Shorter-Duration Actinic Keratosis Treatments Linked to Higher Patient Adherence and Satisfaction

actinic keratosis
actinic keratosis
A systematic review to assess patients’ opinions of topical, field-directed treatments for actinic keratosis was conducted.

Shorter duration of topical treatment for actinic keratosis achieved higher patient satisfaction and improved overall quality of life, according to a study published in Dermatologic Therapy.

Researchers conducted a systematic review to assess patients’ opinions of topical, field-directed treatments for actinic keratosis. The study authors performed a literature search using PubMed Central and identified 14 studies with a total of 4433 prevalently White patients. Among these studies, 7 focused on the face and/or scalp, 4 were clinical trials, and 1 study used a patient-reported outcomes instrument specifically developed for actinic keratosis.

Although no data were available for piroxicam, 10 studies assessed the other 4 topical therapies (imiquimod 5%, ingenol mebutate, ingenol disoxate, or 5-fluorouracil) and found acceptable overall satisfaction. In addition, 4 studies compared different topical treatments: 1 study compared diclofenac vs 5-fluorouracil; 2 studies compared diclofenac vs imiquimod vs ingenol mebutate; and, 1 study compared ingenol mebutate vs imiquimod 5%.

Ingenol mebutate and ingenol disoxate appeared to be well-tolerated by patients, with rather high treatment satisfaction scores and improved quality of life, according to the investigators. Patients who received ingenol mebutate globally had higher satisfaction compared with those who received imiquimod 5% and diclofenac, it was noted. Diclofenac caused fewer adverse events (erythema, edema, crusts, and itching) compared with 5-fluorouracil. Imiquimod improved quality of life in 1 study but not in another. No data were available on topical piroxicam.

Compared with other available pharmacologic options, ingenol mebutate appeared to be superior to the comparators from the patients’ perspective, according to the study authors.

The Actinic Keratosis Quality of Life questionnaire, an actinic keratosis–specific tool that assesses quality of life but not patients’ satisfaction with treatment, was only used in 1 study. Also, 4 studies used ad hoc, nonvalidated questionnaires.

“Involving patients and empowering them, implementing patient-centered and taking into account patients’ preferences and perspectives could enhance and improve their health status, paving the way also for personalized management options,” the researchers commented.

A key limitation to the findings was the small number of studies. Also, the high heterogeneity among the studies did not allow the investigators to conduct a meta-analysis.

The findings underscore the need for effective and well-tolerated, short-duration topical therapies for actinic keratosis, noted the researchers.

Disclosures: Two authors reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of their disclosures.


Grada A, Feldman SR, Bragazzi NL, Damiani G. Patient-reported outcomes of topical therapies in actinic keratosis: a systematic review. Dermatol Ther. Published online February 2, 2021. doi:10.1111/dth.14833