Cryotherapy is preferable to ablative CO2 laser for the treatment of isolated actinic keratoses of the face and scalp: a randomized clinical trial.
BACKGROUND
Actinic keratosis (AK) may progress to squamous cell carcinoma. In the case of normal or mildly photodamaged skin, lesion-directed treatments are considered valuable options despite poor published evidence of their therapeutic activity.


OBJECTIVE
The aim of this single-centre, open-label, prospective, nonsponsored, randomized, controlled clinical trial was to compare CO2 laser ablation with cryotherapy in the treatment of isolated AKs of the face and scalp.


METHODS
Patients with isolated (≤ 4) AKs of the face and scalp were randomized to receive CO2 laser ablation or cryotherapy. After 90 days, the overall complete remission (CR) rates of patients and lesions were assessed and correlated with thickness grade.


RESULTS
Two hundred patients with a total number of 543 AKs were enrolled. The CR rates of lesions after 3 months were 78·2% with cryotherapy and 72·4% with CO2 laser ablation. Thicker lesions were significantly more responsive to cryotherapy (P = 0·034). Seventy-three patients (71·6%) had CR of all lesions 3 months after cryotherapy and 64 (65·3%) after laser ablation. At 12 months after treatment the number of patients with CR was reduced to 53 with cryotherapy and 14 with laser ablation.


CONCLUSIONS
The rate of patients and lesions with CR is similar after 3 months, but more patients remain in stable remission for 12 months after cryotherapy. Cryotherapy is more effective for thick lesions. The cosmetic outcome was good or excellent in almost all patients.
Department of Dermatology, Spedali Civili di Brescia, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
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C
Zane
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E
Facchinetti
M T
MT
Rossi
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C
Specchia
B
B
Ortel
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P
Calzavara-Pinton
D000368:Aged; D000369:Aged, 80 and over; D017679:Cryotherapy / Q000009:adverse effects / Q000379:methods*; D005148:Facial Dermatoses / Q000628:therapy*; D005260:Female; D006801:Humans; D055623:Keratosis, Actinic / Q000628:therapy*; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods; D054020:Lasers, Gas / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012536:Scalp Dermatoses / Q000628:therapy*; D016896:Treatment Outcome