Prevalence, Discontinuation Rate, and Risk Factors for Severe Local Site Reactions with Topical Field Treatment Options for Actinic Keratosis of the Face and Scalp

Abstract

Actinic keratoses (AKs) are common lesions on chronically sun damaged skin, which are morphologically characterized by lower third to full thickness atypia of epidermal keratinocytes. These lesions carry a risk of progression towards invasive squamous cell carcinoma (SCC); therefore, treatment of visible lesions and the field in case of field cancerization is recommended. Treatment of AK includes the destruction of atypical keratinocytes that clinically presents with various degrees of erythema, scaling, crusting, erosion, and other visible and subjective symptoms. Such inflammatory reactions may have an impact on the patient's social life and have shown to decrease compliance and adherence to therapy. Additionally, as various topical treatments have been proven to be effective in treating AK, tolerability of local site reactions (LSRs) might drive the decision for appropriate treatment in an individual scenario. Therefore, we aimed to review prevalence of severe LSRs among various topical treatments for AK. In addition, we summarized discontinuation rates due to LSRs and possible therapy-unrelated risk factors for the development of LSRs with increased severity.

Keywords: actinic keratosis; review; risk factors; severe local site reactions; topical therapy.

Figure 1

Reported rates of treatment discontinuation due to LSRs. Imiq 5%—imiquimod 5% cream; 5-FU 5%—5-fluorouracil 5% cream; 5-FU 0.5%—5-fluorouracil 0.5% cream; 5-FU/SA—5-fluorouracil in combination with salicylic acid 10% solution; Diclof 3%—3% diclofenac in 2.5% hyaluronic acid gel; IngMeb 0.015%—ingenol mebutate 0.015% gel.