Summer 2018 | Live Blog | What’s New with Actinic Keratoses?
Day 3 of the SDPA Annual Summer Conference kicked off with Dr. Neal Bhatia presenting on actinic keratoses (AK). He began his lecture by encouraging providers to examine our definition of actinic keratoses to ourselves and patients. Actinic keratoses can be viewed as a symptom of a bigger problem with at least 8% of AKs progressing into a squamous cell cancer with time. Dr. Bhatia likes to compare AKs with a cutaneous version of “cavities” because dermatology care providers examine for AKs the same way that dentists search for dental caries. Dr. Bhatia relates that filling cavities is much like freezing AKs—” it is a bandage not a remedy”.
Next Dr. Bhatia reviewed the most commonly used topical agents for the treatment of AKs and field vs spot treatment. He highlighted that histological clearance is higher with imiquimod and 5-FU vs cryosurgery. Dr. Bhatia also provided some tips on helping patients through treatments with topical regimens including different dosing strategies and pain-relieving agents (i.e. having patients start treatments on a Sunday, using agents Monday-Thursday and adjunct therapies except steroids).
Dr. Bhatia also reviewed newer topical treatments including 5-FU cream with 4% peanut oil—the peanut oil is found to add moisturizing effects and is safe to use in patients with a peanut allergy and optimal use of use of ingenol mebutate.
Dr. Bhatia also discussed chemoprevention with PDT. He stated the key to treatment with PDT “is to find the right patient and use it as part of a recipe”. It is imperative to inform patients of expectations, review current medication lists, and ensure there are no upcoming social events for the patients. Success with PDT in the office, requires well prepared staff and consideration for pain control, if needed. Dr. Bhatia believes 2 hours is the magic incubation time for PDT treatment.
Finally, Dr. Bhatia explored newer options for post treatment and prevention of actinic keratoses. Sunscreens with photolyases for use post-PDT, Heliocare, Nicotinamide, and chemoprevention of AKs with retinoids.