Guidelines of care for the management of actinic keratosis: Executive summary

J Am Acad Dermatol. 2021 Oct;85(4):945-955. doi: 10.1016/j.jaad.2021.05.056. Epub 2021 Jun 7.


Background: Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. Treatment options for AK include topical medications, photodynamic therapy, cryosurgery, and laser ablation.

Objective: This executive summary provides a synopsis of the 18 evidence-based recommendations for the treatment of AK detailed in the Guidelines of Care for the Management of Actinic Keratosis.

Methods: A multidisciplinary workgroup conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations Assessment, Development and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus.

Results: Analysis of the evidence resulted in 18 recommendations, suggesting there are several effective treatments available for AK.

Limitations: The analysis informing the recommendations was based on the best available evidence at the time it was conducted. The results of future studies may necessitate a revision of current recommendations.

Conclusions: Strong recommendations are presented for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are presented for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.

Keywords: actinic keratosis; actinic keratosis guidelines; clinical guidelines for actinic keratosis; cryosurgery; dermatology; photodynamic therapy; topical agents.

Publication types

  • Systematic Review

MeSH terms

  • Cryosurgery
  • Fluorouracil / therapeutic use
  • Humans
  • Imiquimod / therapeutic use
  • Keratosis, Actinic* / drug therapy
  • Photochemotherapy
  • Practice Guidelines as Topic


  • Imiquimod
  • Fluorouracil