Therapeutic target
- Improvement of symptomatology or cure.
Therapy recommendations
In principle, there is an indication for the treatment of all AKs.
A distinction is made between lesion-directed therapy (= point therapy) for the treatment of single keratoses or multiple actinic keratoses (AKs) and field-directed therapy [S3 guideline: see below]:
- Single or multiple AKs
- Topical therapy
- Grade I-II according to Olsen: diclofenac sodium [EC B]; 5-fluorouracil 5% cream [EC: B]; 5-fluorouracil 0.5% with salicylic acid 10% in solution [EC: B]; ingenol mebutate* [EC: B]; imiquimod 5% or 3.75% cream [EC: B].
- Topical therapy
- Field directed therapy
- Topical therapy
- Diclofenac sodium [EC B]; 5-fluorouracil 5% cream [EC: B]; 5-fluorouracil 0.5% with salicylic acid 10% in solution [EC: B]; ingenol mebutate* [EC: B]; imiquimod 5% or 3.75% cream [EC: B].
- Topical therapy
- See also under “Further therapy“.
Further notes
- Therapy is increasingly focused on area and field carcinogenesis.
- In a randomized trial involving 624 patients with at least 5 lesions of head or neck Olsen grade 1 103, four treatment modalities were compared. The primary end point was healing of at least 75% of lesions at 12 months. The following are the four procedures in descending order of achievement of the primary end point:
- Fluorouracil: 74.7% of patients (95% confidence interval 66.8% to 81.0%); approved for the entire integument (entirety of the external skin)
- Imiquimod: 53.9% of patients (45.4-61.6%); approved for the head region
- Photodynamic therapy: 37.7% of patients (30.0-45.3%).
- Ingenol mebutate* : 28.9% of patients (21.8-36.3%).
- In off-label use (prescription of a finished drug outside the use approved by the drug authorities) are currently still external retinoids such as adapalene or tazarotene and topical colchicine. By means of topical colchicine, skin field cancerization can be reduced.
* Caution in skin cancer history: EMA (European Medicines Agency): There is evidence that ingenol mebutate (trade name Picato) could promote skin tumors such as basal cell carcinoma, Bowen’s disease and squamous cell carcinoma (spinalioma). Note: The European Commission has provisionally ordered the suspension of marketing authorizations by decision of Jan. 17, 2020, under Article 20 of Regulation (EC) No. 726/04. As of now, the drugs are no longer marketable.
Other topicals
Recommendations according to S3 guideline:
- Data do not allow safe recommendations for therapy of AK with colchicine, difluoromethylornithine, canola phenolic acid, topical nicotinamide, or sunscreen filters.
- Birch cork and glucans should not be used in the therapy of grade I-III AK because of a lack of evidence of benefit.
In off-label use are currently still external retinoids such as adapalene or tazarotene and topical colchicine. By means of topical colchicine can be reduced skin field cancerization.
Retinoids: data do not support recommendations for therapy of AK with topical or systemic retinoids.
Phytotherapeutics
- Garden spurge (Euphorbia peplus): diterpene ester ingenol mebutate. (very toxic)Caution in case of skin cancer history:EMA (European Medicines Agency):There is evidence that ingenol mebutate (trade name Picato) may promote skin tumors such as basal cell carcinoma, Bowen’s disease and squamous cell carcinoma (spinalioma).
