The International Leagues of Dermatological Societies (ILDS) in cooperation with the European Dermatology Forum has developed consensus-based guidelines for the treatment of actinic keratosis (AK), which are published in the Journal of the European Academy of Dermatology and Venereology.
“The guidelines were elaborated along adapted recommendations by the WHO guidelines review committee and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group,” say R. N. Werner and colleagues of the Medical University of Berlin. The guidelines include recommendations for treatment of different subgroups of AK patients, how to make an AK diagnosis, how to assess AK patients, and how to define AK.
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The ILDS in cooperation with the European Dermatology Forum has developed consensus-based guidelines for the treatment of actinic keratosis.
The ILDS recommends or suggests the following interventions for treating patients who have single AK lesions:
• Cryotherapy
• Curettage (discrete, hyperkeratotic lesions)
• 0.5% 5-fluorouracil (5-FU)
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 3.75% imiquimod
• 5% imiquimod
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)
• 5-aminolevulinic acid-photodynamic therapy (ALA-PDT)
• methylaminolevulinate-photodynamic therapy (MAL-PDT)
For patients with multiple AK lesions/field cancerization, the ILDS recommends* or suggests that patients use the following therapies:
• 0.5% 5-FU*
• 3.75% imiquimod*
• Ingenol mebutate 0.015% (lesions on the face or scalp) and ingenol mebutate 0.05% (lesions on the trunk or extremities)*
• ALA-PDT*
• MAL-PDT*
• Cryotherapy (patients with multiple lesions, especially for multiple discrete lesions; not suitable for the treatment of field cancerization)
• 3% diclofenac in 2.5% hyaluronic acid gel
• 5% 5-FU
• 0.5% 5-FU + 10% salicylic acid (discrete, hyperkeratotic lesions)
• 5% imiquimod
• 2.5% imiquimod
• CO2 laser and Er:YAG laser
For immunosuppressed AK patients, the ILDS suggests the following treatments:
• Cryotherapy (especially for single lesions or multiple discrete lesions; not suitable for the treatment of field cancerization);
• Curettage (discrete, hyperkeratotic lesions)
• 5% 5-FU
• 5% imiquimod
• ALA-PDT
• MAL-PDT
The ILDS additionally recommends that immunosuppressed AK patients not use CO2 laser and Er:YAG laser.
“Deviation from the recommendations may be justified or inevitable in specific situations. The ultimate judgment regarding patient care must be individualized and must be made by the physician and patient in light of all presenting circumstances,” the authors said. “International guidelines are intended to be adapted to national or regional circumstances” (J Eur Acad Dermatol Venereol. 2015;29:2069-79).
The “long version of the guidelines” is available as an online supplement. Additionally, a methods report, results report, and declarations of interest of the guidelines development have been published at doi: 10.1111/jdv.13179 in the Journal of the European Academy of Dermatology and Venereology (2015).