Epidemiology and Management of Actinic Keratosis in France: A General Population Survey (REAKT)
DOI:
https://doi.org/10.2340/actadv.v105.42372Keywords:
Actinic keratosis, Epidemiology, Disease management, Squamous cell carcinoma, surveys and questionnairesAbstract
The objective of this retrospective observational study was to estimate the prevalence of actinic keratosis (AK) in individuals aged ≥ 40 years in France, to describe the characteristics of affected patients, and to describe treatments. A representative panel of 20,000 households with ≥ 1 member aged ≥ 40 years were invited to participate. Participants who reported AK lesions diagnosed by a physician were eligible. The study questionnaire collected data on demographics, lesion characteristics, Fitzpatrick phototype, diagnosis, and treatments. In total, 15,246 questionnaires (78.5%) were returned and 639 responders were eligible. The adjusted prevalence of AK was 4.03% (95% CI: 3.73–4.35). Prevalence is probably underestimated due to data collection by self-report and low awareness of AK. 177 participants (27.7%) were aged < 65 years. AK was diagnosed by a dermatologist for 521 participants (81.6%). Some 200 participants (31.3%) had no lesions at the time of the survey and 243 (37.9%) had never been treated; 312 participants (78.6%) were prescribed physical treatment, principally cryotherapy; and 125 (31.5%) were prescribed topical treatment, principally 5-fluorouracil or imiquimod. In conclusion, improving diagnosis of AK in everyday clinical practice is important to ensure that all individuals with AK are treated optimally and encouraged to take sun protection measures to prevent progression to SCC.
Downloads
References
de Oliveira ECV, da Motta VRV, Pantoja PC, Ilha CSO, Magalhães RF, Galadari H, et al. Actinic keratosis - review for clinical practice. Int J Dermatol 2019; 58: 400-407.
https://doi.org/10.1111/ijd.14147 DOI: https://doi.org/10.1111/ijd.14147
Rosen T, Lebwohl MG. Prevalence and awareness of actinic keratosis: barriers and opportunities. J Am Acad Dermatol 2013; 68: S2-9.
https://doi.org/10.1016/j.jaad.2012.09.052 DOI: https://doi.org/10.1016/j.jaad.2012.09.052
Werner RN, Sammain A, Erdmann R, Hartmann V, Stockfleth E, Nast A. The natural history of actinic keratosis: a systematic review. Br J Dermatol 2013; 169: 502-518.
https://doi.org/10.1111/bjd.12420 DOI: https://doi.org/10.1111/bjd.12420
Reinehr CPH, Bakos RM. Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects. An Bras Dermatol 2019; 94: 637-657.
https://doi.org/10.1016/j.abd.2019.10.004 DOI: https://doi.org/10.1016/j.abd.2019.10.004
Goldenberg G, Perl M. Actinic keratosis: update on field therapy. J Clin Aesthet Dermatol 2014; 7: 28-31.
Feldman SR, Fleischer AB, Jr. Progression of actinic keratosis to squamous cell carcinoma revisited: clinical and treatment implications. Cutis 2011; 87: 201-207.
Fernandez Figueras MT. From actinic keratosis to squamous cell carcinoma: pathophysiology revisited. J Eur Acad Dermatol Venereol 2017; 31: 5-7.
https://doi.org/10.1111/jdv.14151 DOI: https://doi.org/10.1111/jdv.14151
Bernard P, Dupuy A, Sasco A, Brun P, Duru G, Nicoloyannis N, et al. Basal cell carcinomas and actinic keratoses seen in dermatological practice in France: a cross-sectional survey. Dermatology 2008; 216: 194-199.
https://doi.org/10.1159/000112925 DOI: https://doi.org/10.1159/000112925
Reach G, Pellan M, Crine A, Touboul C, Ciocca A, Djoudi Y. Holistic psychosocial determinants of adherence to medication in people with type 2 diabetes. Diabetes Metab 2018; 44: 500-507.
https://doi.org/10.1016/j.diabet.2018.06.001 DOI: https://doi.org/10.1016/j.diabet.2018.06.001
Briot K, Grange L, Cortet B, Feron JM, Chauvin P, Coulomb A, et al. Real-world care for individuals aged over fifty with fractures in France: evidence for a wide care gap - The EPIFRACT Study. Joint Bone Spine 2020; 87: 467-473.
https://doi.org/10.1016/j.jbspin.2020.04.007 DOI: https://doi.org/10.1016/j.jbspin.2020.04.007
Mosnier-Pudar H, Hochberg G, Eschwege E, Halimi S, Virally ML, Guillausseau PJ, et al. How patients' attitudes and opinions influence self-care behaviours in type 2 diabetes. Insights from the French DIABASIS Survey. Diabetes Metab 2010; 36: 476-483.
https://doi.org/10.1016/j.diabet.2010.08.004 DOI: https://doi.org/10.1016/j.diabet.2010.08.004
Cortet B, Chauvin P, Feron JM, Grange L, Coulomb A, Launois R, et al. Fragility fractures in France: epidemiology, characteristics and quality of life (the EPIFRACT study). Arch Osteoporos 2020; 15: 46.
https://doi.org/10.1007/s11657-019-0674-2 DOI: https://doi.org/10.1007/s11657-019-0674-2
Charles MA, Basdevant A, Eschwege E. [Prevalence of obesity in adults in France: the situation in 2000 established from the OBEPI Study]. Ann Endocrinol (Paris) 2002; 63: 154-158.
