Review of permanent medication due topossible effect on existing disease.
Avoidance of environmental stress:
Damage to the skin by UV radiation (sunlight or solarium) [→ UV protection (textile light protection, light protection preparations)].
Arsenic
Infrared radiation (thermal radiation)
X-ray radiation / ionizing radiation
Tar products (lignite tar/lignite workers) and other hydrocarbons.
Regularly check skin yourself (regardless of follow-up examinations).
Conventional non-surgical therapy methods
Photodynamic therapy (PDT; in this case, ALA-/MAL-PDT) should be offered in a field-directed manner for single or multiple Olsen grade 1-2 actinic keratoses and field cancers, according to the current S3 guideline [EC: B]; may also be offered in immunocompromised patients [EG: B]PDT uses so-called photosensitizers (5-aminolevulinic acid (5-ALA); methylaminolevulinic acid (MAL)) to destroy pathologic (diseased) cells. A major advantage of photodynamic therapy over surgical procedures is the fact that usually no visible scars remain. Furthermore, there is significantly less pain than with other treatment methods. Should recurrence (recurrence of the disease) occur, can be treated again using PDT.For more information on photodynamic therapy (PDT), see “Other conventional therapies”.
MAL-PDT with daylight: “MAL (methylaminolevulinic acid) in combination with daylight (daylight MAL-PDT) should be offered on a field-directed basis for nonpigmented, single or multiple grade I-II AK according to Olsen, and for field carcinomatization of the face and capillitium of immunocompetent individuals” [EC: B].
Therapy of single, isolated actinic keratosis is often performed using physical therapy techniques, such as cryotherapy (using a cotton rod dipped in liquid nitrogen and pressing it onto the skin lesion for approximately 10-20 seconds; strong recommendation) or CO2 laser ablation. Patients with thick lesions (grade III keratoses) respond better to cryotherapy. Note: According to one study, it appears to have fewer side effects to first apply ingenol mebutate to the skin in a planar fashion and then treat individual lesions with cryotherapy. Regardless, both sequences of therapy were equally effective: limitation: small number of participants.
Photodynamic therapy combined with peeling: exfoliation by peeling a few days before conventional red light PDT (cPDT) or daylight PDT (DL-PDT) makes the skin more accessible to the photosensitizer.
Microwave therapy: a phase II study used microwave therapy to clear actinic keratosis. The overall response rate was 78%, increasing to 90% after 120 days. Patients reported the therapy as painful. However, the pain was gone after 30 minutes. Other side effects included redness, scaly skin, and pruritus (itching).Limitation: small number of patients.
Regular checkups
Regular medical checkups
Nutritional medicine
Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means:
Consume only limited energy-rich foods.
Moderate total fat intake
Reduce consumption of smoked and cured foods. Their preparation produces compounds (nitrosamines), which are risk factors for various tumor diseases.
