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Joseph L Jorizzo - One of the best experts on this subject based on the ideXlab platform.
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current issues in the management of Actinic Keratosis
Journal of The American Academy of Dermatology, 2013Co-Authors: Roger I Ceilley, Joseph L JorizzoAbstract:Actinic keratoses are common sun-induced skin lesions that should be treated to prevent the development of nonmelanoma skin cancer. Although cryotherapy is commonly used to treat individual lesions, it fails to address the Actinically damaged field of neighboring sun-damaged skin, which is more effectively treated by field therapies to clear both visible and subclinical lesions. Most topical treatments require prolonged use and cause an inflammatory response that limits tolerability and adherence. Education is essential to teach patients about the chronic nature of Actinic Keratosis, the risk of nonmelanoma skin cancer, and the importance of correct use of topical medications. The addition of nonphysician clinicians to dermatologic practices provides a valuable source of education, treatment, and follow-up care to the management of Actinic Keratosis.
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Spreading pigmented Actinic Keratosis: A review
Journal of the American Academy of Dermatology, 2010Co-Authors: Elizabeth E. Uhlenhake, Omar P. Sangueza, Andrew D. Lee, Joseph L JorizzoAbstract:Introduction Spreading pigmented Actinic Keratosis (SPAK) is a common, but uncommonly reported or appreciated, variant of classic Actinic Keratosis (AK). It can mimic different pigmented lesions, which may be benign (eg, solar lentigo) or malignant (eg, lentigo maligna). Objective We sought to review current data and identify areas needing further research to establish diagnostic guidelines for SPAK and to increase awareness of this common entity. Methods A literature search was performed in both PubMed and MEDLINE databases using the search terms "spreading pigmented Actinic Keratosis," "pigmented solar Keratosis," "pigmented Actinic," and "pigmented solar." Each article was retrieved, reviewed, and summarized. Results SPAK is a rarely reported lesion that can be difficult to distinguish from other benign and malignant pigmented lesions, including seborrheic Keratosis, melanoma in situ (lentigo maligna type), and lentigo maligna melanoma. Located mainly on sun-exposed areas and with a size greater than 1.5 cm, the lesion typically spreads laterally. Pathologically, the lesion resembles classic AK with increased basal melanization. The malignancy potential has not yet been elucidated but destructive therapies such as cryotherapy are recommended. Limitations Reports not yet published or not included in the comprehensive databases we used may exist that were not analyzed. Conclusions SPAK can be associated with adjacent melanoma in situ; therefore, its diagnosis merits increased suspicion for coexisting melanoma.
Steven R. Feldman - One of the best experts on this subject based on the ideXlab platform.
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Pharmacoeconomic Considerations in Treating Actinic Keratosis: An Update
PharmacoEconomics, 2017Co-Authors: Spencer M. Vale, Dane Hill, Steven R. FeldmanAbstract:Actinic Keratosis is one of the most common dermatological diagnoses worldwide, especially among the elderly, fair-skinned, and immunocompromised, and is associated with a risk of transformation to skin cancer. With Actinic Keratosis and skin cancer prevalence increasing as the aged population expands in the US, optimizing treatment strategies may produce cost savings for the healthcare system. Since the time of our last review in 2008, investigation of the economic considerations in treating Actinic Keratosis has advanced. To provide an update of treatment cost effectiveness and to review factors relating to the costs of care, we conducted a systematic review of pharmacoeconomic publications since December 2008. We identified 11 pharmacoeconomic studies, with one cost-of-treatment, five cost-effectiveness, and five cost-utility analyses. Photodynamic therapy (PDT) was well tolerated and produced a favorable cosmetic outcome in most studies. Ingenol mebutate, the newest but most expensive topical field therapy, 5-fluorouracil, and PDT were the most cost-effective treatments in our review. Patient adherence to therapy and the management of adverse effects were significant contributors to treatment costs. In the US, treatment guidelines and formalized cost-effectiveness analyses for Actinic Keratosis are absent from the recent literature. Future pharmacoeconomic investigation will depend on up-to-date comparative efficacy data, as well as clarification of rates of, and management strategies for, adverse effects, therapeutic non-adherence, and lesion recurrence.
