WAIKOLOA, HAWAII – Half of patients whose face or scalp actinic keratoses clear completely in response to 3 consecutive days of topical field therapy with ingenol mebutate gel 0.015% will remain clear 12 months later with no further treatment.
That finding from a multicenter prospective study is just one of several recent developments of note in the treatment of actinic keratoses. Other recent studies have addressed the effectiveness of fractional laser therapy and cryotherapy followed by ingenol mebutate, and there have been new developments in phototherapy, Dr. James E. Sligh said in a review of actinic keratosis research at the Hawaii Dermatology Seminar sponsored by the Global Academy for Medical Education/Skin Disease Education Foundation.
Dr. James Sligh
• Long-term follow-up of ingenol mebutate therapy. In a multicenter study, dermatologists followed 100 patients with complete clearance of AKs on the face or scalp in response to 3 consecutive days of ingenol mebutate gel (Picato) and 71 patients whose AKs on the trunk or limbs cleared after 2 consecutive days of therapy. The sustained lesion reduction rate, compared with pretreatment baseline was 87.2% for the face and scalp lesions and 86.8% for AKs on the trunk or extremities.
The median time to recurrence was 365 days for AKs on the face and scalp, and shorter at 274 days for lesions on the trunk or extremities, which notably had received 1 less day of treatment. No safety concerns arose during follow-up (JAMA Dermatol. 2013;149:666-70).
• Sequential cryosurgery followed by ingenol mebutate. In a randomized, double-blind, multicenter phase-III trial, 329 patients were randomized to field therapy of AKs on the face or scalp with ingenol mebutate or vehicle 3 weeks after cryosurgery. The complete clearance rate in the treated area at week 11 was significantly higher in the sequential therapy group: 60.5%, compared with 49.4% with cryosurgery alone (J. Drugs Dermatol. 2014;13:154-60).
"I think this is the first in what will be a number of studies where you start to see assessment of combined therapies. But I think the target to look at is not so much what happens at 11 weeks, as in this study, but what happens 1 or 2 years down the road. If you can maintain complete clearance for that long I think it’s worth the extra effort to combine treatment cycles at the beginning," commented Dr. Sligh, chief of the division of dermatology at the University of Arizona, Tucson.
• Laser therapy. Investigators at the Laser and Skin Surgery Center of New York investigated treatment of facial AKs using a fractionated 1927-nm nonablative thulium laser. Twenty-four patients received up to four fractional resurfacing treatments in this prospective trial. At 6 months follow-up, the AK lesion count was down 87%, compared with baseline. Patient satisfaction was high – all participants reported marked or noticeable improvement in overall photodamage – and treatment was well tolerated (J. Am. Acad. Dermatol. 2013;68:98-102).
"If you look at the reduction in AK counts, it stands up very nicely to some of our medical therapies in terms of overall clearance at 6 months, with an 87% reduction – provided you have this special thulium laser in your office," Dr. Sligh observed.
• Photodynamic therapy. What’s new in photodynamic therapy for AKs is not currently available in the United States: methyl aminolevulinate cream 16.8% (Metvixia) for use with red light illumination. This photosensitizer does remain available, however, in Canada and Mexico, according to Dr. Sligh. And aminolevulinic acid (Levulan) is still available as an approved photosensitizer for use with blue light.
"There are many people I know who will activate the Levulan with either a red or blue light source," he said.
Dr. Sligh is on the advisory board for and a consultant to Genentech and has received research grants from DermSpectra and Scibase.
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