Lmax and imiquimod 3.75% in daily clinical practice

Abstract

Background Lmax, the maximum lesion count during treatment, is a new concept for evaluating the efficacy of field-directed treatments for actinic keratosis (AK) against clinical and subclinical lesions. Imiquimod 3.75% is a field-directed AK treatment, which can detect and clear clinical and subclinical lesions across an entire sun-exposed field such as the full face or balding scalp. Objectives To evaluate the importance of integrating Lmax into daily clinical practice by describing the clinical features and outcomes obtained in the first 10 patients who were treated with imiquimod 3.75% in a UK dermatology department. Methods Ten AK patients were treated with imiquimod 3.75% in two 2-week treatment cycles separated by a 2-week treatment-free interval. Lesions were counted before, during and 2 months after treatment was completed. Patients compared the imiquimod 3.75% regimen with their previous AK therapies in terms of treatment duration and side-effect profile. Conclusions Imiquimod 3.75% in daily clinical practice enables dermatologists to detect and clear clinical and subclinical AK lesions across a large sun-exposed area. Patients generally find imiquimod 3.75% easy-to-use with a better side-effect profile than other AK treatments. Results All 10 patients in this cohort had used two or more prior AK treatments including 5-flurouracil, diclofenac, imiquimod 5% and photodynamic therapy. The patients had a median of 10 AK lesions on clinical presentation and a median Lmax of 14. The median lesion count was zero 2 months after treatment was completed. All patients thought that imiquimod 3.75% was easy-to-use and that the duration of treatment was better than that of previous AK therapies. Seven of the patients considered the side-effect profile of imiquimod 3.75% to be better than that of their prior AK treatments.