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Evidence summaries

Topical Creams and Cryotherapy for Actinic Keratoses

Topical medical treatments appears to be effective in clearing the skin lesions of actinic keratoses. Level of evidence: "B"

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.

Summary

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

OutcomeNumber of participants (trials)Control:2.5% hyaluronic acidIntervention:3% diclofenac in 2.5% hyaluronic acidEffect size (95 % CI)
Complete clearance420(3)13%31%RR 2.46(1.66 to 3.66)
Withdrawal because of adverse events592(4)4%14%RR 3.59(1.92 to 6.7)
OutcomeNumber of participants (trials)Control:VehicleIntervention:0.5% 5-fluorouracilEffect size (95 % CI)
Complete clearance522(3)2%14%RR 8.86(3.67 to 21.44)
Withdrawal because of adverse events177(1)0%4%RR 5.41(0.3 to 96.18)
OutcomeNumber of participants (trials)Control:PlaceboIntervention:5% imiquimodEffect size (95 % CI)
Complete clearance1871(9)5%37%RR 7.70(4.63 to 12.79)
Withdrawal because of adverse events1871(9)2%6%No significant differences in various dose regimens
OutcomeNumber of participants (trials)Control:CryotherapyIntervention: 0.5% 5-fluorouracilEffect size (95 % CI)
Complete clearance514%33%RR 8.3 (1.1 to 61.7)
OutcomeNumber of participants (trials)Control:CryotherapyIntervention: 5% imiquimod Effect size (95 % CI)
Complete clearance51(1)68%85%RR 1.24 (0.9 to 1.7)

Clinical comments

The choice of treatment option for actinic keratosis depends on the number of lesions, the individual's desired results, and tolerance to the treatments.

Note

Date of latest search: 23.03.2011

    References

    • Gupta AK, Paquet M, Villanueva E et al. Interventions for actinic keratoses. Cochrane Database Syst Rev 2012;(12):CD004415. [PubMed]

Primary/Secondary Keywords