Guidelines of care for the management of actinic keratosis - 03/04/21

Doi : 10.1016/j.jaad.2021.02.082

Daniel B. Eisen, MD ^a, Maryam M. Asgari, MD, MPH ^b,^c, Daniel D. Bennett, MD ^d, Suzanne M. Connolly, MD ^e, Robert P. Dellavalle, MD, PhD, MSPH ^f, Esther E. Freeman, MD, PhD ^b, Gary Goldenberg, MD ^g, David J. Leffell, MD ^h, Sue Peschin, MHS ⁱ, James E. Sligh, MD, PhD ^j,^k, Peggy A. Wu, MD, MPH ^a, Lindsy Frazer-Green, PhD ^l,^⁎ , Sameer Malik, MD, MBA ^l, Todd E. Schlesinger, MD ^m
^a Department of Dermatology, University of California, Davis, Sacramento, California
^b Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
^c Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
^d Department of Dermatology, University of Wisconsin, Madison, Wisconsin
^e Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
^f Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
^g Mount Sinai School of Medicine, New York, New York
^h Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
ⁱ Alliance for Aging Research, Washington, DC
^j Section of Dermatology, University of Arizona College of Medicine, Tucson, Arizona
^k Southern Arizona Department of Veterans Affairs Healthcare System, Tucson, Arizona
^l American Academy of Dermatology, Rosemont, Illinois
^m Dermatology & Laser Center of Charleston, Clinical Research Center of the Carolinas, Charleston, South Carolina

^∗Correspondence to: Lindsy Frazer-Green, PhD, American Academy of Dermatology, 9500 Bryn Mawr Avenue, Suite 500, Rosemont, IL 60018.American Academy of Dermatology9500 Bryn Mawr Avenue, Suite 500RosemontIL60018

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Abstract

Background

Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma.

Objective

This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed.

Methods

A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus.

Results

Analysis of the evidence resulted in 18 recommendations.

Limitations

This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data.

Conclusions

Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.

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Key words : actinic keratosis, actinic keratosis guidelines, clinical guidelines for actinic keratosis, cryosurgery, dermatology, photodynamic therapy, topical agents

Abbreviations used : AAD, AK, ALA, CI, DFS, FDA, FU, GRADE, MD, PDT, RCT, RR, SCC, US, UV

Plan

	Drs Eisen and Schlesinger are co-chairs.
	Funding sources: This study was funded in total by internal funds from the American Academy of Dermatology.
	IRB approval status: Not applicable.
	Reprints not available from the authors.