Actinic keratosis

Actinic keratosis (AK), rough scaly patches that arise on chronically ultraviolet-exposed skin, is one of the most common conditions diagnosed and treated by dermatologists in the United States. This guideline addresses the management of actinic keratosis, providing evidence-based recommendations for treatment.

Guideline highlights

• Although they often persist as chronic skin lesions, AKs can spontaneously involute, or most importantly, evolve into keratinocyte carcinoma if left untreated.

• Treatment options for AK include field-directed therapies, such as topical medications and photodynamic therapy, and lesion-directed therapies, like cryosurgery and laser ablation.

• Analysis of the evidence from a systematic review based on five research questions resulted in eighteen evidence-based recommendations and suggests there are several effective treatments available for AK.

• Strong recommendations were made for the use of UV protection, cryosurgery, topical imiquimod, and 5-FU. Conditional recommendations were made for the use of PDT and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.

• In a focused update published in June 2022, a strong recommendation for the use of tirbanibulin as field therapy was added to the guidelines.

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