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Pharmacoeconomic Considerations in Treating Actinic Keratosis
PharmacoEconomics, 2009Co-Authors: Marjorie V. Neidecker, Mary Lynn Davis-ajami, Rajesh Balkrishnan, Steven R. FeldmanAbstract:Actinic Keratosis is among the most commonly treated skin conditions in the outpatient setting. Its prevalence spans the globe, with greater distribution in fair skinned individuals and the immunocompromised. With high prevalence, increasing incidence and the risk of transformation to a cancerous lesion, prevention and timely treatment present opportunities to rein in costs. The purpose of this article is to review published economic studies relating to the treatment of Actinic Keratosis, to summarize results discussing the cost drivers of current treatment modalities and to identify parameters most likely to influence the cost effectiveness of treatment. We systematically conducted a published literature search for pharmacoeconomic research of Actinic Keratosis using title, abstract or full-text searches with the following search terms ([Actinic OR solar] AND [Keratosis OR keratoses]) AND (economic OR cost OR pharmacoeconomics OR decision). We included published articles referencing Actinic Keratosis in a standalone study or in a broader study referencing non-melanoma skin cancer and articles evaluating cost-of-illness, cost-of-treatment, cost minimization, cost effectiveness, cost utility, cost-benefit analysis and cost consequence. Our review of the literature found nine studies devoted to pharmacoeconomic considerations of Actinic Keratosis treatments, with one article investigating both cost-of-illness and cost-of-treatment, two measuring cost-of-illness, two evaluating cost-of-treatment, one focusing on cost minimization, and three focusing on cost effectiveness. The literature compared a broad range of Actinic Keratosis treatments including topical medications, cryotherapy, photodynamic therapy, excision and a combination of treatment modalities. The direct cost of Actinic Keratosis management in the US was estimated at $US1.2 billion per year, with indirect costs totalling $US295 million (year 2004 values). The primary drivers of cost were physician office visits and associated procedures. Pharmacoeconomic research defining standards, outcomes and areas of efficiencies in the treatment of Actinic Keratosis is in its infancy. To move towards more comprehensive analysis, research needs to focus on updating epidemiological data, evolving evidence-based standards, delineating cost drivers in immunocompetent and immunocompromised populations, and on health outcomes.
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Pharmacoeconomic considerations in treating Actinic Keratosis.
PharmacoEconomics, 2009Co-Authors: Marjorie V. Neidecker, Mary Lynn Davis-ajami, Rajesh Balkrishnan, Steven R. FeldmanAbstract:Actinic Keratosis is among the most commonly treated skin conditions in the outpatient setting. Its prevalence spans the globe, with greater distribution in fair skinned individuals and the immunocompromised. With high prevalence, increasing incidence and the risk of transformation to a cancerous lesion, prevention and timely treatment present opportunities to rein in costs.
Emily H. Tang - One of the best experts on this subject based on the ideXlab platform.
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Actinic Keratosis
American Journal of Clinical Dermatology, 2000Co-Authors: Edward W. B. Jeffes, Emily H. TangAbstract:Actinic keratoses are hyperkeratotic skin lesions that represent focal abnormal proliferation of epidermal keratinocytes. Some Actinic keratoses evolve into squamous cell carcinoma of the skin, while others resolve spontaneously. The conversion rate of Actinic Keratosis to squamous cell carcinoma is not accurately known, but appears to be in the range of 0.25 to 1% per year. Although there is a low rate of conversion of Actinic keratoses to squamous cell carcinoma, 60% of squamous cell carcinomas of the skin probably arise from Actinic keratoses. The main cause of Actinic keratoses in otherwise healthy Caucasians appears to be the sun. Therapy for Actinic keratoses begins with prevention which starts with sun avoidance and physical protection. Sunprotection with sunscreens actually slows the return of Actinic keratoses in patients already getting Actinic keratoses. Interestingly, a few studies are available that demonstrate that a high fat diet is associated with the production of more Actinic keratoses than is a low fat diet. One of the mainstays of therapy has been local destruction of the Actinic keratoses with cryotherapy, and curettage and electrodesiccation. A new addition to this group of therapies to treat individual Actinic keratoses is photodynamic therapy with topical aminolevulinic acid and light. In patients who have numerous Actinic keratoses in an area of severely sun damaged skin, therapies which are applied to the whole Actinic Keratosis area are used. The goal of treating such an area of skin is to treat all of the early as well as the numerous clinically evident Actinic keratoses at the same time. The classical approaches for treating areas of photodamaged skin without treating Actinic keratoses individually include: the use of topically applied fluorouracil cream, dermabrasion, and cutaneous peels with various agents like trichloroacetic acid. Both topically as well as orally administered retinoids have been used to treat Actinic keratoses but retinoids alone are probably not an optimal monotherapy. Photodynamic therapy with topical aminolevulinic acid and light is a new therapy for Actinic keratoses. Aminolevulinic acid is a precursor of protoporphyrin IX (PpIX) which is synthesized in the Actinic Keratosis when it is treated with aminolevulinic acid, and the PpIX photosensitizes the Actinic Keratosis so that light exposure can lead to its destruction. Photodynamic therapy with topical aminolevulinic acid is approved in the US to treat multiple individual Actinic keratoses on the face and scalp and has similar cure rates to those reported for cryotherapy and fluorouracil therapy.
