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    More common sense needed in treating AKs

    Consider strategies to prevent and minimize treatment problems

    In his seminar, “Treating Actinic Keratoses in 2015,” at the Fall Clinical Dermatology Conference (Friday, Oct. 2), Neal Bhatia, M.D., took a rather non-traditional approach: Rather than review recent pharma data or trial results, he asked attendees to consider why they treat AKs in the first place and challenged them to think of more strategies for preventing and minimizing treatment problems.

    Dr. Bhatia asked these questions:

    • Just what is the disease?
    • Can it can either regress, persist or progress to squamous cell carcinoma (SCC)?
    • Is it a symptom of photodamage, a disease that cannot be cured?
    • Is it SCC in situ that should be treated to avoid recurrence or invasion?

    The answer to the last three questions is an emphatic “yes,” says Dr. Bhatia, though not all derms might be so emphatic about it. The stats back him up, however. For example, he cited one study showing that as much as 16 percent of AKs can progress to SCC. Another study shows that more than 80 percent of patients with invasive SCC arising on sun-exposed areas have a history of AK.

    MORE: Why routine eradication of AKs is necessary but controversial

    And while those stats and others also show that not all AKs lead to SCC, Dr. Bhatia says that shouldn’t rule out treating them.

    “The analogy I use is brushing teeth,” he says. “We don’t brush our teeth to treat decay and disease, we do it to prevent decay and disease. And we don’t just brush one tooth—we brush them all. Just like we should treat all AKs.”

    Too often, Dr. Bhatia says, treatment is put off because the after effects are perceived as being more concerning than the disease.

    “We’re sometimes so focused on reactions that we lose sight of what and why we’re treating,” he says. “In the final analysis, we just need to use more common sense.”

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