Actinic Keratosis Guidelines

Updated: Jun 03, 2021
  • Author: James M Spencer, MD; Chief Editor: William D James, MD  more...
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Guideline Summary

Guidelines on the management of actinic keratosis were published in April 2021 by the American Academy of Dermatology. [71, 72]

Ultraviolet light protection is strongly recommended for all actinic keratosis patients, to include sun avoidance, sun-protective clothing, and broad-spectrum sunscreen.

For topical therapy field treatment, 5-fluorouracil and imiquimod are strongly recommended. Diclofenac is conditionally recommended for topical therapy.

Cryosurgery is strongly recommended, and it is conditionally recommended over carbon dioxide laser surgery.

Photodynamic therapy (PDT) is conditionally recommended, to include aminolevulinic acid (ALA)–red light PDT, ALA-daylight PDT, or ALA-blue light PDT. The recommended incubation time for ALA-red light PDT is 1-4 hours. Daylight PDT is less painful but equally effective compared with ALA-red light PDT. ALA-red light PDT is preferred over trichloroacetic acid peel. Conditional recommendations were issued against (1) pretreatment with alpha-hydroxy acid solution prior to ALA-blue light PDT and (2) treatment with ALA-red light PDT over cryosurgery alone.

For combination therapy, conditional recommendations included 5-fluorouracil/cryosurgery and imiquimod/cryosurgery over 5-fluorouracil or imiquimod alone. Conditional recommendations were issued against (1) diclofenac or topical adapalene use in addition to cryosurgery compared with cryosurgery alone and (2) adding imiquimod following ALA-blue light PDT.