Dirschka Thomas, Ardigò Marco, Fargnoli Maria Concetta, Ferrándiz-Pulido Carla, Gilaberte Yolanda, Hadshiew Ina, Peris Ketty, Szeimies Rolf-Markus
CentroDerm Clinic, Heinz-Fangman-Strasse 57, Wuppertal, Germany.
Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy.
J Dermatolog Treat. 2025 Dec;36(1):2487657. doi: 10.1080/09546634.2025.2487657. Epub 2025 Apr 14.
Actinic keratosis (AK) is the main precursor of invasive cutaneous squamous cell carcinoma (cSCC). Since it is impossible to predict which lesions will progress to cSCC, early treatment of AK is crucial. Although AK treatments are effective, some are associated with local skin reactions that may impact treatment compliance and effectiveness. The aim of this modified Delphi study was to review the efficacy and safety of the different AK treatments, gain an understanding of the dermatologists' perspectives on their use, and provide guidelines for clinical practice.
This document corresponds to a modified Delphi consensus survey, based on a literature review and a single round of questionnaire.
The Delphi questionnaire was completed by 73 dermatologists from Germany, Italy, and Spain. Agreement was achieved for 78% of statements, while 11% showed discrepancies or were rejected.
Key findings emphasize the importance of patient-centered approaches and treatment attributes beyond efficacy (e.g. tolerability or adherence). Understanding the mechanisms of action of treatments is vital for managing patients' and clinicians' expectations and optimizing outcomes. Alternative strategies for evaluating efficacy, including the Actinic Keratosis Area and Severity Index (AKASI) score and lesion reduction from baseline, were also highlighted.
光化性角化病（AK）是侵袭性皮肤鳞状细胞癌（cSCC）的主要前驱病变。由于无法预测哪些病变会进展为cSCC，因此AK的早期治疗至关重要。尽管AK治疗有效，但有些治疗会伴有局部皮肤反应，这可能会影响治疗依从性和有效性。这项改良的德尔菲研究旨在回顾不同AK治疗方法的疗效和安全性，了解皮肤科医生对其使用的看法，并为临床实践提供指导。
本文档对应一项基于文献综述和一轮问卷调查的改良德尔菲共识调查。
来自德国、意大利和西班牙的73名皮肤科医生完成了德尔菲问卷。78%的陈述达成了共识，而11%的陈述存在分歧或被否决。
主要发现强调了以患者为中心的方法以及疗效之外的治疗属性（如耐受性或依从性）的重要性。了解治疗的作用机制对于管理患者和临床医生的期望以及优化治疗结果至关重要。还强调了评估疗效的替代策略，包括光化性角化病面积和严重程度指数（AKASI）评分以及相对于基线的病变减少情况。
