{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:21:09Z","timestamp":1791343269828,"version":"4.3.1"},"reference-count":27,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Actinic keratosis (AK) is a precancerous lesion that can progress to invasive squamous cell carcinoma if untreated. However, no gold standard treatment has been established. We aimed to investigate the management of AK by comparing the effectiveness and treatment duration of treatment modalities, including cryotherapy, imiquimod (IMQ), and photodynamic therapy (PDT). We reviewed the medical records of 316 patients diagnosed with AK at Seoul St. Mary\u2019s Hospital from February 2015 to May 2020, and a total of 195 patients were included. The clearance rate was the highest in PDT, followed by cryotherapy and IMQ (82.4%, 71.2%, and 68.0%, respectively). The recurrence rate was the lowest in cryotherapy, followed by PDT and IMQ (3.5%, 6.7%, and 10.5%, respectively, p &lt; 0.05). The average treatment duration was shortest with PDT, followed by IMQ and cryotherapy (5.5 weeks, 6.8 weeks, and 9.1 weeks, respectively, p &lt; 0.05). The number of hospital visits was lowest for PDT, followed by cryotherapy and IMQ (1.8, 2.8, and 3.6, respectively, p &lt; 0.05). PDT showed the highest clearance rate, a moderate recurrence rate, the shortest treatment duration, and the least number of visits, suggesting that PDT could be the first choice for treatment of AK. Considering the advantages as a topical agent, IMQ could also be a treatment option.<\/jats:p>","DOI":"10.3390\/jcm11143953","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T07:51:56Z","timestamp":1657180316000},"page":"3953","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Treatment of Actinic Keratosis: The Best Choice through an Observational Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5794-6046","authenticated-orcid":false,"given":"Seung-Ah","family":"Yoo","sequence":"first","affiliation":[{"name":"Department of Dermatology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4983-4906","authenticated-orcid":false,"given":"Yeong-Ho","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3194-5202","authenticated-orcid":false,"given":"Ju-Hee","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6246-0331","authenticated-orcid":false,"given":"Chul-Hwan","family":"Bang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Min","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/ijd.14147","article-title":"Actinic keratosis-review for clinical practice","volume":"58","author":"Pantoja","year":"2019","journal-title":"Int. J. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1080\/09546634.2016.1254328","article-title":"Real-world approach to actinic keratosis management: Practical treatment algorithm for office-based dermatology","volume":"28","author":"Dirschka","year":"2017","journal-title":"J. Dermatolog. Treat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1056\/NEJMoa1811850","article-title":"Randomized Trial of Four Treatment Approaches for Actinic Keratosis","volume":"380","author":"Jansen","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/bjd.15107","article-title":"British Association of Dermatologists\u2019 guidelines for the care of patients with actinic keratosis 2017","volume":"176","author":"McGregor","year":"2017","journal-title":"Br. J. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.jaad.2021.05.056","article-title":"Guidelines of care for the management of actinic keratosis: Executive summary","volume":"85","author":"Eisen","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/ijd.14767","article-title":"Current therapies for actinic keratosis","volume":"59","author":"Dianzani","year":"2020","journal-title":"Int. J. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/DSS.0000000000000989","article-title":"Variables in Cryosurgery Technique Associated With Clearance of Actinic Keratosis","volume":"43","author":"Berman","year":"2017","journal-title":"Dermatol. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.jaad.2019.07.083","article-title":"Efficacy and safety of ingenol mebutate gel in field treatment of actinic keratosis on full face, balding scalp or approximately 250 cm(2) on the chest: A Phase III randomized controlled trial","volume":"82","author":"Hanke","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/bjd.14222","article-title":"Efficacy and safety of follow-up field treatment of actinic keratosis with ingenol mebutate 0.015% gel: A randomized, controlled 12-month study","volume":"174","author":"Garbe","year":"2016","journal-title":"Br. J. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/j.biopha.2018.07.049","article-title":"Photodynamic therapy-mechanisms, photosensitizers and combinations","volume":"106","author":"Kwiatkowski","year":"2018","journal-title":"Biomed. Pharmacother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1358\/dot.2013.49.1.1910723","article-title":"Ingenol mebutate: A new option for actinic keratosis treatment","volume":"49","author":"Gras","year":"2013","journal-title":"Drugs Today"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/ijd.13235","article-title":"Imiquimod in dermatology: An overview","volume":"55","author":"Hanna","year":"2016","journal-title":"Int. J. