{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:12:43Z","timestamp":1791994363863,"version":"4.4.0"},"reference-count":80,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,8,2]],"date-time":"2018-08-02T00:00:00Z","timestamp":1533168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2015\/02129\u20106"],"award-info":[{"award-number":["2015\/02129\u20106"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Actinic keratosis (<jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>) is a lesion that arises as a result of excessive exposure to solar radiation and appearing predominantly on Fitzpatrick phototype I and <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> skin. Given that some <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>s evolve into squamous cell carcinoma, these lesions are considered premalignant in nature, occurring mostly in elderly men and immunosuppressed individuals chronically exposed to ultraviolet (<jats:styled-content style=\"fixed-case\">UV<\/jats:styled-content>) radiation. There are several mechanisms for the formation of <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content>s; among them are oxidative stress, immunosuppression, inflammation, altered proliferation and dysregulation of cell growth, impaired apoptosis, mutagenesis, and human papillomavirus (<jats:styled-content style=\"fixed-case\">HPV<\/jats:styled-content>). Through the understanding of these mechanisms, several treatments have emerged. Among the options for <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content> treatment, the most commonly used include 5\u2010fluorouracil (5\u2010<jats:styled-content style=\"fixed-case\">FU<\/jats:styled-content>), cryotherapy, diclofenac, photodynamic therapy (<jats:styled-content style=\"fixed-case\">PDT<\/jats:styled-content>), imiquimod (<jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content>), retinoids, and ingenol mebutate (<jats:styled-content style=\"fixed-case\">IM<\/jats:styled-content>). There have been recent advances in the treatment options that have seen the emergent use of newer agents such as resiquimod, betulinic acid, piroxicam, and dobesilate. The combination between therapies has presented relevant results with intention to reduce duration of therapy and side effects. All <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content> cases must be treated because of their propensity to transform into malignancy and further complicate treatment. In addition to medical or surgical care, education about sun exposure prevention remains the best and most cost\u2010effective method for <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content> prevention. The objective of this article is to conduct a literature review of the clinical presentation of <jats:styled-content style=\"fixed-case\">AK<\/jats:styled-content> including advances in treatment options available.<\/jats:p>","DOI":"10.1111\/ijd.14147","type":"journal-article","created":{"date-parts":[[2018,8,4]],"date-time":"2018-08-04T22:12:34Z","timestamp":1533420754000},"page":"400-407","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Actinic keratosis \u2013 review for clinical practice"],"prefix":"10.1111","volume":"58","author":[{"given":"Erika C. V.","family":"de Oliveira","sequence":"first","affiliation":[{"name":"Medical Clinic Post Graduation Program of the Medical Sciences Faculty University of Campinas \u2013 UNICAMP\u2010 Brazil Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9ria R. V.","family":"da Motta","sequence":"additional","affiliation":[{"name":"Medical Clinic Post Graduation Program of the Medical Sciences Faculty University of Campinas \u2013 UNICAMP\u2010 Brazil Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola C.","family":"Pantoja","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences University of Campinas \u2013 UNICAMP\u2010 Brazil Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina S. de O.","family":"Ilha","sequence":"additional","affiliation":[{"name":"Dermatology Medical Residence Program of the Medical Sciences Faculty University of Campinas \u2013 UNICAMP\u2010 Brazil Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata F.","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Dermatology Department in the Medical Sciences Faculty University of Campinas \u2013 UNICAMP\u2010 Brazil Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8223-2769","authenticated-orcid":false,"given":"Hassan","family":"Galadari","sequence":"additional","affiliation":[{"name":"Department of Dermatology College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gislaine R.","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences University of Campinas \u2013 UNICAMP\u2010 Brazil Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,2]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-014-0049-y"},{"key":"e_1_2_4_3_1","first-page":"66","article-title":"Ceratoses act\u00ednicas","volume":"26","author":"Castro IA","year":"2006","journal-title":"Revista HCPA"},{"key":"e_1_2_4_4_1","unstructured":"PiresACB.Da queratoseact\u00ednicaao carcinoma espinocelular[disserta\u00e7\u00e3o].Porto (Portugal):Universidade do Porto 2011:33f."},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1590\/abd1806-4841.20132083"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-015-0070-9"},{"key":"e_1_2_4_7_1","unstructured":"SBD \u2013 SociedadeBrasileira de Dermatologia.Classifica\u00e7\u00e3o dos fototipos de pele. Available from:http:\/\/www.sbd.org.br\/cuidados\/por-que-as-pessoas-tem-tons-de-pele-diferentes\/(Accessed: 13 out. 2016)."