A consensus approach to improving patient adherence and persistence with topical treatment for actinic keratosis

Abstract

BackgroundTopical therapy is important in the treatment of actinic keratosis, but guidance for improving adherence/persistence during topical therapy is still lacking.ObjectivesTo utilize expert consensus to generate a list of recommendations to improve real-world efficacy when prescribing topical therapy for actinic keratosis.MethodsAn expert panel of eight dermatologists was convened to generate recommendations based on facilitated discussion and consensus generation using a modified Delphi session. The recommendations were ratified with the expert panel.ResultsFacilitated discussion generated 31 issues within five themes, which were prioritized using expert voting. Consensus was achieved on the importance of short and simple treatment regimens for maximizing patient compliance, physician awareness of the progression of actinic keratosis to squamous cell carcinoma, provision of appropriate patient information, and the use of effective communication strategies to educate physicians about actinic keratosis. Based on these key findings, eight recommendations were generated.ConclusionsThe recommendations will assist physicians when prescribing topical actinic keratosis therapy. Further research should focus on the types of patient outcomes that are influenced by the characteristics of topical field therapy.

Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

“…In our opinion a possible explanation could be related to the lower rate of self-application errors on face than on scalp; however, in the present study, we obtained the same results even performing a physician-assisted application[17]. Therefore, other factors should be investigated to explain these findings, such as local differences in skin architecture, microbiota and ph.…”

Ingenol Mebutate 0.06% Gel for Field Treatment of Actinic Keratosis on 250 cm2 of Skin on Trunk and Extremities: A Randomized Dose-Finding Trial

“…20 Shorter, simpler treatment regimens should improve adherence and outcomes. 21 In this trial, adherence with IngMeb was high, with 92.9% of patients receiving all four applications of treatment, confirming findings from previous IngMeb studies. 9 Another advantage of short-course treatment is the predictable timing and relatively short duration of LSRs, which should improve patient satisfaction.…”

“…9 Another advantage of short-course treatment is the predictable timing and relatively short duration of LSRs, which should improve patient satisfaction. 21 In the current study, LSR scores peaked at Day 5 in the 3D and 4D groups and at Days 5 and 10 in the 2D group; responses were minimal four weeks after treatment. These findings are similar to those reported over a 25 cm 2 treatment area -LSR score peaked at Day 4 for the face/scalp and at Days 3, 8 and 15 for the trunk/extremities.…”

Topical agents for preventing and treating actinic keratosis

“…31 These can be summarised as: minimise the duration of treatment; and promote awareness and education among clinicians and patients.…”