments and patient and lesion characteristics.

· Statement 3: Limited evidence is available on the efficacy of AK treatments for lesions located on the arms. The majority of studies investigated photodynamic therapy (PDT); some treatments are off-label if used to treat AKs on the arms.

· Statement 4: Few studies are available on effective therapy for reducing the incidence of squamous cell carcinoma (SCC) in patients with AKs. Oral nicotinamide 500 mg twice daily, systemic retinoids, and regular sunscreen use were demonstrated to reduce the number of new SCCs.

· Statement 5: Methyl aminolevulinate (MAL)-PDT, daylight PDT, and 5% imiquimod (IMQ) cream were demonstrated to have the lowest percentage of new AKs after post-treatment follow-up. Regular sunscreen use helps prevent new AKs.

· Statement 6: For IMQ 5% and 3.75%, a higher intensity of skin reactions is associated with higher efficacy.

· Statement 7: MAL-PDT is currently the best studied intervention for the treatment of AKs in organ transplant recipients. There is no evidence in favor or against the use of any of the available treatments in patients with hematological cancer.

“The management of patients with AKs can be challenging,” stated the study group. “AKs are relapsing and remitting and constitute a chronic disease. Many parameters should be taken into consideration when designing a treatment approach. In all instances, management should entail advice on sun protection and long-term follow-up for the associated increased risk of nonmelanoma skin cancer.”


Moscarella E, Di Brizzi EV, Casari A, et al. Italian expert consensus paper on the management of patients with actinic keratoses [e-pub ahead of print]. Dermatol Ther. doi: 10.1111/dth.13992