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J Dermatolog Treat. 2017 Aug;28(5):431-442. doi: 10.1080/09546634.2016.1254328. Epub 2016 Nov 13.

Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology.

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a Centroderm Clinic, Wuppertal, and Faculty of Health , University of Witten-Herdecke , Witten , Germany.
b Department of Dermatology , Monklands Hospital, Lanarkshire, and University of Glasgow , Glasgow , UK.
c Dermatology Clinic , University of Catania , Catania , Italy.
d Klinik für Dermatologie, Venerologie und Allergologie , St. Josef-Hospital, Ruhr-Universität Bochum , Bochum , Germany.
e Policlinique de Dermatologie , Hôpital Saint-Louis , Paris , France.
f Department of Dermatology , Hôpital Erasme - Université Libre de Bruxelles , Bruxelles , Belgium.
g Department of Dermatology Skin Cancer Unit , University Hospital Zürich , Zurich , Switzerland.
h Department of Dermatology , Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen , Copenhagen , Denmark.
i Dermatology Department , Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona , Barcelona , Spain.
j Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) , Valencia , Spain.
k Department of Dermatology , Catholic University of Rome , Largo A. Gemelli 8 , Rome , Italy.
l First Department of Dermatology-Venereology , University of Athens Medical School, Andreas Sygros Hospital , Athens , Greece.
m Non-Melanoma Skin Cancer Unit, Department of Dermatology and Venereology , Medical University of Graz , Graz , Austria.
n Department of Dermatology , University of Modena and Reggio Emilia , Modena , Italy.


Actinic keratosis (AK) is a chronic skin disease in which multiple clinical and subclinical lesions co-exist across large areas of sun-exposed skin, resulting in field cancerisation. Lesions require treatment because of their potential to transform into invasive squamous cell carcinoma. This article aims to provide office-based dermatologists and general practitioners with simple guidance on AK treatment in daily clinical practice to supplement existing evidence-based guidelines. Novel aspects of the proposed treatment algorithm include differentiating patients according to whether they have isolated scattered lesions, lesions clustered in small areas or large affected fields without reference to specific absolute numbers of lesions. Recognising that complete lesion clearance is rarely achieved in real-life practice and that AK is a chronic disease, the suggested treatment goals are to reduce the number of lesions, to achieve long-term disease control and to prevent disease progression to invasive squamous cell carcinoma. In the clinical setting, physicians should select AK treatments based on local availability, and the presentation and needs of their patients. The proposed AK treatment algorithm is easy-to-use and has high practical relevance for real-life, office-based dermatology.


5-fluorouracil; Diclofenac; field cancerisation; imiquimod; ingenol mebutate; photodynamic therapy

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