On the first day of the 2024 Winter Clinical Dermatology Conference in Hawaii, Neal Bhatia, MD, presented his session, “What's New and Hot in AK Management,” which focused on the management of actinic keratosis (AK), a common precancerous skin condition. The session delved into various approaches to AK treatment, emphasizing a comprehensive strategy that includes topical treatments, liquid nitrogen, and photodynamic therapy.

One significant highlight of the session was the discussion on tirbanibulin ointment, which has recently extended its market availability from 25 to 100 square centimeters. This expansion is particularly beneficial for addressing larger surface areas on the face and scalp. Dr Bhatia stressed the importance of considering when to use topicals, opt for live treatment, or resort to freezing, aiming to maximize the benefits of available treatment options. The goal is not just to make AK lesions disappear temporarily but to treat through the disease state and prevent recurrences effectively.

Addressing the latest updates in AK management, Dr Bhatia emphasized the need to balance treatment cycles, especially with photodynamic therapy (PDT). He recommended treating patients at least a couple of times a year, strategically scheduling sessions before and after daylight saving time changes to minimize sunlight exposure.

Dr Bhatia acknowledged the challenges in AK management, particularly in convincing colleagues to advocate for available drugs. He encouraged dermatologists to navigate access challenges, emphasizing that it does not take much effort to optimize specialty pharmacy angles or drug coverage. Additionally, he addressed concerns related to managing local skin reactions and shared strategies to minimize these reactions while ensuring treatment efficacy.

In terms of challenges with patients, Dr Bhatia discussed the importance of timing-based considerations, such as scheduling treatments around vacations or social events. He highlighted the psychological impact of framing AK treatment in the context of skin cancer risk, emphasizing that patients are more likely to comply with aggressive treatment when the term "cancer" is used in the conversation.

At the conclusion of his session, Dr Bhatia emphasized the underutilization of PDT and dispelled misconceptions about its overhead costs. Dr Bhatia sees PDT as a valuable opportunity for comprehensive AK treatment when combined with other modalities, such as liquid nitrogen and topicals.

Reference
Bhatia N. What's new and hot in AK management. Presented at: 2024 Winter Clinical Dermatology Conference-Hawaii; January 12–17, 2024; Honolulu, HI.