Teledermatology-driven topical therapy of actinic keratosis: a comparative study of clinical effectiveness and compliance.
JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY(2018)
Abstract
Background Teledermatology (TD) provides efficient care for skin cancer patients. Objective Methods To compare the clinical effectiveness of imiquimod 5% for the treatment of AK with in-person care and through TD. Longitudinal prospective controlled study including patients with single AK diagnosed and treated at face-to-face visits (FTF group) or through teledermatology (TD group) with imiquimod 5% cream. The main outcome measures assessed were the complete and global response percentage (CR and GR) under per-protocol (PP) and intention-to-treat (ITT) analysis. Results Conclusions A total of 157 patients were enrolled (FTF = 75, TD = 82). PP analysis showed CR in 66.7% of FTF patients and 65.6% in TD patients (P > 0.05). The ITT yielded CR in 64.0% and 51.2% in FTF visits and TD, respectively (P = 0.073). The analysis showed an advantage of FTF care against TD in achieving GR (84.0% vs. 70.7%; P = 0.036). Facial location and local adverse reactions were the only explanatory factors of complete response in the ITT approach. Treatment completion was found in 90.7% and 72.0% in the FTF and TD groups, respectively (P = 0.004). Improvements in patient counselling at the primary care centre are needed before the implementation of TD as a routine methodology for the management of AK.
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Key words
Imiquimod Cream,Actinic Keratoses,Photodynamic Therapy
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