Care for the Management of Actinic Keratosis

Publication Date: April 1, 2021
Last Updated: November 1, 2023

Recommendations

UV protection

For patients with AK, we recommend the use of UV protection. (Strong, )
Remarks: UV protection may include sun avoidance, sun-protective clothing, and broad-spectrum sunscreen.
(Good Practice Statement)
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Topical agents

For patients with AKs, we recommend field treatment with 5-fluorouracil. (StrongModerate)
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For patients with AKs, we recommend field treatment with imiquimod. (StrongModerate)
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For patients with AKs, we conditionally recommend the use of diclofenac. (Conditional, Low)
Remarks: As with other oral and topical medications in the class, NSAIDs carry a black box warning for cardiovascular and gastrointestinal side effects.
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Cryosurgery

For patients with AKs, we recommend the use of cryosurgery. (Strong, )
(Good Practice Statement)
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For patients with AKs, we conditionally recommend treatment with cryosurgery over CO2 laser ablation. (ConditionalModerate)
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Photodynamic therapy

For patients with AKs, we conditionally recommend ALA-red light PDT. (ConditionalLow)
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For patients with AKs, we conditionally recommend 1 to 4-hour 5-ALA incubation time to enhance complete clearance with red light PDT. (ConditionalLow)
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For patients with AKs, we conditionally recommend ALA-daylight PDT as less painful than but equally effective as ALA-red light PDT. (ConditionalModerate)
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For patients with AKs, we conditionally recommend treatment with ALA-red light PDT over trichloroacetic acid peel. (ConditionalModerate)
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For patients with AKs, we conditionally recommend ALA-blue light PDT. (ConditionalModerate)
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For patients with AKs, we conditionally recommend against pretreatment with alpha hydroxy acid solution prior to ALA-blue light PDT. (ConditionalModerate)
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For patients with AKs, we conditionally recommend treatment with ALA-red light PDT over cryosurgery alone. (ConditionalLow)
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Combination therapy

For patients with AKs, we conditionally recommend the combined use of 5-FU and cryosurgery over cryosurgery alone. (ConditionalModerate)
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For patients with AKs, we conditionally recommend the combined use of imiquimod and cryosurgery over cryosurgery alone. (ConditionalLow)
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For patients with AKs, we conditionally recommend against the use of diclofenac in addition to cryosurgery compared to cryosurgery alone. (ConditionalLow)
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For patients with AKs, we conditionally recommend against the use of topical adapalene in addition to cryosurgery compared to cryosurgery alone. (ConditionalLow)
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For patients with AKs, we conditionally recommend against the addition of imiquimod following ALA-blue light PDT. (ConditionalModerate)
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AK, Actinic keratosis; ALA, aminolevulinic acid; CO2, carbon dioxide; FU, fluorouracil; NSAID, nonsteroidal anti-inflammatory drug; No, Number; PDT, photodynamic theraphy; UV, ultraviolet.

Recommendation Grading

Abbreviations

  • 5-F/U: 5- Fluorouracil
  • AAD: American Academy Of Dermatology
  • AK: Actinic Keratosis
  • PDT: Photodynamic Therapy

Overview

Title

Care for the Management of Actinic Keratosis

Authoring Organization

Publication Month/Year

April 1, 2021

Last Updated Month/Year

February 7, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adult

Health Care Settings

Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D055623 - Keratosis, Actinic

Keywords

photodynamic therapy, topical agents, dermatology, Actinic Keratosis, Clinical Guidelines for actinic keratosis, crysurgery, actinic keratosis guidelines

Source Citation

Eisen DB, Asgari MM, Bennett DD, Connolly SM, Dellavalle RP, Freeman EE, Goldenberg G, Leffell DJ, Peschin S, Sligh JE, Wu PA, Frazer-Green L, Malik S, Schlesinger TE. Guidelines of care for the management of actinic keratosis. J Am Acad Dermatol. 2021 Oct;85(4):e209-e233. doi: 10.1016/j.jaad.2021.02.082. Epub 2021 Apr 2. PMID: 33820677.