This comprehensive review delves into various immunotherapeutic approaches for the management of actinic keratoses (AKs), precancerous skin lesions associated with UV exposure. Although there are treatments whose main mechanism of action is immune modulation, such as imiquimod or diclofenac, other treatments, apart from their main effect on dysplastic cells, exert some immunological action, which in the end contributes to their efficacy. While treatments like 5-fluorouracil, imiquimod, photodynamic therapy, and nicotinamide are promising in the management of AKs, especially in immunocompetent individuals, their efficacy is somewhat reduced in solid organ transplant recipients due to immunosuppression. The analysis extends to optimal combination, focusing on cryoimmunotherapy as the most relevant. New immunotherapies include resimiquimod, ingenol disoxate, N-phosphonacetyl-L-aspartate (PALA), or anti-PD1 that have shown promising results, although more studies are needed in order to standardize their use.

Solid organ transplant recipients (SOTRs) have a significantly higher risk of developing cutaneous squamous cell carcinoma. Identifying predictive markers for response to non-surgical treatments such as photodynamic therapy (PDT) may help optimize management strategies. To evaluate the association between dermatoscopic features in actinic keratoses (AK) and Bowen's disease (BD) and response to PDT in SOTRs. A prospective observational study was conducted, including 35 SOTRs with clinically and histologically confirmed AK or BD treated with methyl aminolevulinate-PDT. Thirteen dermatoscopic features were analyzed to assess their correlation with treatment response. Response rates were 62.5% for AK and 89.47% for BD. Among the dermatoscopic features evaluated, white structureless areas in AK and rosettes in BD were significantly associated with resistance to PDT. Dermoscopy may serve as a valuable tool to predict PDT response in SOTRs with AK and BD, potentially improving patient selection and treatment outcomes.

Diese umfassende Übersichtsarbeit gibt einen Überblick über verschiedene immuntherapeutische Ansätze zur Behandlung von aktinischen Keratosen (AKs), präkanzerösen Hautläsionen, die durch UV-Exposition verursacht werden. Neben Behandlungen, deren Hauptwirkmechanismus die Immunmodulation ist, wie Imiquimod oder Diclofenac, haben auch andere Behandlungen, die hauptsächlich auf dysplastische Zellen abzielen, eine gewisse immunologische Wirkung, die zu ihrer Wirksamkeit beiträgt. Während Behandlungen wie 5-Fluorouracil, Imiquimod, photodynamische Therapie und Nicotinamid bei der Behandlung von AKs vielversprechend sind, vor allem bei immunkompetenten Personen, ist ihre Wirksamkeit bei Empfängern solider Organtransplantate aufgrund der Immunsuppression eingeschränkt. Die Übersicht umfasst die optimale Kombination und fokussiert sich auf die Kryoimmuntherapie als relevanteste. Neue Immuntherapien sind Resimiquimod, Ingenoldisoxat, N-Phosphonacetyl-L-Aspartat (PALA) oder Anti-PD-1, die vielversprechende Ergebnisse erzielt haben, aber weitere Studien erfordern, um ihre Verwendung zu standardisieren.