Over 90% of physicians treating actinic keratosis (AK) prefer short duration treatment options with fast resolving local skin responses (LSRs), according to the findings of a global study presented at the 22nd Congress of the European Academy of Dermatology and Venereology (EADV).

This is the first study of its kind to look at physician treatment perceptions in AK. Over 70% of physicians have concerns about adherence and persistence of topical therapies being negatively influenced by long treatment durations, with local skin responses that may be severe and long lasting.

Professor Eggert Stockfleth from the Universitätsmedizin in Berlin, Germany, commented on the study as part of the review panel:

‘Actinic keratosis is a chronic condition which can be considered a form of early-stage skin cancer. Therefore, it is important that physicians identify treatment options that will lead to improved adherence and ultimately improved outcomes for their patients to ensure satisfaction for patients over the longer term. These findings from over 400 physicians across eight countries provide us with a great insight into AK management and enable us to develop recommendations for improved practice.’

The ‘Physician Perceptions and Experience of Current Treatment in Actinic Keratosis’ study also highlighted physicians’ majority view (80%) that field therapy is important for treating AK, with three quarters (76%) of physicians reporting topical therapy as the best form of field therapy.

AKs are rough skin lesions caused by cumulative exposure to the sun, which can lead to non-melanoma skin cancer (NMSC) if not treated early and effectively. The number of patients with AK is rapidly growing, especially in Europe, the US and Australia.

Some treatments such as cryotherapy target single visible lesions (lesion-directed), while others target an area or field, where visible and non-visible lesions are located (field-directed).

Field-directed treatments, such as ingenol mebutate gel, will not only clear obvious AK lesions but also subclinical lesions, reducing the risk of developing new lesions.

Physician consensus

A global dermatology panel reviewed the findings of the ‘Physician Perceptions and Experience of Current Treatment in Actinic Keratosis’ survey and developed a series of consensus recommendations for AK treatment. At the top of the list was the need for greater physician awareness of the link between AK and SCC.

Supporting this recommendation, new findings from a Swedish research study of 952 people show that many people are not seeking treatment during the early stages of SCC, which suggests that some cases of SCC may have been prevented if AK was detected and diagnosed at an earlier disease stage.

There are also cost savings associated with the earlier treatment of AK. A second study conducted in the same area of Sweden reviewed the costs associated with treating AK, and concluded that although there are costs associated with the management of AK, the burden for patients, health care, and society may be even higher if the disease progresses to SCC.

AK therapy is associated with local skin responses that are potentially unsightly and associated with pain, discomfort and disruption of daily activities, underlining the importance of assessing treatment satisfaction and quality of life.

Also presented at the congress of EADV were the results of a Quality of Life (QoL) study  among 1005 patients receiving topical treatment for AK.

The results showed that for those patients treated with ingenol mebutate gel, a novel topical field-directed treatment for AK with a 2–3-day treatment regimen, a significant improvement in QoL versus placebo was demonstrated, as measured by the TSQM and Skindex-16 surveys. Patients reported that ingenol mebutate gel has a QoL benefit as well as a clinical benefit.

Professor Matthias Augustin, Universitätsklinikum Hamburg-Eppendorf, Germany who was involved in the data analysis, commented: ‘This study suggests that patients are satisfied with the short treatment duration and the effect associated with using ingenol mebutate gel. Even patients that were not completely cleared stated improved quality of life when using this treatment.’