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"499","DOI":"10.2174\/138955706776876131","article-title":"Topical imiquimod: Mechanism of action and clinical applications","volume":"6","author":"Vidal","year":"2006","journal-title":"Mini. Rev. Med. Chem."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/j.1365-2133.2007.07942.x","article-title":"Vehicle-controlled, randomized, double-blind study to assess safety and efficacy of imiquimod 5% cream applied once daily 3 days per week in one or two courses of treatment of actinic keratoses on the head","volume":"157","author":"Alomar","year":"2007","journal-title":"Br. J. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.jaad.2004.02.022","article-title":"Imiquimod 5% cream for the treatment of actinic keratosis: Results from a phase III, randomized, double-blind, vehicle-controlled, clinical trial with histology","volume":"51","author":"Szeimies","year":"2004","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1111\/jdv.16017","article-title":"European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: Treatment delivery and established indications-actinic keratoses, Bowen\u2019s disease and basal cell carcinomas","volume":"33","author":"Morton","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1111\/j.1365-4632.2004.02056.x","article-title":"A prospective study of the use of cryosurgery for the treatment of actinic keratoses","volume":"43","author":"Thai","year":"2004","journal-title":"Int. J. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1067\/mjd.2002.119649","article-title":"Photodynamic therapy using topical methyl 5-aminolevulinate compared with cryotherapy for actinic keratosis: A prospective, randomized study","volume":"47","author":"Szeimies","year":"2002","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1111\/j.1365-2133.2008.08488.x","article-title":"Multicentre intraindividual randomized trial of topical methyl aminolaevulinate-photodynamic therapy vs. cryotherapy for multiple actinic keratoses on the extremities","volume":"158","author":"Kaufmann","year":"2008","journal-title":"Br. J. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1001\/archderm.141.4.467","article-title":"Dosing with 5% imiquimod cream 3 times per week for the treatment of actinic keratosis: Results of two phase 3, randomized, double-blind, parallel-group, vehicle-controlled trials","volume":"141","author":"Korman","year":"2005","journal-title":"Arch. Dermatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1586\/era.13.38","article-title":"Update on non-melanoma skin cancer and the value of dermoscopy in its diagnosis and treatment monitoring","volume":"13","author":"Lallas","year":"2013","journal-title":"Expert Rev. Anticancer Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1111\/bjd.15884","article-title":"Photodynamic therapy is more effective than imiquimod for actinic keratosis in organ transplant recipients: A randomized intraindividual controlled trial","volume":"178","author":"Halldin","year":"2018","journal-title":"Br. J. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1111\/phpp.12671","article-title":"Comparative study of imiquimod 3.75% vs. photodynamic therapy for actinic keratosis of the scalp","volume":"37","author":"Cortelazzi","year":"2021","journal-title":"Photodermatol. Photoimmunol. Photomed."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1111\/ijd.14164","article-title":"Sequential treatment of actinic keratosis with cryotherapy and ingenol mebutate: Reflectance confocal microscopy monitoring of efficacy and local skin reaction","volume":"57","author":"Pasquali","year":"2018","journal-title":"Int. J. Dermatol."},{"key":"ref_25","first-page":"16","article-title":"An Investigator-initiated Study to Assess the Safety and Efficacy of Ingenol Mebutate 0.05% Gel When Used After Cryosurgery in the Treatment of Hypertrophic Actinic Keratosis on Dorsal Hands","volume":"9","author":"Hashim","year":"2016","journal-title":"J. Clin. Aesthet. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1001\/archdermatol.2011.334","article-title":"Cryoimmunotherapy: Superficial basal cell cancer and squamous cell carcinoma in situ treated with liquid nitrogen followed by imiquimod","volume":"147","author":"MacFarlane","year":"2011","journal-title":"Arch. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"c94","DOI":"10.1159\/000312871","article-title":"Selection bias and information bias in clinical research","volume":"115","author":"Tripepi","year":"2010","journal-title":"Nephron Clin. Pract."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/3953\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:43:56Z","timestamp":1760139836000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/3953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,7]]},"references-count":27,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jcm11143953"],"URL":"https:\/\/doi.org\/10.3390\/jcm11143953","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,7]]}}}