Neal Bhatia, MD: What You Need to Know About Treating Actinic Keratosis

Neal Bhatia, MD, spoke with the editorial team at HCPLive about his talk ‘What You Need To Know NOW About Actinic Keratosis’ at the 2023 Fall Clinical Dermatology Conference in Las Vegas.

Bhatia is a leading dermatologist in Southern California, working as Director of Clinical Dermatology at Therapeutics Clinical Research and chief medical editor for Practical Dermatology.

“So the idea is thinking about actinic keratosis as kind of like playing golf,” Bhatia said. “You don't just hit the ball, you swing back. You kind of see what's the assessment of what's coming, as well as what's in front of you, and you treat what you see. Then, you make a plan for treating what’s on the way, as well as incorporating as many photoprotection and chemo-prevention strategies as you can.”

Bhatia addressed his biggest motivations for pursuing the topic of actinic keratosis (AK), as well as its importance for patients.

“Really, everyone is just about freezing and then moving on,” he explained. “And I try to convince everyone that in treating actinic keratosis, we don't just freeze or just use topicals or just use (photodynamic therapy). We have to think about incorporating all the modalities that we have at once in a sequence so that we can treat what's on the way and reduce skin cancer risk. My interest in getting that across has not just been teaching dermatologists, but also teaching some of the manufacturers and industry partners we have.”

Bhatia noted the importance of discussing how to manage local skin reactions of topical products, how to manage photodynamic therapy (PDT) responses, and how to get the business end of PDT into the offices so that it is not something that is foreign to dermatologists.

Later, he described risk factors associated with actinic keratosis and why early diagnosis is crucial for patients.

“Most of the common presentations of actinic keratosis on patients who are a little bit more fair skin types, 1 to 2, maybe even 3 in heavily sun damaged areas, obviously,” Bhatia said. “But sometimes we forget about where we're not telling patients to use sunblock on the backs of the hands, dorsal surfaces of the feet, back of the neck, back of the legs, and the forearms.”

Bhatia added that he believes there is a generation of people that do go out into the sun and avoid going to the beach.

“You have to remind those people ‘Well, you're driving in the car, you're walking to the grocery store, you're doing whatever else, it's the same sand that you would get at the beach, you're just not laying out,’” he explained. “That being said, you have to think in terms of how we get patients to adhere to the topical therapies, while still managing their local skin reactions, not calling them side effects.”

He explored the topic of explaining to patients how to manage their condition better.

“There have been some good articles that show that if you spend 5 minutes or more with the patients counseling them, even demonstrating with them on not only how to apply the therapies, but putting together a treatment program for the next 6 months and managing the local skin reactions, that adherence level goes up almost 50%,” he said. “And so some of it is that we're not taking the time to actually get into the teaching of what those patients need.”

Bhatia added that the other half of the equation is that reimbursements for cryotherapy and destruction, as well as reimbursement for photodynamic therapy are all going up.

“It's definitely something, with consolidation of group practices, where photodynamic therapy can be a real integral part of an office,” he said. “And that's really my goal was to create some of that awareness and get them out a little bit off the routine of just freezing and going.”

For further information, view the full interview with Bhatia posted above.

The quotes contained in this interview were edited for clarity.