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):945-955. doi: 10.1016/j.jaad.2021.05.056. Epub 2021 Jun 7.
Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. Treatment options for AK include topical medications, photodynamic therapy, cryosurgery, and laser ablation.
This executive summary provides a synopsis of the 18 evidence-based recommendations for the treatment of AK detailed in the Guidelines of Care for the Management of Actinic Keratosis.
A multidisciplinary workgroup 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, suggesting there are several effective treatments available for AK.
The analysis informing the recommendations was based on the best available evidence at the time it was conducted. The results of future studies may necessitate a revision of current recommendations.
Strong recommendations are presented for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are presented 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）是在慢性暴露于紫外线的皮肤上出现的粗糙鳞片斑块，可能进展为角质形成细胞癌。AK 的治疗选择包括局部药物治疗、光动力疗法、冷冻疗法和激光消融。
本执行摘要概述了《光化性角化病管理护理指南》中详细介绍的 18 项 AK 治疗的循证建议。
一个多学科工作组进行了系统评价，以解决 AK 管理方面的 5 个临床问题，并应用评估建议、制定和分级临床建议的推荐分级评估、制定和评估方法来评估证据的确定性。对分级建议进行投票以达成共识。
对证据的分析产生了 18 项建议，表明有几种有效的 AK 治疗方法。
为这些建议提供信息的分析是基于进行分析时可获得的最佳现有证据。未来的研究结果可能需要对当前的建议进行修订。
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。有条件地建议使用光动力疗法和双氯芬酸治疗 AK，单独使用或作为联合治疗方案的一部分。
