Actinic Keratoses

TREATMENT​

Topical Therapies                                                                                                                                                                                          

Imiquimod plus 5-fluorouracil

• Nightly application of a thin layer of imiquimod and 5-FU (any order) until a brisk reaction occurred across at least 80% of applied area (average was 11 days).  At follow up (mean 7 months), all patients experienced at least 75% reduction in AKs (mean 90%). 38316257

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Photodynamic Therapy (PDT)                                                                                                                                                                      

Daylight PDT

• These are protocols designed to decreased side effects while maintaining efficacy and also improve convenience for the patient.  Instead of application of a sensitizing agent (usually ALA), a long incubation period, and then exposure to a red or blue light device, the sensitizing agent is applied and then exposed to ambient sunlight.  

• One protocol utilizing ALA demonstrated similar clearance rates between daylight PDT (95.5%) and conventional PDT (96.8%). 30336290  However, the protocol described included microneedling and also was confusingly written, possibly due to a language barrier (Chinese authors).  The protocol included:

  • Application of chemical sunscreen with SPF 30 (15min incubation)​

  • Gentle removal of scales, and crusts

  • Microneedling

  • Application of 10% ALA (30min incubation)

  • 2 hours of daylight exposure. 

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