NCLEX Review Guide: Medications to Treat Actinic Keratosis

Definition and Pathophysiology

• Actinic keratosis (AK) are rough, scaly patches on sun-exposed skin caused by years of UV damage, considered precancerous lesions that can progress to squamous cell carcinoma.
• These lesions typically appear on the face, ears, neck, scalp, chest, backs of hands, forearms, or lips as dry, rough, scaly patches that may be red, pink, or brown.

5-Fluorouracil (5-FU)

• Efudex, Carac, Fluoroplex are antimetabolite chemotherapy agents that selectively destroy abnormal keratinocytes by interfering with DNA synthesis.
• Applied twice daily for 2-4 weeks, causing significant inflammation, erythema, and crusting before healing occurs.

Diclofenac Sodium (Solaraze)

• Topical NSAID that reduces inflammation and has anti-proliferative effects on abnormal cells.
• Applied twice daily for 60-90 days with minimal side effects compared to other treatments.

Ingenol Mebutate (Picato)

• Plant-derived agent that causes rapid cell death and immune activation against abnormal cells.
• Short treatment course: face/scalp for 3 days, trunk/extremities for 2 days, with intense local reactions.

Imiquimod (Aldara, Zyclara)

• Topical immune response modifier that stimulates interferon production and T-cell activation to destroy abnormal cells.
• Applied 2-3 times weekly for 16 weeks, causing local inflammatory reactions including erythema, scaling, and crusting.

Patient Education

1. Cleanse area gently with mild soap and water before application
2. Apply thin layer to affected area only, avoiding normal skin
3. Wash hands thoroughly after application
4. Use broad-spectrum sunscreen SPF 30+ daily
5. Avoid sun exposure during treatment period

Monitoring and Follow-up

• Assess for appropriate inflammatory response indicating treatment effectiveness versus excessive reaction requiring dose modification.
• Monitor for signs of secondary bacterial infection in areas of significant inflammation or crusting.

Common Pitfalls

• Don't confuse inflammatory response with treatment failure - redness and scaling indicate medication is working.
• Remember that sun protection is mandatory during treatment to prevent new lesion formation.
• Patients may discontinue treatment due to cosmetic concerns - emphasize cancer prevention benefits.

I understand the mechanism of action for each AK medication
I can identify appropriate patient education points
I know the expected inflammatory response timeline
I understand sun protection requirements during treatment