Opciones de Tratamiento con Recomendación Condicional para la Queratosis Actínica
La queratosis actínica requiere un manejo estructurado y guiado por evidencia. Las guías clínicas identifican un conjunto de alternativas terapéuticas con recomendación condicional para lograr la eliminación completa de las lesiones.
Enfoque Terapéutico
Las alternativas con recomendación condicional para la queratosis actínica incluyen un agente tópico y varias modalidades distintas de terapia fotodinámica. La selección entre estas opciones está guiada por la calidad de la evidencia y los factores específicos del paciente — el algoritmo de decisión completo y los detalles del régimen se encuentran en el protocolo completo.
Objetivo del Tratamiento
Eliminación completa de las lesiones de queratosis actínica, evaluada aproximadamente 12 semanas después del tratamiento.
References
DOI: 10.1016/j.jaad.2021.02.082
- The Work Group conditionally recommends the use of diclofenac, based on lower quality of evidence than that of the evidence supporting strong recommendations for the use of 5-FU or imiquimod (Table III).
- Four RCTs evaluating the efficacy and safety of 3% diclofenac in 2.5% hyaluronic acid for the treatment of AKs were identified by the systematic review (Table IV).
- However, the overall summed quality of this evidence is low; thus, the Work Group conditionally recommends ALA-red light PDT as a treatment for AKs (Table III).
- Although patch-formulated ALA is not FDA approved, 10% ALA gel is available and protocols for this drug usually dictate a 3-hour application time before 10 minutes of red light activation, which aligns with this recommendation.
- Thus, for patients with AKs, we conditionally recommend ALA-daylight PDT as less painful, but equally effective as ALA-red light PDT (Table III).
- The Work Group conditionally recommends ALA-blue light PDT as a treatment for AK, based upon this moderate quality evidence (Table III).
- Pooled data from 3 studies on up to 2 ALA-red light PDT treatments show rates of baseline lesion clearance of 89.1% and 32.7% (RR 2.89; 95% CI 2.28-3.66; P <.00001) at 12 weeks post treatment for ALA-PDT and placebo-PDT patients, respectively.