The quality of evidence is downgraded by study limitations (lack of blinding or lack of blinding and selective reporting) and upgraded by large treatment effect.
A Cochrane review [Abstract] 1 included 83 studies with a total of 10,036 participants. Out of them 60 studies assessed the effect of topical treatments, creams or gels with 18 different pharmaceutical agents, against vehicle or placebo. Two studies compared topical agents with cryotherapy with nitric oxygen. The participants were mostly men with mean ages of 60 to 70 years. Lesions generally located on the head and were of grade I (slightly palpable, better felt than seen) or II (moderately thick, easily seen and felt).
Approximately one third of the patients receiving topical creams benefit the treatment. Diclofenac, 5-fluorouracil, imiquimod, and ingenol mebutate were effective in clearing the lesions, compared to vehicle or placebo. 5-fluorouracil 0.5% and 5% treatments resulted in similar efficacy and safety based on 1 study comparing them directly. 5-fluorouracil seems to be more effective than cryotherapy. Imiquimod treatment resulted in better cosmetic outcomes than 5-fluorouracil. No data on the possible reduction of squamous cell carcinoma was identified in the studies
| Outcome | Number of participants (trials) | Control:2.5% hyaluronic acid | Intervention:3% diclofenac in 2.5% hyaluronic acid | Effect size (95 % CI) |
|---|---|---|---|---|
| Complete clearance | 420(3) | 13% | 31% | RR 2.46(1.66 to 3.66) |
| Withdrawal because of adverse events | 592(4) | 4% | 14% | RR 3.59(1.92 to 6.7) |
| Outcome | Number of participants (trials) | Control:Vehicle | Intervention:0.5% 5-fluorouracil | Effect size (95 % CI) |
| Complete clearance | 522(3) | 2% | 14% | RR 8.86(3.67 to 21.44) |
| Withdrawal because of adverse events | 177(1) | 0% | 4% | RR 5.41(0.3 to 96.18) |
| Outcome | Number of participants (trials) | Control:Placebo | Intervention:5% imiquimod | Effect size (95 % CI) |
| Complete clearance | 1871(9) | 5% | 37% | RR 7.70(4.63 to 12.79) |
| Withdrawal because of adverse events | 1871(9) | 2% | 6% | No significant differences in various dose regimens |
| Outcome | Number of participants (trials) | Control:Cryotherapy | Intervention: 0.5% 5-fluorouracil | Effect size (95 % CI) |
| Complete clearance | 51 | 4% | 33% | RR 8.3 (1.1 to 61.7) |
| Outcome | Number of participants (trials) | Control:Cryotherapy | Intervention: 5% imiquimod | Effect size (95 % CI) |
| Complete clearance | 51(1) | 68% | 85% | RR 1.24 (0.9 to 1.7) |
The choice of treatment option for actinic keratosis depends on the number of lesions, the individual's desired results, and tolerance to the treatments.
Date of latest search: 23.03.2011
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