Re-thinking The Way We Treat Actinic Keratosis

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Many people with an actinic keratosis will need field therapy beyond the usual liquid nitrogen treatment.  These field therapies are often longer term treatments, with side effects that are both painful and can take long periods of time to heal.  We have in America a lot of different field therapy treatment options for treating AK’s (actinic keratosis).

Doctors know that there are many problems with field therapies.  A patient’s side effects can last weeks or months, and looks aesthetically unacceptable during that time.  Sometimes simple compliance from patients is difficult when pain and appearance can cause distress.

Dermatologists and practitioners have a hard time working between efficacy and a user friendly approach to treatments.  As a result, patients with AK’s will only get liquid nitrogen treatment and leave 92 percent of the time.
So the traditional method of treating AK’s normally falls into four basic steps. A patient receives up to four liquid nitrogen treatments. Then we use a topical retinoid and maybe a field therapy, and finally we recommend sunscreen.
“So clearly we’re not doing field therapy well.  We’re not doing it at all” says Dr. Martin, “We need to think about more user friendly ways to approach [field therapies].  Additionally, we need to think about this beyond the once or twice a year we do field therapy. Because when you look at the one-year clearance rates, they are all less than 50%.”

Dr. Martin believes he’s found a novel solution to AK treatments in two ways. First, through Imiquimod, and secondly through a strategic use of photodynamic therapy.

Imiquimod

“Over the years I’ve come to the conclusion that if were to pick one molecule out of them all to treat actinic keratosis, I would pick Imiquimod.” states Dr. Martin. “It modulates your immune system to kill actinically damaged lesions.”
The trick, according to Martin, is to apply Imiquimod daily for one week, with a following two week rest period. And then finally, use once weekly for years. He believes we should treat AK’s like hypertension or diabetes – on a constant basis. “So, it’s a new way of doing a topical that has low down time, and if you use in chronically, it produces incredible results.”

Photodynamic Therapy

Another typical approach to AK’s is photodynamic therapy. PDT can be effective, but in applying alpha-lipoic acid for long periods of time, you get a diffusion of protoporphrin IX that can cause pain. So doctors can be hesitant to use the treatment.
Again, Dr. Martin has come up with a technique that has reduced pain, and maintained efficacy. It is done by using a combination of blue light treatment and shorter application time of ALA. “You apply ALA to the skin for fifteen minutes. You then put them under the blue light for one hour. It does not hurt.”

DiseaseJonathan McClung