Environmental friendliness of
actinic keratosis therapy options
Actinic keratoses (AK), a precursor of squamous cell carcinoma, result from cumulative UV exposure, preferably UVB, from natural sunlight and/or tanning beds. Their incidence increased significantly in the last decade. Causes are increasing life expectancy combined with occupational and private UV exposure. According to estimates, 1.7 million patients with AK are treated in Germany alone.
The estimated number of people suffering from AK cannot be determined. Evidence-based recommendations for the treatment of AK are listed in the S3 guideline Actinic keratoses and squamous cell carcinomas of the skin of the Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Effects of treatment methods on the environment are not considered therein.
The following tables discuss the environmental impact of the galenic composition and adjuvants used in some of the treatment options for AK presented in the AWMF guideline. Direct health effects due to ingredients such as skin irritation or allergies are not named. Also, energy and water consumption due to production of the externals as well as greenhouse gas emissions resulting e.g. from production and supply chains are not listed.
Numerous externals contain questionable ingredients that can accumulate in the environment and cause lasting damage.
Some active ingredients such as cytostatics, TCA and diclofenac require separate disposal, as they are not allowed to enter wastewater.
The proper disposal of medications with toxic ingredients by patients and practices is not adequately ensured by the German Medicines Disposal Act (Gesetz zur Arzneimittelentsorgung, AMG).
It is apparent that similar treatment methods should also be evaluated on the basis of their environmental friendliness in order to make therapy decisions for patients.
It is recommended that in the future, medicinal externals be reviewed for ingredients of concern so that the findings can be incorporated into the AWMF guidelines.
Prompt interdisciplinary identification of additional therapeutics that are available over-the-counter worldwide but have toxic environmental effects and thus on human health would be desirable. For example, over-the-counter drugs such as diclofenac and also peeling substances such as TCA should be reserved exclusively for medical practice.
Since September 1st, 2021, a new active substance, tirbanibulin, has been released that could not yet be included in the AWMF guideline. It is a microtubule and Src tyrosine kinase inhibitor and is therefore a cytostatic. Thus, it is to be classified as an environmentally harmful therapeutic agent. Its galenics are harmless to the environment.
The chemical ingredients and references listed in the table are provided as a link below:
© Dr. med. Dipl. Biol. Susanne Saha und Dr. med. Christina Hecker 10/2021