Actinic keratosis and Bowen’s disease are treated with topical or destructive treatment. Topical treatment may include emollients, sun blocks, salicylic acid ointment, topical non-steroidal anti-inflammatory agents (Diclofenac), topical cytostatic preparation (fluorouracil) and topical immune response modulators (Imiquimod). Topical treatment recommendations from the British Photobiology Group (de Berker et al 2007) are outlined in Table 11.1.
| | | | | | Table 11.1 British Photobiology Groups recommendations for the topical treatment of AK. | | Recommended AK topical therapy | Rationale for AK treatment | | | No therapy | 21% AK respond spontaneously over 12 months. | | | Emollient therapy | Management of clinical manifestations only. Emollients do not reverse biological process. | | | Sun block | Long-term application is preventative against further AK development. | | | Salicylic acid | Removes overlying keratin and does not reverse biological process. | | | Diclofenac gel
(Solaraze®) | Moderate efficacy for AK treatment and clearance of lesions, this treatment is well tolerated with minimal side effects
Application: Apply by smoothing cream into lesion twice daily until clearance (for up to 60–90 days). | | | Fluorouracil
cream (Efudix®) | Good efficacy for AK treatment and clearance of lesions; this treatment is less well tolerated due to side effects of soreness.
Application: Apply thinly once or twice a day until clearance. | | | Imiquimod
(Aldara®) | Moderate efficacy for AK treatment and clearance of lesions; this treatment is less well tolerated due to side effects of pruritus and application site pain, burning and irritation.
Application: Apply thrice a week, for 4 weeks, leave on skin for 8 hours and then wash off. | | | | | | | |
Destructive treatments for AK may include cryotherapy, photodynamic therapy (PDT), surgery, laser chemical peels and dermabrasion. These therapies will be discussed in more detail in the non-melanoma section of this section.
