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Combo of cryosurgery, imiquimod improves actinic keratoses clearance


A 2010 study shows that the use of Zyclara (imiquimod 3.75 percent, Graceway) following cryosurgery complements the efficacy of cryosurgery in the total reduction and complete clearance of actinic keratoses (AKs).

Key Points

The vast majority of patients today are treated with cryosurgery for their AK lesions. Although effective, this treatment modality is limited to visible lesions and does not address other AK lesions in the vicinity that are at various stages of evolution.

"Field-treatment with Zyclara following cryosurgery can effectively address the field cancerization typically seen in patients with severe AK disease. This therapeutic approach allows for a more comprehensive solution to the field-cancerization problem by eradicating yet unseen AK lesions," says Joseph L. Jorizzo, M.D., professor, department of dermatology, Wake Forest University, Winston-Salem, N.C.

Zyclara was approved by the Food and Drug Administration in early 2010 for the treatment of AKs on the face and balding scalp.

Dr. Jorizzo conducted a study in 2010 that evaluated the safety and efficacy of AK lesion–directed cryosurgery followed by a field-directed treatment using imiquimod cream 3.75 percent in a patient population with extensive AK disease on the face.

In the study, 260 adults with greater than or equal to 10 AKs on the face underwent cryosurgery of five to 15 AKs, leaving greater than or equal to five AKs untreated. After one to two weeks, 247 patients were randomized to either imiquimod 3.75 percent or placebo, applied once daily to the full face for two two-week cycles, separated by a two-week drug holiday.

At the week-26 follow-up (20 weeks after completion of topical therapy), primary efficacy of a reduction in AK count from baseline was assessed, along with secondary efficacy of complete clearance, photodamage assessments and investigator and patient satisfaction.

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