},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0365-05962004000400006"},{"key":"e_1_2_4_9_1","first-page":"2","article-title":"Comprehensive management of actinic keratosis: practical integration of availabre therapies with a review of a newer treatment approach","volume":"9","author":"Rosso JQD","year":"2014","journal-title":"J Clin Aesthet Dermatol"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.3315\/jdcr.2015.1199"},{"key":"e_1_2_4_11_1","volume-title":"Estimativa 2016: Incid\u00eancia De C\u00e2ncer No Brasil","author":"INCA\u2010Instituto Nacional de C\u00e2ncer Jos\u00e9 Alencar Gomes da Silva","year":"2015"},{"key":"e_1_2_4_12_1","unstructured":"WeberA(2009).Comparative study between photodynamic therapy and topical imiquimod in actinic keratosis treatment[thesis].Federal University of Porto Alegre Poro Alegre Brazil."},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2000.103342"},{"key":"e_1_2_4_14_1","first-page":"296","article-title":"Therapeutic decision making in the therapy of actinic keratosis","volume":"4","author":"Spencer JM","year":"2005","journal-title":"J Drugs Dermatol"},{"key":"e_1_2_4_15_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-40422007000100027"},{"key":"e_1_2_4_16_1","doi-asserted-by":"publisher","DOI":"10.1590\/abd1806-4841.20131803"},{"key":"e_1_2_4_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-015-0211-7"},{"key":"e_1_2_4_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2011.10387.x"},{"key":"e_1_2_4_19_1","doi-asserted-by":"publisher","DOI":"10.1590\/abd1806-4841.20153302"},{"key":"e_1_2_4_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.16048"},{"key":"e_1_2_4_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1718"},{"key":"e_1_2_4_22_1","doi-asserted-by":"publisher","DOI":"10.1586\/era.10.154"},{"key":"e_1_2_4_23_1","unstructured":"FreitasBJSA.Poss\u00edveis marcadores de estresse oxidativo para c\u00e2ncer de pelen\u00e3o melanoma: efeito da suplementa\u00e7\u00e3o de vitamina C E e mineral zinco em indiv\u00edduos que tiveram c\u00e2ncer de pele n\u00e3o melanoma[tese].Campinas SP:Universidade Estadual de Campinas 2014: 211 p."},{"key":"e_1_2_4_24_1","doi-asserted-by":"publisher","DOI":"10.5507\/bp.2006.003"},{"key":"e_1_2_4_25_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-40422006000100021"},{"key":"e_1_2_4_26_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0365-05962006000500003"},{"key":"e_1_2_4_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.07864.x"},{"key":"e_1_2_4_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(97)70265-2"},{"key":"e_1_2_4_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2006.07692.x"},{"key":"e_1_2_4_30_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071-200304030-00001"},{"key":"e_1_2_4_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/1011-1344(90)85083-9"},{"key":"e_1_2_4_32_1","first-page":"35","article-title":"Non\u2010adherence to topical treatments for actinic keratosis","volume":"8","author":"Shergill B","year":"2014","journal-title":"Dove Med Press"},{"key":"e_1_2_4_33_1","article-title":"Interventions for actinic keratosis (Review)","volume":"12","author":"Gupta AK","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_4_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.12.045"},{"key":"e_1_2_4_35_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-2167"},{"key":"e_1_2_4_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/1203475416659259"},{"key":"e_1_2_4_37_1","first-page":"1","article-title":"Actikerall\u2122 (5 fluorouracil 0.5% and salicylic acid 10%) topical solution for patient directed treatment of actinic keratosis","volume":"21","author":"Nguyen HP","year":"2016","journal-title":"Skin Therapy Lett"},{"key":"e_1_2_4_38_1","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S12498"},{"key":"e_1_2_4_39_1","doi-asserted-by":"publisher","DOI":"10.2147\/DDDT.S84849"},{"key":"e_1_2_4_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/94.4.252"},{"key":"e_1_2_4_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.2010.03921.x"},{"key":"e_1_2_4_42_1","first-page":"1","article-title":"Cost\u2010efficacy analysis of 3% diclofenac sodium, ingenol mebutate and 3.75% imiquimod in the treatment of actinic keratosis","volume":"32","author":"Nistic\u00f2 S","year":"2018","journal-title":"Int J Immunopathol Pharmacol"},{"key":"e_1_2_4_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/2047-783X-16-2-67"},{"key":"e_1_2_4_44_1","doi-asserted-by":"crossref","first-page":"979e1","DOI":"10.1016\/j.jaad.2013.12.037","article-title":"Topical pharmacotherapy for skin cancer: part II. Clinical applications","volume":"70","author":"Micali G","year":"2014","journal-title":"J Am Acad Dermatol"},{"key":"e_1_2_4_45_1","first-page":"188","article-title":"Recidiva da acne ap\u00f3s tratamento com isotretino\u00edna oral: seguimento de cincoanos","volume":"3","author":"Nascimento C","year":"2011","journal-title":"Surg Cosmet Dermatol"},{"key":"e_1_2_4_46_1","first-page":"638","article-title":"40 years of topical tretinoin use in review","volume":"12","author":"Baldwin HE","year":"2013","journal-title":"J Drugs Dermatol"},{"key":"e_1_2_4_47_1","first-page":"1","article-title":"S2k\u2010leitlinie