Treatment of Actinic Keratosis with Combination Topical and Procedural Therapy for Maximum Clearance
Achieving complete clearance of actinic keratosis lesions can require a combination approach rather than a single modality alone. This protocol outlines a strategy that pairs topical treatment with a procedural intervention to maximise the therapeutic response.
Clinical Goal
Complete clearance of actinic keratosis lesions, assessed at approximately 22 weeks following completion of treatment.
Treatment Approach
The protocol involves combining a topical agent with a procedural intervention — sequenced to enhance overall lesion response beyond what either modality achieves alone.
Agent selection, sequencing, and the full treatment schedule are detailed in the complete structured protocol below.
References
DOI: 10.1016/j.jaad.2021.02.082
A randomized study compared a 1-week pretreatment course of 0.5% 5-FU cream with cryosurgery to the use of vehicle cream before cryosurgery.
Based on this moderate quality evidence suggesting enhanced lesion reduction without increased adverse events, combined 5-FU cream and cryosurgery is conditionally recommended over cryosurgery alone.
Studies have compared the use of imiquimod in 3.75% or 5% concentrations following cryosurgery to cryosurgery with subsequent application of a vehicle.
Thus, the intervention is conditionally recommended over cryosurgery alone, based on this low quality evidence.
At 22 weeks post treatment, rates of complete clearance were 22.6% in participants treated with a combination of 5% imiquimod and cryosurgery and 9.4% in participants treated with a vehicle cream and cryosurgery (RR, 2.41; 95% CI, 0.68-8.48; P = .17).
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