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.

Medication

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[Guideline] Eisen DB, Asgari MM, Bennett DD, Connolly SM, Dellavalle RP, Freeman EE, et al. Guidelines of care for the management of actinic keratosis. J Am Acad Dermatol. 2021 Apr 2. [QxMD MEDLINE Link]. [Full Text].
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Media Gallery

Actinic keratosis. Courtesy of Hon Pak, MD.
Actinic keratosis during treatment with topical 5-fluorouracil. Courtesy of Hon Pak, MD.
Actinic keratosis right after treatment with topical 5-fluorouracil. Courtesy of Hon Pak, MD.
Erythematous, scaly lesions on the temple area, typical of actinic keratosis.

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Author

James M Spencer, MD Professor of Clinical Dermatology, Mount Sinai School of Medicine; Private Practice, Spencer Dermatology

James M Spencer, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, International Society for Dermatologic Surgery

Disclosure: Received grant/research funds from Genentech for independent contractor; Received grant/research funds from DUSA for independent contractor; Received honoraria from Leo Pharmicuticals for review panel membership.

Coauthor(s)

Laura Jordan, DO, MA, MS, MLS Dermatology-Focus Traditional Rotating Intern, UH Regional Hospitals

Laura Jordan, DO, MA, MS, MLS is a member of the following medical societies: American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Kelly M Cordoro, MD Assistant Professor of Clinical Dermatology and Pediatrics, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Medical Society of Virginia, Society for Pediatric Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology, National Psoriasis Foundation, Dermatology Foundation

Disclosure: Nothing to disclose.

Michelle Henry, MD Fellow in Procedural Dermatology, Department of Dermatology, Lahey Clinic, Harvard Medical School

Disclosure: Nothing to disclose.

Acknowledgements

Amy Lynn Basile, DO, MPH Sun Coast Hospital/Largo Medical Center, Largo, Florida

Disclosure: Nothing to disclose.

Mary Farley, MD Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

James Fulton Jr, MD, PhD Medical Director, Fulton Skin Institute

Disclosure: Nothing to disclose.