Treatment of Actinic Keratosis by Topical 25%Podophyllin Solution

Background: Actinic keratoses (AK) are most common type of in situ SCC of the skin among light-skinned individuals. And it is not uncommon in Iraqi population. Numerous modalities of treatment are available. Podophyllin is an antimitotic and caustic agent that has been used in treatment of genital warts. Objective: To test the effectiveness and safety of topical 25% podophyllin solution in treatment of actinic keratosis. Patients and Methods: Twenty patients with actinic keratosis enrolled in this open labeled interventional study that had been conducted in Department of Dermatology-Baghdad Hospital, Baghdad, from January 2010 to October 2011. History and examination were carried for each patient and all related points were recorded. Skin phototype was established for all patients according to Fitzpatrick's classification. Actinic keratoses were identified regarding their number, type, and site, morphology of the lesion, size, color, and surface. All the following conditions were excluded from the study, pregnancy, immunosuppressant conditions like organ transplantation, lesion near the eyelids, and lesion more than 1.5 cm in diameter. Biopsies were done as confirmatory test for some lesions. The lesions of actinic keratosis were treated with 25% topical podophyllin solution once weekly for 6 weeks to evaluate the response and side effects of the treatment, And for every 3 months for 6 months after clinical cure to check for any sign of recurrence of the lesions. Results: All the twenty patients with actinic keratosis completed the study: 15 (75%) males and 5 (25%) females with males to females ratio 3:1, their ages ranged from 26 - 80 with a mean (57.25 ± 14.18) years, and the duration of the disease ranged from 2 months to 10 years with a mean (4.029 ± 4.5867) years. The total numbers of lesions were 120 lesions their size ranged from 5-15 with a mean (8.2 ±.2.19) mm. The total number of podophyllin applications ranged from 3–6 with a mean (4.3 ± 0.80) sessions. Regarding the occupation of patients was mainly outdoors in 14 (70%) patients, indoors in 6 (30%) patients. Regarding skin phototypes, 12 (60%) patients were of type IV and 8 (40%) patients were type III. The lesions were distributed mainly on the bald scalp, forehead, cheek, nose, and dorsum of the hands. One hundred and seventeen from 120 of all treated lesions in 20 patients showed complete clinical cure (97.5%) in 3-6 sessions. While 3 (2.5%) of all treated lesions showed partial response with 6 sessions. All the patients did not show clinical recurrence, for up to 6 months follow up. No evidence of systemic side effects was seen and this had been confirmed clinically and by laboratory tests during the sessions and 1 month later. Local side effects like irritation, burning, and slight pain were noticed. Conclusions: Topical 25% podophyllin solution is a new therapeutic modality in treatment of actinic keratosis which gave 97.5% cure rate within short time.