Combined treatment of actinic keratosis with carbon dioxide laser and imiquimod

Objective — to increase the effectiveness of treatment of various forms of actinic keratosis (AK) with application of topical immunoregulator imiquimod in combination with carbon dioxide (СО2) laser in the form of dermal optical thermolysis (DOT). 
Materials and methods. 95 patients with various forms of AK were under observation. They were divided into two groups: the main group (50 persons) and the control group (45 persons). Patients of both groups used imiquimod as the main method of treatment for AK. In the main group, before applying imiquimod, additional treatment of AK zone was carried out 1 cm along the peripheral area with a СО2-laser in the form of DOT. 
Results and discussion. The results of treatment of patients of both groups were evaluated 10, 20 and 60 days after the last application of imiquimod. The following characteristics were analyzed: soreness during and after the procedure, speed of epidermis recovery, presence or absence of dermatoscopic signs of AK, formation of complications (scarring or dyschromic), absence or presence of disease recurrences within 2 months. It was noted that combined treatment with imiquimod and СО2-laser slowed down the epithelialization of the affected areas (up to 20 days in 37 (39.5 %) patients of the main group and only in 19 (20 %) patients of the control group), by increasing the depth and intensity of the intervention, but it slightly increased the effect of post-traumatic hyperpigmentation (after 60 days) in 5 (5.2 %) patients of the main group and in 3 (3.1 %) patients of the control group. This therapy reduced the number of AK recurrences (especially in the hyperkeratotic form) by 3.2 % compared to the imiquimod monotherapy and had a positive effect on the rate of disappearance of dermatoscopic signs of AK (20 days after the end of treatment, they were observed only in 2 (2.1 %) patients of the main group and in 7 (7.5 %) patients of the control group). 
Conclusions. The combined treatment of AK that includes the application of imiquimod and the use of СО2-laser is promising, etiopathogenetically justified and well tolerated.