Comparison of Four Field-Directed Treatments for Actinic Keratosis
Posted: Monday, April 1, 2019
According to a Dutch study published in The New England Journal of Medicine, 5% fluorouracil cream was the most successful treatment of four field-directed treatments among patients with actinic keratosis, the most common premalignant skin disease in the white population. In addition, Maud H. E. Jansen, MD, of Maastricht University Medical Center, The Netherlands, and colleagues did not observe any unexpected toxic effects associated with the treatment.
The study included 624 patients with at least 5 actinic keratosis lesions on the head in a single continuous area of 25 to 100 cm2. The authors randomly assigned patients to receive 1 of the 4 frequently used field-directed treatments: 5% fluorouracil cream (n = 155), 5% imiquimod cream (n = 156), methyl aminolevulinate photodynamic therapy (MAL-PDT; n = 156), or 0.015% ingenol mebutate gel (n = 157). The authors evaluated the proportion of patients with at least a 75% reduction in the number of actinic keratosis lesions 1 year after treatment.
The cumulative probability of patients remaining free from treatment failure after 12 months was highest among those treated with 5% fluorouracil cream (74.4%). The probabilities of remaining free from treatment failure in the imiquimod, MAL-PDT, and ingenol mebutate groups were 53.9%, 37.7%, and 28.9% respectively. The 3 groups also had significantly greater hazard ratios compared with fluorouracil: 2.03 with imiquimod, 2.73 with MAL-PDT, and 3.33 with ingenol mebutate (P < .001 for all ).
“Because of the increasing age of the general population and the high recurrence rate of actinic keratosis, this condition puts a high burden on the health care system, with 5 million dermatology visits per year in the United States alone,” the researchers noted. “Our results could affect treatment choices in both dermatology and primary care.”
Disclosure: The study author’s disclosure information can be found at nejm.org.
