title: Treatment of actinic keratoses with a novel betulin-based oleogel. A prospective, randomized, comparative pilot study.
abstract: BACKGROUND
  Actinic keratoses (AK) are squamous cell carcinomas in situ and require treatment. Betulin-based oleogel prepared from a standardized triterpene dry extract from birch bark represents a new topical agent with anti-inflammatory and anti-tumor potential.
  
  
  METHODS
  In the prospective, randomized, monocentric phase 2a study 45 patients with < 10 AK were included and randomly assigned to one of the three treatment groups. Intervention consisted of topical betulin-based oleogel twice daily versus cryotherapy with liquid nitrogen versus the combination of cryotherapy with topical betulin-based oleogel. Treatment response was assessed clinically after three months. The clinical response was graded into complete clearing (100 %), therapy responders (> 75 % clearing of the lesions) and non-responders (< 75 % clearing). Additionally, punch biopsies were obtained from some patients before and at the end of treatment.
  
  
  RESULTS
  Therapy with betulin-based oleogel was well tolerated.Three patients discontinued therapy because of personal reasons. After three months, the 100% (and > 75%) clearing rates of the lesions were as follows: 64% (86%) with betulin-based oleogel (n = 14),79% (93%) with cryotherapy (n = 14),and 71% (71%) with the combined therapy (n = 14). Histological analysis of biopsies taken before and after treatment (n = 8) showed a reduced degree of dysplasia in the epidermis in all study arms.
  
  
  CONCLUSIONS
  Betulin-based oleogel seems to be an effective novel approach in the topical treatment of actinic keratoses. However,the clinical and histological findings of the present pilot study have to be verified against placebo with larger case numbers.
authors.affiliation: Competence center skintegral, Department of Dermatology, University Medical Center Freiburg, Hauptstrasse 7, Freiburg, Germany.
authors.forename: Constance
authors.initials: C
authors.lastname: Huyke
authors.forename: Juliane
authors.initials: J
authors.lastname: Reuter
authors.forename: Mirko
authors.initials: M
authors.lastname: Rödig
authors.forename: Astrid
authors.initials: A
authors.lastname: Kersten
authors.forename: Melanie
authors.initials: M
authors.lastname: Laszczyk
authors.forename: Armin
authors.initials: A
authors.lastname: Scheffler
authors.forename: Dorothee
authors.initials: D
authors.lastname: Nashan
authors.forename: Christoph
authors.initials: C
authors.lastname: Schempp
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009930:Organic Chemicals / Q000737:chemistry; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D014315:Triterpenes / Q000008:administration & dosage*; D000094062:Betulinic Acid
chemical_list: D009930:Organic Chemicals; D014315:Triterpenes; C016021:oleogels; C002503:betulin; D000094062:Betulinic Acid