THICKNESS rough and uncomfortable when touched, red or brown spots that develop on the skin of the areas most exposed to sunlight such as the face, hands and scalp. And that should not be archived as simple signs of aging: they can in fact be manifestations of actinic keratosis, a very common disease (the frequency in Europe is around 27-28%) and which presents with epidermal lesions that can evolve into much more aggressive and dangerous forms of cancer. The good news is that actinic keratosis is cured, and today better than yesterday, with the approval of a new topical therapy: a 5-fluorouracil-based cream, with “selective” action, effective and well tolerated.
What is Actinic Keratosis
“Actinic keratosis is a pre-cancerous disease that deserves attention and that cannot be underestimated”, explains Ketty Peris, National President of the Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases (SIDEMAST): “It manifests itself after 40 years as pink, red or brown spots that over time can thicken and become hard, rough and very adherent to the skin. The size can range from a few millimeters to a few centimeters and 45% of patients have at least six or more lesions on the skin. The most affected areas of our body are those most exposed to the sun such as the face, ears, scalp and the back of the hands “.
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Light and very light skin are a predisposing factor but not the only one. Lifestyle greatly affects the appearance of actinic keratosis: chronic photo-exposure for work, sport or just for aesthetics, especially if adequate sun protection has not been used, put you at risk. “If actinic keratoses are not treated, they can, up to 16% of cases, evolve into squamous cell carcinoma,” continues Peris. “The latter alone accounts for 25% of all forms of cancer that can affect our skin and has a high risk of developing metastases.”
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A new topical therapy
Although it has long been underestimated, actinic keratosis is a condition that can, and indeed should, according to dermatologists, treat. After diagnosis and confirmation by the specialist, the lesions can be treated effectively, for example by laser surgery or cryotreatment with liquid nitrogen. However, resolution of clinical lesions often does not resolve the problem and the lesions recur. “Particularly where the lesions are multiple it is likely that the damage is more extensive than what can be seen and that the area is also affected by subclinical lesions”, explains Peris. “It thus becomes essential to be able to use a treatment capable of acting not only on the pathology already present, but also on the development of new lesions”.
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In these cases, therefore, it is necessary to treat the whole area, which is now possible thanks to the approval of the therapy based on fluorouracil creams, a cytostatic agent capable of interfering with the synthesis of DNA and RNA, thus causing an inhibition of growth. mobile phone. “5-Fluorouracil 4% is a cream that must be applied, in adults, once a day for at least four weeks”, explains Piergiacomo Calzavara Pinton, Department of Dermatology AST Spedali Civili and Dermatology Clinic of the University of Brescia. “It demonstrated a 100% cure rate in 54% of patients, while a 75% cure rate in 80% of cases. Furthermore, 45% of patients are still free from relapses after 12 months. It is easy to apply, has a low systemic absorption after skin application and has shown great tolerability. All this favors therapeutic adherence which is also fundamental in dermatology, especially when it concerns pathologies that affect the not very young. In fact, only one out of ten patients interrupted treatment following the appearance of adverse events. This is a lower dropout rate than that recorded for other topical treatments used against the same pathology “.
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Prevention, before and after
Actinic keratosis is in effect a tumor in its very early stages. It does not always degenerate into invasive carcinoma, but we know that almost all squamous cell carcinomas originate from lesions of this type. “Not being able to predict which lesions will degenerate and which will not, secondary prevention, therefore resolving them all, is fundamental”, insists Giuseppe Argenziano, full professor and director of the Dermatological clinic of the University of Campania “Luigi Vanvitelli”, Naples. “Hence the need to have treatments that act in a timely manner, and 5-fluorouracil allows us to treat the entire field of cancerization and not just the clinically detectable lesions, which are only the tip of the iceberg.”
However, the importance of primary prevention of the pathology that passes from correct exposure to sunlight should not be forgotten. “For us dermatologists, true photoprotection is total protection, which shields a large part of the UV rays as well. In the end, the lower SPF factors are not very effective ”, concludes Argenziano. The advice is to always protect yourself adequately, all year round – those who practice snow sports are no less at risk than lovers of summer tanning – and at all ages because sun damage accumulates over time, avoiding sunbeds and lamps. bronzers. And after the age of 40, an annual dermatological examination must be planned.
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