Table 5.
Ablative-surgical and drug therapy modalities for actinic keratoses and their levels of evidence.
| Modalities of surgical treatments | Topical and oral treatment modalities |
|---|---|
| Cryosurgery (recommendation grade A, level of evidence 1++)131 | 5-Fluorouracil (recommendation grade A, level of evidence 1++)131 |
| Imiquimod (recommendation grade A, level of evidence 1++)131 | |
| CO2 laser (recommendation grade B, level of evidence 1+)131 | Ingenol mebutate (recommendation grade A, level of evidence 1+)131 |
| Photodynamic therapy (recommendation grade A, level of evidence 1+)131 | |
| Curettage and electrodessication (recommendation grade D, level of evidence 4) | Diclofenac (recommendation grade A, level of evidence 1+)131 |
| Topical retinoids (recommendation grade B, level of evidence 1+)131 | |
| Surgical exeresis (recommendation grade D, level of evidence 4) | Systemic therapies (recommendation grade C, level of evidence 2+)131 |
Degree of recommendation: A, at least one meta-analysis, systematic review or RCT 1+ and meta-analyses; B, group of 2++ studies with consistent results; C, group of 2+ studies with consistent results; D, evidence level 3 or 4, or formal consensus.
Level of evidence: 1++: high quality meta-analyses, systematic review of RCTs or RCTs with very low risk of bias; 1+: well-conducted meta-analyses, systematic review of RCTs or RCTs with low risk of bias; (1) meta-analysis, systematic review or RCT with high risk of bias; 2++: high quality systematic reviews, case–control or cohort studies. The case–control and cohort studies have a low risk of confounders, biases and a high probability of having a causal relationship. 2+: case–control studies or well-conducted cohorts with low risk of confounders and biases, and moderate likelihood of presenting causal relationship; (2) case–control studies or well-conducted cohorts with low confounders and biases, and high probability of not having a causal relationship; (3) non-analytical studies (case reports, case series); (4) expert opinion, formal consensus.
RCT, randomized clinical trial.