Therapies for Actinic Keratosis With a Focus on Cosmetic Outcomes
Actinic keratosis (AK) is a commonly encountered premalignant epidermal lesion that has a predilection to manifest on highly visible areas such as the face, head, and hands. Lesions may be cosmetically unappealing and have been reported to reduce patients’ quality of life (QOL), but appropriate treatment can resolve these issues. In this article, we review the efficacy of the most commonly utilized treatments for AKs including topical medications, procedural modalities, and light-based therapies, and we discuss the relevant cosmetic considerations and outcomes.
Practice Points
- In addition to their risk for progression to malignancy, actinic keratoses (AKs) can have negative impacts on cosmetic appearance and quality of life.
- A variety of topical medications, procedural modalities, and light-based therapies are available for treatment of AKs, which offer varying degrees of efficacy for clearance of lesions and cosmetic outcomes. Based on the current data, imiquimod and photodynamic therapy are the treatments most likely to provide an excellent cosmetic outcome.
Overall, PDT is an excellent therapeutic option that is able to provide efficacious clearance of AKs as well as superior cosmetic outcomes. Common AEs of PDT include burning, itching, and stinging during therapy, but pain intensity decreases dramatically upon termination of illumination, with cessation of most symptoms by 12 hours posttherapy.73 Permanent pigmentation changes have been reported to occasionally occur following PDT therapy.81
Conclusion
When determining which therapy to use in a patient, clinicians must take into account a variety of factors such as patient preference, cost of treatment, availability, tolerance for AEs, and the need for field therapy. Although all therapies discussed within this article are effective and reasonable treatment choices, patients who are particularly concerned about cosmetic outcomes would most likely benefit from either IMQ or PDT, as the data for cosmetic outcomes with these therapies are the strongest. Combination or sequential treatments may be required in some cases and all patients should be monitored for lesion recurrence regardless of treatment choice. A summary of the therapies and key studies discussed here is available in the PDF.
