Document Detail

Pharmacotherapy of actinic keratosis: an update.
MedLine Citation:
PMID:  22888917     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Actinic keratosis (AK) represents the initial intraepidermal manifestation of abnormal keratinocyte proliferation, with the potential of progression to squamous cell carcinoma (SCC). Few visible AKs lead to the use of lesion-directed treatments, including ablative and/or surgical procedures. Multiple and/or the suspicion of subclinical (non-visible) AKs lead to the use of field-directed therapies, including topical and ablative treatments. Predicting which AK will progress to SCC is difficult, and so all are treated. The goals of treatment are to eliminate visible AKs and to treat subclinical (non-visible) AKs, minimizing their risk of progression to invasive SCC, while pursuing good cosmesis.
AREAS COVERED: This review discusses the prevention of AKs (such as ultraviolet light avoidance, sunscreen use, protective clothing, and frequent self-examinations, in addition to chemoprevention with retinoids, eflornithine, silymarin, and others). It also covers lesion-directed treatments (e.g., cryotherapy, electrodessication and curettage, and surgery). Field-directed treatments are also mentioned (including laser resurfacing, dermabrasion, chemical peels, topical immunomodulators (imiquimod and diclofenac), topical chemotherapeutic agents (5-fluorouracil and retinoids), and photodynamic therapy). Finally, newer and investigational treatments are discussed (including ingenol mebutate).
EXPERT OPINION: There is no panacea in the treatment of AKs. The current best approach is the sequential treatment with a lesion-directed and a field-directed therapy. Several combinations seem to work well; they just need to be selected based on the evidence and adjusted to patient needs, preferences and dermatologist expertise.
Brian Berman; Sadegh Amini
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert opinion on pharmacotherapy     Volume:  13     ISSN:  1744-7666     ISO Abbreviation:  Expert Opin Pharmacother     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-14     Completed Date:  2013-01-07     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  100897346     Medline TA:  Expert Opin Pharmacother     Country:  England    
Other Details:
Languages:  eng     Pagination:  1847-71     Citation Subset:  IM    
Center for Clinical and Cosmetic Research, Skin and Cancer Associates, Aventura, FL 33180, USA.
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MeSH Terms
Carcinoma, Squamous Cell / etiology,  prevention & control*
Cell Proliferation
Disease Progression
Keratinocytes / pathology
Keratosis, Actinic / complications,  prevention & control,  therapy*
Photochemotherapy / methods
Skin Neoplasms / etiology,  prevention & control*

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