Field Treatment for Actinic Keratoses: Personalized Therapy Based on Patient Preference

Actinic keratoses (AKs) are common precancerous lesions with potential to progress to squamous cell carcinoma, underscoring the need for effective, patient-centered management that addresses visible and subclinical lesions on sun-damaged skin. Field-directed therapies, including photodynamic therapy (PDT) and topical treatments, are frequently used, but treatment success depends on aligning therapy with patient preferences regarding efficacy, tolerability, treatment duration, cosmetic outcomes, cost, and lifestyle factors. We conducted a systematic review of 16 studies evaluating conventional PDT, laser-mediated PDT, daylight PDT (DLPDT), and topical therapies including 5-fluorouracil, diclofenac, and imiquimod, focusing on patient-reported outcomes, satisfaction, adherence, and perceptions. This protocol was registered on PROSPERO (CRD420251068877). Conventional and laser-mediated PDT demonstrated high efficacy and short treatment durations, aligning with patients prioritizing rapid clearance, though transient discomfort may occur. DLPDT offered lower pain and greater tolerability with acceptable efficacy, making it suitable for patients prioritizing comfort or living in sunny climates. Topical therapies provided favorable cosmetic outcomes and lower costs, aligning with patients prioritizing aesthetics and affordability, though requiring longer use and adherence. Aligning AK treatment with patient preferences can enhance adherence, satisfaction, and outcomes while reducing cancer progression risk. Incorporating shared decision-making and patient education into practice empowers patients and supports adherence, enabling dermatologists to optimize AK management while improving quality of life and personalizing care.