zurtherapie der akne [S2k guideline for therapy of acne]","volume":"8","author":"Nast A","year":"2010","journal-title":"J Dtsch Dermatol Ges"},{"key":"e_1_2_4_48_1","first-page":"59","article-title":"Avalia\u00e7\u00e3o e tratamento do doente com acne: parte 1","volume":"27","author":"Massa A","year":"2011","journal-title":"Rev Port Clin Geral"},{"key":"e_1_2_4_49_1","first-page":"66","article-title":"Avalia\u00e7\u00e3o e tratamento do doente com acne \u2013 parte II: tratamento t\u00f3pico, sist\u00e9mico e cir\u00fargico, tratamento da acne na gr\u00e1vida, algoritmo terap\u00eautico","volume":"27","author":"Figueiredo A","year":"2011","journal-title":"Rev Port Clin Geral"},{"key":"e_1_2_4_50_1","first-page":"22","article-title":"Updated physician's guide to the off\u2010label uses of oral isotretinoin","volume":"7","author":"Nickle SB","year":"2014","journal-title":"J Clin Aesthet Dermatol"},{"key":"e_1_2_4_51_1","first-page":"7","article-title":"Double\u2010blind randomized study of 5% and 10% retinoic acid peels in the treatment of melasma: clinical evaluation and impact on the quality of life","volume":"3","author":"Magalh\u00e3es GM","year":"2011","journal-title":"Surg Cosmet Dermatol"},{"key":"e_1_2_4_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2005.12.039"},{"key":"e_1_2_4_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(91)70070-I"},{"key":"e_1_2_4_54_1","doi-asserted-by":"publisher","DOI":"10.2147\/ciia.2006.1.4.327"},{"key":"e_1_2_4_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canlet.2006.11.019"},{"key":"e_1_2_4_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5876-5-7"},{"key":"e_1_2_4_57_1","doi-asserted-by":"publisher","DOI":"10.4103\/0253-7613.161249"},{"key":"e_1_2_4_58_1","unstructured":"NIH \u2013 NationalInstitutesof Health.Imiquimod. Available from:https:\/\/aidsinfo.nih.gov\/drugs\/482\/imiquimod\/0\/professiona. (Accessed 13 out. 2016)."},{"key":"e_1_2_4_59_1","first-page":"36","article-title":"An investigator\u2010initiated study to assess the safety and efficacy of imiquimod 3.75% cream when used after cryotherapy in the treatment of hypertrophic actinic keratosis on dorsal hands and forearms","volume":"6","author":"Goldenberg G","year":"2013","journal-title":"J Clin Aesthet Dermatol"},{"key":"e_1_2_4_60_1","unstructured":"FDA \u2013 Food and Drugs Administration.Draft Guidance on Imiquimod. Available from:https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2010\/020723s022lbl.pdf. (Accessed 13 out. 2016)."},{"key":"e_1_2_4_61_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/135916"},{"key":"e_1_2_4_62_1","doi-asserted-by":"publisher","DOI":"10.1517\/14656560903382622"},{"key":"e_1_2_4_63_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153975"},{"key":"e_1_2_4_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14222"},{"key":"e_1_2_4_65_1","first-page":"241","article-title":"What is the role of field\u2010directed therapy in the treatment of actinic keratosis? Part 1: overview and investigational topical agents","volume":"89","author":"Berman B","year":"2012","journal-title":"Cutis"},{"key":"e_1_2_4_66_1","first-page":"310","article-title":"Campo canceriz\u00e1vel: artigo de revis\u00e3o","volume":"6","author":"AbdallaRstom AS","year":"2014","journal-title":"Surg Cosmet Dermatol"},{"key":"e_1_2_4_67_1","first-page":"1","article-title":"Efficacy, safety and tolerability of field treatment of actinic keratosis with ingenol mebutate 0.015% gel: a single center case series","volume":"14","author":"Bobyr I","year":"2016","journal-title":"Springerplus"},{"key":"e_1_2_4_68_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-014-0059-9"},{"key":"e_1_2_4_69_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.20114"},{"key":"e_1_2_4_70_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0365-05962010000400011"},{"key":"e_1_2_4_71_1","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S9910"},{"key":"e_1_2_4_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-397927-8.00012-9"},{"key":"e_1_2_4_73_1","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2016.1174678"},{"key":"e_1_2_4_74_1","doi-asserted-by":"publisher","DOI":"10.1159\/000481770"},{"key":"e_1_2_4_75_1","doi-asserted-by":"publisher","DOI":"10.5507\/bp.2003.019"},{"key":"e_1_2_4_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fitote.2016.09.003"},{"key":"e_1_2_4_77_1","doi-asserted-by":"publisher","DOI":"10.2174\/1871520618666171229190835"},{"key":"e_1_2_4_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/phpp.12221"},{"key":"e_1_2_4_79_1","doi-asserted-by":"publisher","DOI":"10.1684\/ejd.2016.2822"},{"key":"e_1_2_4_80_1","doi-asserted-by":"publisher","DOI":"10.1590\/abd1806-4841.20175175"},{"key":"e_1_2_4_81_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-017-0219-9"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fijd.14147","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.14147","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T04:15:27Z","timestamp":1694492127000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijd.14147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,2]]},"references-count":80,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1111\/ijd.14147"],"URL":"https:\/\/doi.org\/10.1111\/ijd.14147","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,2]]},"assertion":[{"value":"2017-09-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}