|
Daily Medical Update
Actinic keratosis
Friday, April 03, 2026
|
🔬 Practice‑Changing Findings
Evidence from RCTs and meta‑analyses published in the last 12 months.
|
Photodiagnosis and photodynamic therapy (2025) - Meta-Analysis
Key Findings
- At 12 months, 5-fluorouracil achieved higher complete clearance than PDT (74.7% vs 37.7%; RR 0.50, 95% CI 0.40-0.64; P < 0.001).
- PDT matched cryotherapy overall yet cleared grade III lesions more effectively (56.9% vs 13.4%; P = 0.021) and caused less hypopigmentation (0%-3% vs 31%; P < 0.001).
- Against imiquimod, PDT performed better in organ transplant recipients (78% vs 61%; P < 0.001) and delivered higher patient satisfaction (90% vs 61%; P < 0.003).
📋 Practice Implication: Use 5-fluorouracil when durable field clearance is the primary goal, and reserve PDT for patients with grade III lesions, transplant status, or strong cosmetic priorities.
|
Photodiagnosis and photodynamic therapy (2025) - Randomized Controlled Trial
Key Findings
- Initial complete clearance at 3 months was higher with liquid nitrogen plus PDT than with PDT alone (93.6% vs 68.4%; P < 0.05).
- Sustained complete clearance at 6 months remained higher with combination therapy (95.1% vs 72.6%; P < 0.05).
- Clearance improved versus PDT alone without a reported increase in safety concerns during follow-up.
📋 Practice Implication: For thicker or treatment-resistant AK clusters, add cryotherapy before PDT to improve short-term and sustained clearance instead of repeating PDT alone.
|
JAMA dermatology (2025) - Randomized Controlled Trial
Key Findings
- Median AK reduction was greater with HPV vaccination than sham at month 6 (47% vs 29%; P = .01) and month 12 (58% vs 47%; P = .05).
- Total AK counts and thick AK counts were lower in the vaccinated group at 12 months (10.0 vs 16.0 total AKs, P = .02; 3.0 vs 5.0 thick AKs, P = .049).
- Rates of new AKs and keratinocyte cancers did not differ significantly over 12 months versus sham.
📋 Practice Implication: HPV vaccination is not ready to replace standard AK therapy, but it may merit discussion as an adjunctive strategy or trial option in immunocompetent patients with very high lesion burden.
|
|
Recent actinic keratosis evidence supports tailoring field therapy to durability goals, lesion burden, and patient context rather than using a single default approach. A 2025 meta-analysis found 5-fluorouracil more durable than photodynamic therapy for 12-month clearance, while PDT retained advantages for grade III lesions, transplant recipients, and cosmetic outcomes; a randomized trial also showed higher 3- and 6-month clearance when cryotherapy was added to PDT. An emerging sham-controlled trial suggests HPV vaccination may reduce lesion burden in heavily affected immunocompetent adults, although it did not lower new AK or keratinocyte cancer events over 12 months.
|
|