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Actinic Keratosis. Current treatment options.
American journal of clinical dermatology, 2000Co-Authors: Edward W. B. Jeffes, Emily H. TangAbstract:Actinic keratoses are hyperkeratotic skin lesions that represent focal abnormal proliferation of epidermal keratinocytes. Some Actinic keratoses evolve into squamous cell carcinoma of the skin, while others resolve spontaneously. The conversion rate of Actinic Keratosis to squamous cell carcinoma is not accurately known, but appears to be in the range of 0.25 to 1% per year. Although there is a low rate of conversion of Actinic keratoses to squamous cell carcinoma, 60% of squamous cell carcinomas of the skin probably arise from Actinic keratoses. The main cause of Actinic keratoses in otherwise healthy Caucasians appears to be the sun. Therapy for Actinic keratoses begins with prevention which starts with sun avoidance and physical protection. Sunprotection with sunscreens actually slows the return of Actinic keratoses in patients already getting Actinic keratoses. Interestingly, a few studies are available that demonstrate that a high fat diet is associated with the production of more Actinic keratoses than is a low fat diet. One of the mainstays of therapy has been local destruction of the Actinic keratoses with cryotherapy, and curettage and electrodesiccation. A new addition to this group of therapies to treat individual Actinic keratoses is photodynamic therapy with topical aminolevulinic acid and light. In patients who have numerous Actinic keratoses in an area of severely sun damaged skin, therapies which are applied to the whole Actinic Keratosis area are used. The goal of treating such an area of skin is to treat all of the early as well as the numerous clinically evident Actinic keratoses at the same time. The classical approaches for treating areas of photodamaged skin without treating Actinic keratoses individually include: the use of topically applied fluorouracil cream, dermabrasion, and cutaneous peels with various agents like trichloroacetic acid. Both topically as well as orally administered retinoids have been used to treat Actinic keratoses but retinoids alone are probably not an optimal monotherapy. Photodynamic therapy with topical aminolevulinic acid and light is a new therapy for Actinic keratoses. Aminolevulinic acid is a precursor of protoporphyrin IX (PpIX) which is synthesized in the Actinic Keratosis when it is treated with aminolevulinic acid, and the PpIX photosensitizes the Actinic Keratosis so that light exposure can lead to its destruction. Photodynamic therapy with topical aminolevulinic acid is approved in the US to treat multiple individual Actinic keratoses on the face and scalp and has similar cure rates to those reported for cryotherapy and fluorouracil therapy.
Eggert Stockfleth - One of the best experts on this subject based on the ideXlab platform.
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Efficacy Endpoints in Clinical Trials in Actinic Keratosis
Dermatology and Therapy, 2018Co-Authors: Torsten Skov, Eggert Stockfleth, Rolf-markus Szeimies, Brian BermanAbstract:Introduction Actinic Keratosis is regarded as a chronic disease of the skin and, although fluctuating, is chronically progressive. Approval of new products for the treatment of Actinic Keratosis requires the use of a standard methodology in clinical trials which emphasize complete clearance of all Actinic keratoses in a treatment field in a defined time span and the evaluation of long-term efficacy in terms of recurrence rate among completely cleared patients. Methods Analysis of data from six previously published clinical trials in patients with Actinic Keratosis. Results There was poor agreement over a period of 1 month in the complete clearance endpoint. This variation in assessment renders recurrence in cleared patients invalid as the estimate of long-term efficacy. Furthermore, complete clearance was shown to depend heavily on the number of baseline Actinic keratoses. Conclusion The main endpoints presently in use for the assessment of short- and long-term efficacy of Actinic Keratosis field-directed therapy, namely, complete clearance and recurrence rate, are obsolete and should be replaced by the percentage reduction in Actinic Keratosis count or the absolute Actinic Keratosis count. Funding LEO Pharma A/S.
