Actinic Keratosis: Field Treatments—5-Fluorouracil, Imiquimod, Ingenol and Photodynamic Therapy (PDT)

Field treatments for actinic keratosis are very effective, however, they can be quite reactive so patients need to be aware of this.  For patients applying 5-Fluorouracil (Efudex) or Imiquimod (Aldara) the treatment cycle is usually 4 weeks.  There are variations in this, such as, 2 weeks on, 2 weeks off then 2 weeks on again.  Ingenol (Picato) is a shorter treatment option applying it over 2-3 days (depending on the region) and does not result in as exuberant of a topical reaction.  Photodynamic therapy (PDT) is the use of a topical agent that sensitizes the actinic keratosis to specific wavelengths of light, and with exposure to these wavelengths of light for a few minutes results in a very controlled therapeutic option.  PDT Patients are treated every few months and often have a very significant improvement.  The amount of skin reaction with PDT is also not as pronounced as with other field treatments.  The patient above was treated for 4 weeks with 5-Fluorouracil with a very significant reaction.

This is how the patient looked after treatment.  As you can see the response was very dramatic with significant improvement in actinic damage…as well as an excellent cosmetic result.  In my experience the more exuberant the reaction, the better the results.  Caveat—I have seen significant scarring as a result of too fulminant of a reaction, so patients need to be monitored closely.  For more information on field treatments click HERE.  For more information on actinic keratosis click HERE.  For information on treating actinic keratosis with cyrotherapy click HERE.