Guidelines of care for the management of actinic keratosis

Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classificat...

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Vydané v:Journal of the American Academy of Dermatology Ročník 85; číslo 4; s. e209 - e233
Hlavní autori: Eisen, Daniel B., Asgari, Maryam M., Bennett, Daniel D., Connolly, Suzanne M., Dellavalle, Robert P., Freeman, Esther E., Goldenberg, Gary, Leffell, David J., Peschin, Sue, Sligh, James E., Wu, Peggy A., Frazer-Green, Lindsy, Malik, Sameer, Schlesinger, Todd E.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Elsevier Inc 01.10.2021
Predmet:
actinic keratosis
actinic keratosis guidelines
clinical guidelines for actinic keratosis
cryosurgery
dermatology
Diclofenac - therapeutic use
Fluorouracil - therapeutic use
Humans
Imiquimod - therapeutic use
Keratosis, Actinic - drug therapy
Photochemotherapy
photodynamic therapy
topical agents
actinic keratosis guidelines
RR
PDT
UV
FDA
RCT
AAD
topical agents
photodynamic therapy
CI
AK
actinic keratosis
FU
DFS
SCC
dermatology
ALA
MD
GRADE
cryosurgery
clinical guidelines for actinic keratosis
US
ISSN:0190-9622, 1097-6787, 1097-6787
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Popis
Shrnutí:Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. 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. 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. Analysis of the evidence resulted in 18 recommendations. 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. 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.
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Sameer Malik, MD, MBA, has no relationships to disclose.
Suzanne M. Connolly, MD, has no relationships to disclose.
Daniel B. Eisen, MD, has no relationships to disclose.
Maryam M. Asgari, MD, MPH, serves as an investigator for Pfizer, Inc. receiving grants and/or research funding.
James E. Sligh, MD, PhD, serves as an investigator for AbbVie, DermTech International, Genentech, Inc, and Novartis receiving no compensation; as a consultant for Mayne Pharma Group receiving honoraria; as a speaker for Castle Biosciences, Inc, and Genentech, Inc receiving honoraria.
Daniel D. Bennett, MD, has no relationships to disclose.
Authors (listed alphabetically) with relevant conflicts of interest with respect to this guideline are noted with an asterisk (*).
David J. Leffell, MD, serves as an advisory board member for DermaSensor, Inc receiving fees.
Todd E. Schlesinger, MD,* serves as an investigator for AbbVie, Aclaris Therapeutics, Inc, Arcutis Premier Research, Arcutis Biotherapeutics, Akros, Allergan, Astellas Pharma US, AOBiome Therapeutics, Bioderma, Biofrontera, BioPharmx, Boehringer Ingelheim, Bristol-Myers Squibb, Cara Therapeutics, Castle BioScience, Celgene, Centocor Ortho Biotech, Inc, ChemoCentryx, Coherus Biosciences, Corrona, Inc, Demira, Dermavant Sciences, DT Pharmacy & DT Collagen, Eli Lilly and Company, Galderma USA, Genentech, Janssen Pharmaceuticals, Kinex, Kiniksa Pharmaceuticals, Ltd., LEO Pharmaceuticals, Merz Aesthetics, Novartis, Pfizer, Regeneron, Regeneron Pharmaceuticals, Sanofi, Sebacia, Inc, Sienna Biopharmaceuticals, SiSaf Ltd., Tetra Derm Group, LLC., and Trevi receiving grants and/or research funding; as a consultant for AbbVie, Aclaris Therapeutics, Inc, Allergan, Inc, Almirall, BioFrontera, Bristol-Meyers Squibb, Castle Biosciences, Eli Lilly and Company, Evolus, Foundation for Research and Education in Dermatology, EPI Health, Galderma USA, LEO Pharmaceuticals, Lilly, MED Learning Group CME Program, Merz Aesthetics, MJH Associates, Nextphase, Novartis, Ortho Dermatologics, Pfizer, Inc, Prolacta Bioscience, Regeneron, SiSaf Ltd, Sun Pharma, Suneva Medical, UCB, Unilever, and Verrica receiving honoraria and/or fees; as a speaker for Aclaris, Almirall, Demira, DUSA, EPI Health, Regeneron, Sanofi Genzyme, Sun Pharma, Suneva Medical, Inc, and Sun Pharmaceutical Industries Ltd receiving honoraria; as an advisory board member for Allergan, Almirall, Amgen, Bioderma, Biofrontera AG, Celgene, Greenway Therapeutix (no compensation received), Remedly, Inc, and Suneva Medical, Inc receiving honoraria and/or stock; as an independent contractor for SiSaf Ltd receiving grants and/or research funding.
Work group members disclosures
Esther E. Freeman, MD, PhD, has no relationships to disclose.
Drs Eisen and Schlesinger are co-chairs.
Gary Goldenberg*, MD, serves as an investigator for Leo Pharma Inc, Pharmaderm, Stiefel (a GSK company), and Valeant Pharmaceuticals North America LLC receiving grants and/or research findings; as a consultant for Allergan, Inc, Alma Lasers, Anacor Pharmaceuticals, Inc, Bayer Pharmaceuticals, Celgene Corporation, Eclipse Medical, Eli Lilly and Company, Genentech, Inc, Janssen Pharmaceuticals, Inc, Leo Pharma US, MelaSciences, Novartis Pharmaceuticals Corp, Ranbaxy Laboratories Limited, Stiefel (a GSK company), Taro Pharm, Teva Pharmaceuticals USA, Valeant Pharmaceuticals North America LLC, and Xoft receiving honoraria and/or fees; as a speaker for AbbVie, Bayer Pharmaceuticals, Castle Biosciences, Celgene Corporation, Eli Lilly and Company, Galderma USA, LEO Pharma US, Novartis Pharmaceuticals Corp, Pharmaderm, and Valeant Pharmaceuticals North America LLC receiving honoraria; as an advisory board member for Dermira and Pharmaderm receiving honoraria.
Lindsy Frazer-Green, PhD, has no relationships to disclose.
Robert P. Dellavalle, MD, PhD, MSPH, serves as a principal investigator for Pfizer, Inc and the U.S. Department of Veterans Affairs receiving grants and/or research funding; as an editorial board member for the Cochrane Collaboration, Journal of Investigative Dermatology, and the Journal of the American Academy of Dermatology receiving other financial benefits; as an independent contractor for UpToDate, Inc receiving patent royalties and/or compensation for intellectual property rights; as a consultant for Altus Labs and ParaPRO LLC receiving fees and/or stock.
Sue Peschin, MHS, has no relationships to disclose.
Peggy A. Wu, MD, serves on the Board of Directors of the American Contact Dermatitis Society receiving no compensation; as a panel review committee member for the National Eczema Association receiving honoraria; as an independent contractor for UpToDate, Inc receiving honoraria.
ISSN:0190-9622
1097-6787
1097-6787
DOI:10.1016/j.jaad.2021.02.082