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. 2021 Oct;85(4):e209-e233.
doi: 10.1016/j.jaad.2021.02.082. Epub 2021 Apr 2.

Guidelines of care for the management of actinic keratosis

Daniel B Eisen  1 , Maryam M Asgari  2 , Daniel D Bennett  3 , Suzanne M Connolly  4 , Robert P Dellavalle  5 , Esther E Freeman  6 , Gary Goldenberg  7 , David J Leffell  8 , Sue Peschin  9 , James E Sligh  10 , Peggy A Wu  1 , Lindsy Frazer-Green  11 , Sameer Malik  12 , Todd E Schlesinger  13
Affiliations

Guidelines of care for the management of actinic keratosis

Daniel B Eisen et al. J Am Acad Dermatol. 2021 Oct.

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.

Keywords: actinic keratosis; actinic keratosis guidelines; clinical guidelines for actinic keratosis; cryosurgery; dermatology; photodynamic therapy; topical agents.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The American Academy of Dermatology (AAD) strives to produce clinical guidelines that reflect the best available evidence supplemented with the judgment of expert clinicians. Significant efforts are taken to minimize the potential for conflicts of interest to influence guideline content. The management of conflict of interest for this guideline complies with the Council of Medical Specialty Societies’ Code of Interactions with Companies. Funding of guideline production by medical or pharmaceutical entities is prohibited, full disclosure is obtained and evaluated for all guideline contributors throughout the guideline development process, and recusal is used to manage identified relationships. The AAD conflict of interest policy summary may be viewed at www.aad.org.

The information below represents the authors’ disclosed relationship with industry during guideline development. Authors (listed alphabetically) with relevant conflicts with respect to this guideline are noted with an asterisk (*). In accordance with AAD policy, a minimum 51% of Work Group members did not have any relevant conflicts of interest.

Participation in 1 or more of the listed activities below constitutes a relevant conflict:

  1. Service as a member of a speaker bureau, consultant, advisory board, for pharmaceutical companies on actinic keratosis or actinic keratosis drugs in development or FDA approved

  2. Sponsored research funding or investigator-initiated studies with partial/full funding from pharmaceutical companies on actinic keratosis or actinic keratosis drugs in development or FDA approved

If a potential conflict was noted, the Work Group member recused themselves from the discussion and drafting of recommendations pertinent to the topic area of interest. Complete group consensus was obtained for draft recommendations. Areas where complete consensus was not achieved are shown transparently in the guideline.

Comment in

References

    1. Uhlenhake EE. Optimal treatment of actinic keratoses. Clin Interv Aging. 2013;8:29–35. - PMC - PubMed
    1. Cerio R The importance of patient-centred care to overcome barriers in the management of actinic keratosis. J Eur Acad Dermatol Venereol. 2017;31(Suppl 2):17–20. - PubMed
    1. Singal AG, Higgins PDR, Waljee AK. A primer on effectiveness and efficacy trials. Clin Transl Gastroenterol. 2014;5(1):e45. - PMC - PubMed
    1. Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66(7):719–725. - PubMed
    1. Andrews JC, Schunemann HJ, Oxman AD, et al. GRADE guidelines: 15. Going from evidence to recommendation–determinants of a recommendation’s direction and strength. J Clin Epidemiol. 2013;66(7):726–735. - PubMed

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