Actinic keratoses are small, red, scaly spots that can feel like dry, sandpapery skin. They are a direct result of ultraviolet radiation, which is why they most commonly occur in sun-exposed areas, such as the face, forearms, and hands.
Why are actinic keratoses a concern? If left untreated, some actinic keratoses can develop into squamous cell skin cancers. Actinic keratosis can develop in almost 40% of white patients older than 50, making it the most common precancerous skin condition in this population. It is also one of the most common reasons for which people visit a dermatologist.
Cryotherapy, or the targeted use of liquid nitrogen, is commonly used to treat individual lesions. But what if there are many actinic keratoses scattered all over the face or hands? This is when field-directed therapy — using a treatment method to treat an entire area of skin — can be helpful.
There are several field-directed therapies available.
All of these therapies are frequently used by dermatologists, but there are no clear guidelines on which treatment is preferred.
An exciting study recently published in the New England Journal of Medicine sought to determine how effectively each of these four field-directed therapies treats multiple actinic keratoses. In this study, 624 patients with multiple actinic keratoses were randomized to treatment with one of the four aforementioned field-directed treatments.
The primary endpoint of the study was the percentage of patients who had at least 75% reduction in their number of actinic keratoses after one year. The study found that the percentage of patients who achieved this goal was significantly higher in people treated with topical fluorouracil (75%), compared to those treated with topical imiquimod (54%), photodynamic therapy (38%), and topical ingenol mebutate (29%).
This seminal study highlights the important role of field-directed treatment of actinic keratosis in decreasing a person’s risk of developing squamous cell skin cancers.
While this study found topical fluorouracil cream to be the most effective agent, other treatments may still have a role; each treatment has advantages and disadvantages in terms of time and cost, which may influence individual preferences. If you have multiple actinic keratoses, speak to your dermatologist to determine which treatment is the right choice for you.
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The post Topical treatment helps prevent actinic keratosis from developing into skin cancer appeared first on Harvard Health Blog.
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