In clinical guidelines issued by the American Academy of Dermatology and published in the October issue of the Journal of the American Academy of Dermatology, recommendations are presented for the treatment of actinic keratoses (AK).

Daniel B. Eisen, M.D., from the University of California, Davis, in Sacramento, and colleagues examined the literature relating to AK management to provide evidence-based treatment recommendations. Five clinical questions on management of AKs were addressed.

The researchers developed 18 recommendations relating to ultraviolet (UV) protection, topical agents, cryosurgery, photodynamic therapy (PDT), and combination therapy. For patients with AK, use of UV protection is strongly recommended. In terms of topical agents, field treatment with 5-fluorouracil (5-FU) and imiquimod is strongly recommended; diclofenac is conditionally recommended. Use of cryosurgery is strongly recommended for patients with AK; cryosurgery is conditionally recommended over CO%u2082 laser ablation. PDT recommendations include conditional recommendations for aminolevulinic acid (ALA)-red light PDT, ALA-daylight PDT as less painful than but equally effective as ALA-red light PDT; ALA-red light PDT over trichloroacetic acid peel; ALA-blue light PDT; and ALA-red light PDT over cryosurgery alone. Conditional recommendations for combination therapies include combined use of 5-FU and cryosurgery over cryosurgery alone; combined use of imiquimod and cryosurgery over cryosurgery alone; and not to use diclofenac in addition to cryosurgery versus cryosurgery alone.

"This analysis is based on the best available data at the time it was conducted. The results of future studies may necessitate revision of current recommendations," the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

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