AK field tx

Question 1

Name two methods for overcoming hyperkeratotic AK resistance to PDT

Answer 1

Curette
Fractionated ablative laser (laser assisted drug delivery) prior to PDT (eg fractionated Er YAG)
- allows better penetration of the ALA
- also has direct cytotoxic effects on the target cells
JAAD Apr 19

Question 2

Laser assisted PDT for AK treatment is associated with increased pain

Answer 2

F
Not reported to be more painful than conventional PDT
JAAD Apr 19

Question 3

There is evidence to suggest that 5-FU is more effective than imiquimod at reducing longterm risk of keratinocyte cancers in treated site

Answer 3

F
When looking at risk of KC cancer development, they appear equal both short + longterm
When looking at AK clearance rates, 5-FU seems to be more effective than imiquimod short term (but maybe not longterm - equal)
JAAD Apr 19 + 18

Question 4

ingenol mebutate is more effective at short term clearance of AKs than PDT

Answer 4

F
5FU (75% clearance) > imiquimod (54% clearance) > PDT (38%) > picato (28%)
- NEJM Mar 19

Question 5

Describe MOA of efudix

Answer 5

5-FU inhibits thymidylate synthetase, interfering w DNA + RNA synthesis - reduced cellular proliferation + increased cell death

Question 6

Describe MOA of imiquimod

Answer 6

immune modulator - works through toll-like receptors to enhance innate + acquired immune responses