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[2 min read] Field treatments for actinic keratosis | Prof David Wilkinson
Treating actinic keratosis is very common in general practice, and especially so in primary care skin cancer medicine. Many patients require treatment of both individual lesions (for example, by cryotherapy) and of the whole field that is affected (for example, the whole face, using a topical treatment, or a field treatment more generally).
Recently published in the Australasian Journal for Dermatology by Sinclair et al, a review on these field treatments concludes as follows:
“All the common topical therapies reviewed provided some short-term reduction in actinic keratosis with 5% 5-FU and PDT being the most effective formulations for short-term clearance and ingenol mebutate being marginally less effective.
“Overall clearance at 12 months was marginally better for PDT compared to other agents but all had significant recurrence in a field of cancerisation, with approximately 50% of the baseline numbers evident at one year post-treatment.”
It is well worth reading through this clearly written review to see how your preferred treatment option performs.
In short, Efudix and PDT are really effective in the short term (90% complete clearance at three months) but all therapies show quite poor performance at 12 months (50% clear). This indicates the need for regular follow up of patients treated with these therapies, consistent use of sun protection interventions, and the likely need for re-treatment in many cases.
Professor David Wilkinson