AAD drops proposal to adopt British guidelines for care of actinic keratoses

September 1, 2010

The American Academy of Dermatology (AAD) announced at press time that it is scuttling a proposal to adopt British Association of Dermatologists (BAD) guidelines for management of actinic keratoses (AKs). The move follows a June public comment period during which academy members expressed "significant concerns" about the proposal, sources say.

Key Points

National report - The American Academy of Dermatology (AAD) announced at press time that it is scuttling a proposal to adopt British Association of Dermatologists (BAD) guidelines for management of actinic keratoses (AKs).

The move follows a June public comment period during which academy members expressed "significant concerns" about the proposal, sources say.

Dermatologists objected that the British guidelines, based on studies completed prior to 2004, are outdated and don't include research on some of the most accepted current therapies.

She said the AAD's Clinical Guidelines and Research Committee (CGRC) will follow up by developing a plan to provide the specialty with the most up-to-date and relevant evidence for the treatment of AKs.

"It is reassuring that the AAD board saw the wisdom in rejecting antiquated guidelines," says George Martin, M.D., of Maui, Hawaii, who had forwarded a letter of objection to the proposal, signed by 17 dermatologists.

On June 8, the AAD posted the BAD guidelines, plus an AAD companion document, for member review until June 21. The companion document summarized the AAD's methodological and scientific review of the guidelines and proposed adding six qualifications.

'Significant' concerns

Neither he nor the AAD would specify how many dermatologists commented on the guidelines.

Dr. Martin says he and 16 other leading dermatologists in AK treatment sent the AAD a signed letter rejecting the British guidelines and the AAD companion document.

He says the guidelines omit treatment with imiquimod 3.75 percent, which earned Food and Drug Administration (FDA) approval in early 2010, as well as photodynamic therapy using aminolevulinic acid (ALA-PDT), which is approved in the United States but not in Europe.

Also missing are many long-term studies on efficacy and safety of other drugs for AKs, he says.

The AAD's companion document attempted to acknowledge newer information, he says, "but some of the comments regarding imiquimod and 5-fluorouracil (were) so vague they provide no benefit."

Dr. Martin says the British guidelines were developed for the British healthcare system, in which most AKs are treated by primary care physicians who prefer topical therapies for their ease of use.