AAD Guidelines of Care for the Management of Actinic Keratosis Supplementary File

Background: Actinic keratoses (AK) are rough scaly papules and plaques that arise on chronically ultraviolet (UV)-exposed skin and can progress to squamous cell carcinoma. Treatment options for AK include field-directed therapies, including topical medications and photodynamic therapy, and lesion-directed therapies, including cryosurgery and laser ablation. Objective: This analysis examined the literature related to the management of AK to provide evidence-based recommendations regarding the efficacy, effectiveness, and adverse effects of AK treatment in immunocompetent and immunocompromised individuals. Methods: Work Group members developed clinical questions on the treatment of AK. EMBASE, MEDLINE (via PubMed), and the Cochrane Library were systematically searched for relevant literature. Search results were screened for inclusion, and vetted evaluation tools were used to assess the risk of bias in included studies, to extract data, and to grade the strength and level of evidence supporting each recommendation. Graded recommendations were voted on to achieve consensus.

背景：光线性角化病（Actinic keratoses，AK）是好发于长期紫外线（ultraviolet，UV）暴露皮肤的粗糙鳞屑性丘疹与斑块，可进展为鳞状细胞癌。AK的治疗选择包括区域靶向治疗与病灶靶向治疗：前者涵盖外用药物与光动力疗法，后者包括冷冻手术与激光消融术。
目的：本分析梳理了与AK诊疗相关的文献，旨在为免疫功能正常及免疫功能受损人群的AK治疗，提供基于证据的疗效、有效性与不良反应相关推荐意见。
方法：工作组成员围绕AK治疗拟定临床问题。系统检索EMBASE、MEDLINE（通过PubMed）及Cochrane图书馆的相关文献，对检索结果进行纳入筛选；采用经过审定的评价工具评估纳入研究的偏倚风险、提取数据，并对每项推荐意见的证据强度与证据等级进行分级。最终对分级后的推荐意见进行投票以达成共识。