Charles MA, Eschwege E, Basdevant A. Monitoring the obesity epidemic in France: the Obepi surveys 1997-2006. Obesity (Silver Spring) 2008; 16: 2182-2186.
https://doi.org/10.1038/oby.2008.285 DOI: https://doi.org/10.1038/oby.2008.285
Eschwege E, Basdevant A, Crine A, Moisan C, Charles MA. Type 2 diabetes mellitus in France in 2012: results from the ObEpi survey. Diabetes Metab 2015; 41: 55-61.
https://doi.org/10.1016/j.diabet.2014.11.007 DOI: https://doi.org/10.1016/j.diabet.2014.11.007
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869-871. DOI: https://doi.org/10.1001/archderm.124.6.869
https://doi.org/10.1001/archderm.1988.01670060015008 DOI: https://doi.org/10.1001/archderm.1988.01670060015008
Institut National de la Statistique et des Etudes Economiques. Bilan démographique 2017. 2018.
Deville J-C, Sarndal C-E, Sautory O. Generalized raking procedures in survey sampling. J Am Stat Assoc 1993; 88: 1013-1020.
https://doi.org/10.1080/01621459.1993.10476369 DOI: https://doi.org/10.1080/01621459.1993.10476369
Memon AA, Tomenson JA, Bothwell J, Friedmann PS. Prevalence of solar damage and actinic keratosis in a Merseyside population. Br J Dermatol 2000; 142: 1154-1159.
https://doi.org/10.1046/j.1365-2133.2000.03541.x DOI: https://doi.org/10.1046/j.1365-2133.2000.03541.x
Harvey I, Frankel S, Marks R, Shalom D, Nolan-Farrell M. Non-melanoma skin cancer and solar keratoses. I. Methods and descriptive results of the South Wales Skin Cancer Study. Br J Cancer 1996; 74: 1302-1307.
https://doi.org/10.1038/bjc.1996.534 DOI: https://doi.org/10.1038/bjc.1996.534
Flohil SC, van der Leest RJ, Dowlatshahi EA, Hofman A, de Vries E, Nijsten T. Prevalence of actinic keratosis and its risk factors in the general population: the Rotterdam Study. J Invest Dermatol 2013; 133: 1971-1978.
https://doi.org/10.1038/jid.2013.134 DOI: https://doi.org/10.1038/jid.2013.134
Schaefer I, Augustin M, Spehr C, Reusch M, Kornek T. Prevalence and risk factors of actinic keratoses in Germany--analysis of multisource data. J Eur Acad Dermatol Venereol 2014; 28: 309-313.
https://doi.org/10.1111/jdv.12102 DOI: https://doi.org/10.1111/jdv.12102
Halpern AC, Kopp LJ. Awareness, knowledge and attitudes to non-melanoma skin cancer and actinic keratosis among the general public. Int J Dermatol 2005; 44: 107-111.
https://doi.org/10.1111/j.1365-4632.2005.02090.x DOI: https://doi.org/10.1111/j.1365-4632.2005.02090.x
MacKie RM. Awareness, knowledge and attitudes to basal cell carcinoma and actinic keratoses among the general public within Europe. J Eur Acad Dermatol Venereol 2004; 18: 552-555.
https://doi.org/10.1111/j.1468-3083.2004.00993.x DOI: https://doi.org/10.1111/j.1468-3083.2004.00993.x
Bernard P, Dupuy A, Brun P, Sasko A, Duru G, Nicoloyannis N, et al. Évaluation médico-économique de la prise en charge des carcinomes basocellulaires superficiels et des kératoses actiniques multiples par les dermatologues français. Ann Dermatol Venereol 2007; 134: 527-533.
https://doi.org/10.1016/S0151-9638(07)89263-5 DOI: https://doi.org/10.1016/S0151-9638(07)89263-5
Savary J, Tine MC, Weber AC, Dorey J. Management and clinical practice of multiple face and scalp actinic keratosis in France. J Mark Access Health Policy 2019; 7: 1605787.
https://doi.org/10.1080/20016689.2019.1605787 DOI: https://doi.org/10.1080/20016689.2019.1605787
Aggarwal I, Puyana C, Chandan N, Jetter N, Tsoukas M. Field cancerization therapies for the management of actinic keratosis: an updated review. Am J Clin Dermatol 2024; 25: 391-405.
https://doi.org/10.1007/s40257-023-00839-8 DOI: https://doi.org/10.1007/s40257-023-00839-8
Dréno B, Amici JM, Basset-Seguin N, Cribier B, Claudel JP, Richard MA. Management of actinic keratosis: a practical report and treatment algorithm from AKTeam™ expert clinicians. J Eur Acad Dermatol Venereol 2014; 28: 1141-1149.
https://doi.org/10.1111/jdv.12434 DOI: https://doi.org/10.1111/jdv.12434
Werner RN, Stockfleth E, Connolly SM, Correia O, Erdmann R, Foley P, et al. Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version. J Eur Acad Dermatol Venereol 2015; 29: 2069-2079.
https://doi.org/10.1111/jdv.13180 DOI: https://doi.org/10.1111/jdv.13180
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Brigitte Dréno, Pierre Lévy, Gregory Caillet, Chantal Touboul, Jean-Michel Joubert, Jean-Michel Amici
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
