Treating Actinic Keratosis: A Randomized Trial

Patients with actinic keratoses (AKs), which can progress to cutaneous squamous cell carcinoma, often are treated with any of several “field-directed” therapies when they have areas with multiple lesions. In this randomized trial that involved 624 patients, four field-directed alternatives were compared:

• 5% fluorouracil cream (disrupts DNA synthesis)

• 5% imiquimod cream (stimulates local immune response)

• Photodynamic therapy (induces cell necrosis when photosensitizing drug is applied and skin is exposed to light)

• Ingenol mebutate gel (injures mitochondria and plasma membranes)

All participants had at least five AKs on their heads, within an area of 25 cm² to 100 cm². Patients could be retreated if initial response was inadequate. The primary end…