Comparing the efficacy of field treatments for actinic keratosis: a critical appraisal of a randomized trial in the New England Journal of Medicine.

Summary: Aim: Jansen et al. conducted a randomized trial to compare the efficacy of four field treatments for actinic keratosis (AK). Setting and design: This was a multicentre, single‐blind, randomized trial conducted in the dermatology departments of four Netherlands hospitals. Patients were not blinded. The investigator who evaluated the trial outcome was blinded. Study exposure: This study included adult patients with at least five AKs on the face or vertex scalp. Patients were randomized to treatment with fluorouracil 5% cream, imiquimod 5% cream, methyl aminolaevulinate photodynamic therapy (MAL‐PDT) or ingenol mebutate 0·015% gel. Outcomes: The primary outcome was whether patients had ≥ 75% reduction in AK count 12 months after treatment. Results: In total 624 patients participated. The likelihood of having ≥ 75% reduction in AK count 12 months after treatment was significantly higher (twice as high or greater) for fluorouracil than for any other therapy. Approximately 75% of patients treated with fluorouracil experienced ≥ 75% reduction in AK count at 12 months. Conclusions: Jansen et al. conclude that 1 year after treatment, fluorouracil was significantly more effective at AK reduction than imiquimod, MAL‐PDT or ingenol mebutate. [ABSTRACT FROM AUTHOR]