Imiquimod Cryotherapy Combination Improves Actinic Keratoses Treatment Outcomes

The use of  Imiquimod 3.75% cream (brand name Zyclara) following cryotherapy yields better results when treating actinic keratoses over the use of cryotherapy alone, according to a new study published in the September issue of Journal of Drugs in Dermatology (JDD).

Actinic keratoses (AKs) are a common precancerous skin lesion that appear on sun-exposed areas.  Actinic Keratoses are routinely treated by dermatologists because they are are at risk of developing into a type of skin cancer called “squamous cell carcinoma”.

There a several options available for removing actinic keratoses. Cryotherapy, freezing of the AK lesion, is the most commonly performed procedure. However, the region around a specific lesion is also sun-damaged and at risk of developing new actinic keratoses over time, requiring additional treatments. In one previous study, only 4% of treated patients had sustained clearance one year later in the area around the original AK lesion.

There has been growing in interest in combining a procedure that removes a specific AK lesion with a medication, such as 5-FU or imiquimod, that treats the surrounding region.

This recently published study, “A Randomized, Double-blinded, Placebo-controlled, Multicenter, Efficacy and Safety Study of 3.75% Imiquimod Cream Following Cryosurgery for the Treatment of Actinic Keratoses” authored by Drs. Joseph Jorizzo, Orit Markowitz, Mark Lebwohl, Marc Bourcier and others investigated the benefit of using imiquimod 3.75% (Zyclara) after cryotherapy.

Adults with at least 10 actinic keratoses on the face underwent cryotherapy of 5 to 14 lesions. Those with at least 5 actinic keratoses remaining were randomized to receive 3.75% imiquimod (Zyclara) or a placebo cream applied to the entire face daily for two two-week cycles. Efficacy of these two treatment options was assessed 26 weeks later.

Mark Lebwohl, M.D. and the other study authors concluded that “while cryosurgery is an effective treatment for actinic keratoses, the subsequent use of 3.75% imiquimod cream (Zyclara) is safe and well tolerated and provides additional therapeutic benefits to cryosurgery alone. These results suggest that dual-mode therapy with lesion-directed cryosurgery followed by field-directed 3.75% imiquimod cream may be an appropriate option for patients with multiple actinic keratoses on the face.”

The study also “confirmed the findings of previous investigators regarding the efficacy of two two-week treatment cycles of daily 3.75% imiquimod cream (Zyclara) to treat all actinic keratoess in a large field of application.