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Efficacy Endpoints in Clinical Trials in Actinic Keratosis.
Dermatologic Therapy, 2018Co-Authors: Torsten Skov, Eggert Stockfleth, Rolf-markus Szeimies, Brian BermanAbstract:Actinic Keratosis is regarded as a chronic disease of the skin and, although fluctuating, is chronically progressive. Approval of new products for the treatment of Actinic Keratosis requires the use of a standard methodology in clinical trials which emphasize complete clearance of all Actinic keratoses in a treatment field in a defined time span and the evaluation of long-term efficacy in terms of recurrence rate among completely cleared patients. Analysis of data from six previously published clinical trials in patients with Actinic Keratosis. There was poor agreement over a period of 1 month in the complete clearance endpoint. This variation in assessment renders recurrence in cleared patients invalid as the estimate of long-term efficacy. Furthermore, complete clearance was shown to depend heavily on the number of baseline Actinic keratoses. The main endpoints presently in use for the assessment of short- and long-term efficacy of Actinic Keratosis field-directed therapy, namely, complete clearance and recurrence rate, are obsolete and should be replaced by the percentage reduction in Actinic Keratosis count or the absolute Actinic Keratosis count. LEO Pharma A/S.
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New Topical Treatment Options for Actinic Keratosis: A Systematic Review
Acta dermato-venereologica, 2016Co-Authors: Eggert Stockfleth, Gillian C Sibbring, Ivette AlarconAbstract:This systematic review compared the relative efficacy of 5-fluorouracil 0.5% in salicylic acid 10% (5-FU/SA), ingenol mebutate (IMB) and imiquimod 2.5%/3.75% (IMI) for Actinic Keratosis on the face, forehead or scalp. Only 11 publications, relating to 7 randomised controlled trials, met inclusion criteria and it was only possible to compare the effect of all 3 treatments on complete clinical clearance, and the effect of 5-FU/SA and IMB on Actinic Keratosis recurrence rate. Despite a higher vehicle response rate for 5-FU/SA, complete clinical clearance was higher than IMB and IMI (55.4, 42.2, and 25.0-30.6/34.0-35.6%, [corrected] respectively). 5-FU/SA was also associated with lower Actinic Keratosis recurrence rate than IMB at 12 months post-treatment (32.7 vs. 53.9%). Although qualitative assessment suggested a numerical advantage of 5-FU/SA over IMB and IMI in terms of complete clinical clearance and sustained clearance, clinical data from longer term trials, with comparable outcome measures, are required to corroborate these findings.
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A consensus approach to improving patient adherence and persistence with topical treatment for Actinic Keratosis.
International journal of dermatology, 2015Co-Authors: Eggert Stockfleth, Rino Cerio, Ketty Peris, C. Guillén, Nicole Basset-seguin, Peter Foley, José Antonio Sanches, Alex Culshaw, Sandra Erntoft, Mark LebwohlAbstract:Background Topical therapy is important in the treatment of Actinic Keratosis, but guidance for improving adherence/persistence during topical therapy is still lacking. Objectives To utilize expert consensus to generate a list of recommendations to improve real-world efficacy when prescribing topical therapy for Actinic Keratosis. Methods An expert panel of eight dermatologists was convened to generate recommendations based on facilitated discussion and consensus generation using a modified Delphi session. The recommendations were ratified with the expert panel. Results Facilitated discussion generated 31 issues within five themes, which were prioritized using expert voting. Consensus was achieved on the importance of short and simple treatment regimens for maximizing patient compliance, physician awareness of the progression of Actinic Keratosis to squamous cell carcinoma, provision of appropriate patient information, and the use of effective communication strategies to educate physicians about Actinic Keratosis. Based on these key findings, eight recommendations were generated. Conclusions The recommendations will assist physicians when prescribing topical Actinic Keratosis therapy. Further research should focus on the types of patient outcomes that are influenced by the characteristics of topical field therapy.
Edward W. B. Jeffes - One of the best experts on this subject based on the ideXlab platform.
