Actinic Keratosis and Warts: A Sibling Rivalry

There are many similarities between AK’s and warts:

  • They are similar in appearance, can linger for a long time untreated, share a similar trigger (human papillomavirus), and resist host cell apoptosis and defenses.
  • Patients often overlook them until they either grow, bleed, change in size, or meet their deductibles.
  • Dermatologists usually take the same approach with each disease: freeze and go.
  • There are few prevention strategies for either condition that are either adhered to, are approved, or actually work.
  • The topical management strategies for both are usually painful, expensive, or impossible to get covered by insurance.

The same destructive and immune-based therapies approved for AKs or warts have been used off-label for treatment of the alternate condition and are typically effective in both of them.

An ongoing study of ingenol mebutate 0.05% gel applied for 2 days in patients with common warts involved paring down of warts on day 1, occlusion of the largest wart with adherent dressing for 24 hours (the dressing was removed and then replaced after second dose applied).

This trials has already provided some clues to best treatment and has also raised other questions:

  • Occlusion of warts on the digits gave the best results.
  • Paring down of the warts is essential along with allowing the treatment to dry.
  • Would monthly cryotherapy be of added benefit to prevent recurrence or persistence?
  • Would extra treatment applications be useful?

It has also been noted that ingenol mebutate has more rapid visibly clinical effects vs some other topical therapies that might be used in the treatment of warts (e.g., salicylic acid, imiquimod, 5-FU, retinoids).

However, it has been suggested that application of ingenol mebutate near the eye should be avoided (Del Rosso, 2016). A recent study that included 17 patients has also shown that ingenol mebutate gel is effective against anogenital warts (Schopf, 2016).


References

Del Rosso JQ. Ingenol mebutate topical gel: a status report on clinical use beyond actinic keratosis. J Clin Aesthet Dermatol. 2016;9 (11 Suppl 1):S3-S11.

Schopf RE. Ingenol mebutate gel is effective against anogenital warts – a case series in 17 patients. J Eur Acad Dermatol Venereol. 2016;30:1041-3.

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