Daniel B Eisen1, Maryam M Asgari2, Daniel D Bennett3, Suzanne M Connolly4, Robert P Dellavalle5, Esther E Freeman6, Gary Goldenberg7, David J Leffell8, Sue Peschin9, James E Sligh10, Peggy A Wu1, Lindsy Frazer-Green11, Sameer Malik12, Todd E Schlesinger13. 1. Department of Dermatology, University of California, Davis, Sacramento, California. 2. Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts. 3. Department of Dermatology, University of Wisconsin, Madison, Wisconsin. 4. Department of Dermatology, Mayo Clinic, Scottsdale, Arizona. 5. Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado. 6. Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 7. Mount Sinai School of Medicine, New York, New York. 8. Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut. 9. Alliance for Aging Research, Washington, DC. 10. Section of Dermatology, University of Arizona College of Medicine, Tucson, Arizona; Southern Arizona Department of Veterans Affairs Healthcare System, Tucson, Arizona. 11. American Academy of Dermatology, Rosemont, Illinois. Electronic address: lfrazer-green@aad.org. 12. American Academy of Dermatology, Rosemont, Illinois. 13. Dermatology & Laser Center of Charleston, Clinical Research Center of the Carolinas, Charleston, South Carolina.
Abstract
BACKGROUND: Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. OBJECTIVE: This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed. METHODS: A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus. RESULTS: Analysis of the evidence resulted in 18 recommendations. LIMITATIONS: This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data. CONCLUSIONS: Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
BACKGROUND: Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. OBJECTIVE: This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed. METHODS: A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus. RESULTS: Analysis of the evidence resulted in 18 recommendations. LIMITATIONS: This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data. CONCLUSIONS: Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
Authors: Ben Novak; Janet DuBois; Osama Chahrour; Tamara Papusha; Stefan Hirt; Thomas Philippi; Corinna Zogel; Katharina Osenberg; Beate Schmitz; Hermann Lübbert Journal: Clin Pharmacol Drug Dev Date: 2021-10-11
Authors: Manijeh Goldberg; Aaron Manzi; Peter Conway; Stefanie Cantin; Vasudha Mishra; Alka Singh; Alexander T Pearson; Eric R Goldberg; Sam Goldberger; Benjamin Flaum; Rifat Hasina; Nyall R London; Gary L Gallia; Chetan Bettegowda; Sonya E O'Neill; Erkin Aydin; Alex Zhavoronkov; Anxo Vidal; Atenea Soto; Maria Jose Alonso; Ari J Rosenberg; Mark W Lingen; Anil D'Cruz; Nishant Agrawal; Evgeny Izumchenko Journal: Nat Commun Date: 2022-08-17 Impact factor: 17.694