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Actinic Keratosis
American Journal of Clinical Dermatology, 2000Co-Authors: Edward W. B. Jeffes, Emily H. TangAbstract:Actinic keratoses are hyperkeratotic skin lesions that represent focal abnormal proliferation of epidermal keratinocytes. Some Actinic keratoses evolve into squamous cell carcinoma of the skin, while others resolve spontaneously. The conversion rate of Actinic Keratosis to squamous cell carcinoma is not accurately known, but appears to be in the range of 0.25 to 1% per year. Although there is a low rate of conversion of Actinic keratoses to squamous cell carcinoma, 60% of squamous cell carcinomas of the skin probably arise from Actinic keratoses. The main cause of Actinic keratoses in otherwise healthy Caucasians appears to be the sun. Therapy for Actinic keratoses begins with prevention which starts with sun avoidance and physical protection. Sunprotection with sunscreens actually slows the return of Actinic keratoses in patients already getting Actinic keratoses. Interestingly, a few studies are available that demonstrate that a high fat diet is associated with the production of more Actinic keratoses than is a low fat diet. One of the mainstays of therapy has been local destruction of the Actinic keratoses with cryotherapy, and curettage and electrodesiccation. A new addition to this group of therapies to treat individual Actinic keratoses is photodynamic therapy with topical aminolevulinic acid and light. In patients who have numerous Actinic keratoses in an area of severely sun damaged skin, therapies which are applied to the whole Actinic Keratosis area are used. The goal of treating such an area of skin is to treat all of the early as well as the numerous clinically evident Actinic keratoses at the same time. The classical approaches for treating areas of photodamaged skin without treating Actinic keratoses individually include: the use of topically applied fluorouracil cream, dermabrasion, and cutaneous peels with various agents like trichloroacetic acid. Both topically as well as orally administered retinoids have been used to treat Actinic keratoses but retinoids alone are probably not an optimal monotherapy. Photodynamic therapy with topical aminolevulinic acid and light is a new therapy for Actinic keratoses. Aminolevulinic acid is a precursor of protoporphyrin IX (PpIX) which is synthesized in the Actinic Keratosis when it is treated with aminolevulinic acid, and the PpIX photosensitizes the Actinic Keratosis so that light exposure can lead to its destruction. Photodynamic therapy with topical aminolevulinic acid is approved in the US to treat multiple individual Actinic keratoses on the face and scalp and has similar cure rates to those reported for cryotherapy and fluorouracil therapy.
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Actinic Keratosis. Current treatment options.
American journal of clinical dermatology, 2000Co-Authors: Edward W. B. Jeffes, Emily H. TangAbstract:Actinic keratoses are hyperkeratotic skin lesions that represent focal abnormal proliferation of epidermal keratinocytes. Some Actinic keratoses evolve into squamous cell carcinoma of the skin, while others resolve spontaneously. The conversion rate of Actinic Keratosis to squamous cell carcinoma is not accurately known, but appears to be in the range of 0.25 to 1% per year. Although there is a low rate of conversion of Actinic keratoses to squamous cell carcinoma, 60% of squamous cell carcinomas of the skin probably arise from Actinic keratoses. The main cause of Actinic keratoses in otherwise healthy Caucasians appears to be the sun. Therapy for Actinic keratoses begins with prevention which starts with sun avoidance and physical protection. Sunprotection with sunscreens actually slows the return of Actinic keratoses in patients already getting Actinic keratoses. Interestingly, a few studies are available that demonstrate that a high fat diet is associated with the production of more Actinic keratoses than is a low fat diet. One of the mainstays of therapy has been local destruction of the Actinic keratoses with cryotherapy, and curettage and electrodesiccation. A new addition to this group of therapies to treat individual Actinic keratoses is photodynamic therapy with topical aminolevulinic acid and light. In patients who have numerous Actinic keratoses in an area of severely sun damaged skin, therapies which are applied to the whole Actinic Keratosis area are used. The goal of treating such an area of skin is to treat all of the early as well as the numerous clinically evident Actinic keratoses at the same time. The classical approaches for treating areas of photodamaged skin without treating Actinic keratoses individually include: the use of topically applied fluorouracil cream, dermabrasion, and cutaneous peels with various agents like trichloroacetic acid. Both topically as well as orally administered retinoids have been used to treat Actinic keratoses but retinoids alone are probably not an optimal monotherapy. Photodynamic therapy with topical aminolevulinic acid and light is a new therapy for Actinic keratoses. Aminolevulinic acid is a precursor of protoporphyrin IX (PpIX) which is synthesized in the Actinic Keratosis when it is treated with aminolevulinic acid, and the PpIX photosensitizes the Actinic Keratosis so that light exposure can lead to its destruction. Photodynamic therapy with topical aminolevulinic acid is approved in the US to treat multiple individual Actinic keratoses on the face and scalp and has similar cure rates to those reported for cryotherapy and fluorouracil therapy.
