28521 Frequency of procedural and medical treatments for actinic keratosis

Abstract

Actinic keratosis (AK) is a common dermatologic diagnosis with the potential of malignant transformation. Treatment options include destructive therapies, such as cryotherapy, and topical medications, such as 5-fluorouracil (5-FU), imiquimod, and ingenol mebutate. Historically, destructive procedures have remained the standard of care. There have been limited updates on AK management practices; we determined the frequency of procedural and medical treatments of AK. We assessed visits from the 2009 to 2016 National Ambulatory Medical Care Survey to quantify the use of cryotherapy, topical 5-fluorouracil, imiquimod, ingenol and topical aminolevulonic acid (as a proxy for photodynamic therapy). There were an estimated 11.5 (10.6, 12.4) million visits with a primary diagnosis of AK. One or more of the studied treatments were identified at 47.1% (42.5, 51.6) of visits. Of visits with some kind of AK treatment, cryotherapy was used in 90.6% (81.5, 99.7) of visits, while 5-fluorouracil, imiquimod, and ingenol were prescribed at 4.06% (2.20, 5.92), 5.00% (1.65, 8.36) and 0.16% (0, 0.33) of all visits (respectively). Photodynamic therapy was used at 0.90% (0.25, 1.55) of all visits with treatment. Despite the expansion of treatment options, cryotherapy remains the standard of care. Future development of therapies with improved tolerability and patient compliance as well as alternate payment models have the potential to change the standard of practice.