ACTINIC KERATOSIS

Scaly, pink papules commonly found on sun-exposed areas of the skin, particularly in the elderly.  May progress on to Squamous Cell Carcinoma (est'd risk 0.25%-1%/yr--Med. Lett. 44:57, 2002)

Treatment options:

• Topical liquid nitrogen
• Topical aminolevulinic acid photodynamic therapy
• Electrodessication
• Curettage
• Excision
• Chemical peels
• Laser resurfacing
• Medications
  • 5-fluorouracil (Efudex 5% cream, 2% or 5% solution; Fluoroplex 1% cream or solution; Carac 0.5% cream) QD-BID x several weeks
    • > 90% effective
    • Can cause temporary erythema, blisters, and ulceration
  • Imiquimod (Aldara 5% cream 2-3x/wk x 16wks; Zyclara 3.75% cream QD at bedtime then wash off after 8h x 2wks then off x 2wks; max one cycle per skin area)
  • Diclofenac (Solaraze 3% gel)
    • Clearance rates around 50% in randomized trials (Med. Lett. 44:57, 2002)
    • Can cause dry skinm itching, and local rash
  • Aminolevulinic acid (Levulan Kerastick 20% solution)
    • Requires co-tx with a photoactivating blue light (BLU-U)
    • Can cause stinging & burning esp. during the light tx
    • Applied by the physician and followed by light tx the following day; can re-tx at 8wks if necessary
  • Ingenol mebutate gel
    • Causes cellular necrosis and affects various immunomodulatory mechanisms
    • Used QD x 3d (either 0.025% or 0.05%), more effective than placebo (J. Am. Acad. Dermatol. 60:934, 2009-JW)
    • Can cause redness, flaking, and scaling for up to 2 weeks