Teledermatology‐driven topical therapy of actinic keratosis: a comparative study of clinical effectiveness and compliance

Background Teledermatology ( TD ) provides efficient care for skin cancer patients. Objective To compare the clinical effectiveness of imiquimod 5% for the treatment of AK with in‐person care and through TD . Methods Longitudinal prospective controlled study including patients with single AK diagnosed and treated at face‐to‐face visits ( FTF group) or through teledermatology ( TD group) with imiquimod 5% cream. The main outcome measures assessed were the complete and global response percentage ( CR and GR ) under per‐protocol ( PP ) and intention‐to‐treat ( ITT ) analysis. Results A total of 157 patients were enrolled ( FTF = 75, TD = 82). PP analysis showed CR in 66.7% of FTF patients and 65.6% in TD patients ( P > 0.05). The ITT yielded CR in 64.0% and 51.2% in FTF visits and TD , respectively ( P = 0.073). The analysis showed an advantage of FTF care against TD in achieving GR (84.0% vs. 70.7%; P = 0.036). Facial location and local adverse reactions were the only explanatory factors of complete response in the ITT approach. Treatment completion was found in 90.7% and 72.0% in the FTF and TD groups, respectively ( P = 0.004). Conclusions Improvements in patient counselling at the primary care centre are needed before the implementation of TD as a routine methodology for the management of AK .