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European Journal of Dermatology

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Evidence for field cancerisation treatment of actinic keratoses with topical diclofenac in hyaluronic acid Volume 24, issue 2, March-April 2014

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Authors
1 Dermatologie am Regierungsviertel,
Luisenstr. 54/55,
10117 Berlin, Germany
2 Department of Dermatology,
University of Modena and Reggio Emilia,
via del Pozzo 71,
41100 Modena, Italy
3 Servicio de Dermatología,
Hospital Universitario Germans Trias i Pujol,
Badalona, Universidad Autónoma de Barcelona, Spain
4 Dermatology Department and Manchester Academic Health Science Centre,
Manchester Royal Infirmary,
Oxford Road, Manchester,
M13 9WL, United Kingdom
* Reprints

Actinic keratosis (AK) is a common skin disease seen in daily practice. It is associated with a risk of progression to invasive squamous cell carcinoma and can be regarded as a marker of increased risk for non-melanoma skin cancer. The use of a field-directed treatment approach reflects the need to initiate early treatment over an affected area to prevent tumour development and local recurrence. Candidate field-directed treatments require a mechanism of action compatible with an effect on field cancerisation, immediate and long-term efficacy against visible lesions and efficacy against subclinical AK. Applicability to large treatment areas, tolerability compatible with long-term use, utility in organ transplant patients and, ideally, evidence of extended long-term activity may also be desirable. We review the evidence of a role for topical diclofenac sodium 3% administered in a 2.5% hyaluronic acid gel (diclofenac/HA) as field-directed treatment. Diclofenac/HA directly targets AK pathophysiology through multiple mechanisms, including induction of apoptosis, inhibition of angiogenesis and reduced inflammation. Clearance of visible field cancerisation is safely and rapidly achieved with a 90-day treatment course in patients with affected areas of up to 50 cm2 and is associated with a ≥75% reduction in target lesion number score in 85% and 91% of patients, respectively, at 30 days and 1 year post-treatment. Following treatment of AK in high-risk transplant patients, 45% remained free of lesions in the treatment area at 2 years post-treatment. We conclude that diclofenac/HA fulfils most criteria necessary to be considered an appropriate candidate for a field-directed treatment in AK.