Department of Dermatology, University of California, Davis, Sacramento, California.
Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts.
J Am Acad Dermatol. 2021 Oct;85(4):e209-e233. doi: 10.1016/j.jaad.2021.02.082. Epub 2021 Apr 2.
Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma.
This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed.
A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus.
Analysis of the evidence resulted in 18 recommendations.
This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data.
Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.
光化性角化病（AK）是在慢性紫外线暴露的皮肤上出现的粗糙鳞片斑块，可进展为角质形成细胞癌。
本分析检查了与 AK 治疗相关的文献，为治疗提供了循证建议。还讨论了 AK 的分级、组织学分类、自然史、进展风险和皮肤科监测。
一个多学科工作组进行了系统评价，以解决 5 个关于 AK 管理的临床问题，并应用推荐分级、评估、发展和评估方法评估证据的确定性，并制定和分级临床建议。对分级建议进行了投票，以达成共识。
对证据的分析产生了 18 项建议。
本分析基于进行时的最佳可用证据。出于将文献综述仅限于英语随机试验的实际考虑，可能排除了以其他语言发表的数据或限制了对相关长期随访数据的识别。
强烈建议使用紫外线防护、局部咪喹莫特、局部 5-氟尿嘧啶和冷冻疗法。对光动力疗法和双氯芬酸治疗 AK 的使用提出了有条件的建议，包括单独使用和作为联合治疗方案的一部分。
