Up until now, current treatments for actinic keratosis (AK) have been far from perfect, but because AK is thought to be a precursor to squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), an imperfect treatment was better than none.
Actinic keratoses are scaly, red and occasionally itchy patches on areas of exposed skin — usually on patients over 50 years old, but can manifest in younger adults particularly with prolonged sun exposure. The risk of an AK developing into an SCC is thought to be one in 1,000, however it can’t be predicted which ones will progress and patients often have many lesions.
Current treatments include photodynamic therapy, topical diclofenac (Solaraze), topical imiquimod (Aldara and Zyclara) and topical fluorouracil (Efudex). All of these require several weeks of application for treatment to work and they tend to cause a huge inflammatory skin response — meaning compliance becomes an issue and patients do not continue through with the treatments, as the side effects are often worse than the original lesion.
For this reason efficacy is not perfect. Existing AK treatments often don’t clear the entire field of AK and keep it clear, so recurrence and the development of new lesions is a major problem, particularly when patients don’t push through with the full treatment program.
But recently a new topical cream has been released that not only shows promise in treatment of AK, but may also have the ability to regress early stage BCC, without any visible side effects.
The product, marketed under the brand name of ZenaDerm, is a topical cream utilising the active ingredients found in Tea Tree Oil, known as terpinen-4-ol. In clinical trials, first conducted at the University of Western Australiaby a team of doctors headed up by Professor Thomas V Riley, and then later the subject of 5 clinical trials at the University of Kentucky by Professor Don Cohen, this product showed remarkable ability to regress early stage Basal Cell Carcinoma in mouse models.
Although the exact mode of action is unknown for Tea Tree Oil, one study showed that TTO appeared to stimulate an immune response (i.e. neutrophils, dendritic, and T Cells) and anti-tumor efficacy is facilitated by a direct effect on subcutaneous AE17 tumor cells in vivo Ireland et al. (2012)
Whatever the mode of action, several clinical trials support the efficacy of Tea Tree Oil and its active components, including terpinen-4-ol, for the treatment of AK lesions. While most lab models used a solvent called DMSO to improve penetration of the Tea Tree Oil, this causes irritation similar to other topical treatments, such as Efudex and Aldara, but the manufacturers of ZenaDermhave been able to overcome those laboratory issues by the clever use of Vanilla extracts as the coupling agent in their formula. Vanilla is a natural vasodilator and carries the Tea Tree Oil below the skin, where it needs to be, to penetrate the lesion and work quickly to regress it.
The product shows great promise for the treatment of AK in the future.
Complimentary Healthcare Group
CHG provides clinical data and research on complimentary options for healthcare. Supported by a unique group of Doctors around the world, CHG provides a snapshot on alternative health and the growing clinical evidence to support the uses of alternative medicicnes.
Dr. Richard Teague