OBJECTIVES: To characterize the clinical management of actinic keratosis (AK) in the real-world setting by disease severity as measured by the 0 to 10-point pain visual analogue scale (VAS) and the lesion count.

METHODS: Outpatient electronic health records (2017-2024) from 6 specialty dermatology networks in the OMNY Health real-world data platform were accessed, and patients were selected if they had at least 1 pain VAS or lesion count assessment associated with the AK diagnosis code. Prescription and procedure orders were assessed at the same visit as the pain VAS or lesion count measurement. Proportions of patients by pain VAS and lesion count were calculated for topical agents (fluorouracil, diclofenac, imiquimod, and tirbanibulin) and procedures (lesion destruction [laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement], shaving, excision, chemical peel, and photodynamic therapy).

RESULTS: A total of 334,410 AK patients with 704,665 pain VAS or lesion count assessments were included. Distributions of gender (45% female), race (2% nonwhite), and age (mean: 68 years; standard deviation: 12 years) were similar between clinical assessment categories. Fluorouracil prescriptions decreased with increasing pain VAS (5% and 1% for pain VAS 0-1 and 8-10, respectively) and increased with increasing lesion count (3% and 8% for 1 and ≥ 15 lesions, respectively). With increasing pain VAS, lesion destruction decreased (91% and 11% for pain VAS 0-1 and 8-10, respectively) and photodynamic therapy increased (1% and 83% for pain VAS 0-1 and 8-10, respectively). Proportions of encounters with lesion destruction and photodynamic therapy did not vary notably by lesion count. Other topical agent prescriptions and procedures were negligible.

CONCLUSIONS: Results provide insights into the roles of pain and lesion count in the management of AK patients in the real-world dermatology setting. Analyses of clinical notes may be beneficial to understand reasons behind different clinical management strategies.