The “Personalising Actinic Keratosis Treatment for Immunocompromised Patients”(IM-PAKT) Project - An Expert Panel Opinion

Sep 22, 2026

Upload by Oliver

Actinic keratosis (AK) is an intraepithelial condition marked by scaly, erythematous lesions after repeated ultraviolet exposure. Significant immunosuppression increases the risk of AK development and progression to squamous cell carcinoma (SCC), making immunocompromised patients (ICPs), especially organ transplant recipients, harder to treat and with worse outcomes. The IM-PAKT expert panel addresses gaps in guidance by proposing patient-centred, scenario-based care and a risk-adapted triage approach for follow-up and disease surveillance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Introduction

Key risks in immunocompromised patients

Rationale for expert panel guidance

Keywords

Dermatol Ther (Heidelb) (2024) 14:1739–1753 [https://doi.org/10.1007/s13555-024-01215-y](https://doi.org/10.1007/s13555-024-01215-y) REVIEW The “Personalising Actinic Keratosis Treatment for Immunocompromised Patients”(IM‑PAKT) Project: An Expert Panel Opinion Rolf‑Markus Szeimies · Claas Ulrich · Carla Ferrándiz‑Pulido · Gunther F. L. Hofbauer · John Thomas Lear · Celeste Lebbé · Stefano Piaserico · Merete Hædersdal Received: March 18, 2024 / Accepted: June 11, 2024 / Published online: June 21, 2024 © The Author(s) 2024 ABSTRACT Actinic keratosis (AK) is an intraepithelial condi‑ tion characterized by the development of scaly, erythematous lesions after repeated exposure to ultraviolet radiation. Significant immuno‑ suppression is a risk factor for the development of AK and subsequent lesion progression tosquamous cell carcinoma. Immunocompro‑ mised patients (ICPs), particularly organ trans‑ plant recipients, often have more advanced or R.‑M. Szeimies (*) Department of Dermatology & Allergology, Klinikum Vest GmbH Academic Teaching Hospital, Recklinghausen, Germany e‑mail: Rolf‑Markus.Szeimies@Klinikum‑[Vest.de](Vest.de) C. Ulrich GmbH & Department of Dermatology, Collegium Medicum, Charité Universitätsmedizin, Berlin, Germany C. Ferrándiz‑Pulido Department of Dermatology, University Hospital Vall d’Hebron, Barcelona, Spain C. Ferrándiz‑Pulido Factultad de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain G. F. L. Hofbauer Universität Zürich, Zurich, Switzerland G. F. L. Hofbauer Dermatologische Klinik, Universitätsspital Zürich, Zurich, Switzerland complex AK presentations and an increased risk of skin carcinomas versus non‑ICPs with AK, making lesions more difficult to treat and resulting in worse treatment outcomes. The recent “Personalising Actinic Keratosis Treat‑ ment”(PAKT) consensus reported that delivering patient‑centric care may play a role in support‑ ing better clinical outcomes and patient satisfac‑ tion with treatments for chronic dermatologic conditions such as AK, which require repeated cycles of treatment. Additionally, currently pub‑ lished guidance and recommendations were J. T. Lear Department of Dermatology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK J. T. Lear Manchester Academic Health Science Centre, Manchester, UK C. Lebbé Dermato‑Oncology and CIC AP‑HP Hôpital Saint Louis, INSERM U976, Université Paris Cite, Paris, France S. Piaserico Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy M. Hædersdal Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark M. Hædersdal Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark considered by the PAKT panel to be overly broad for managing ICPs with their unique and com‑ plex needs. Therefore, the “Personalising Actinic Keratosis Treatment for Immunocompromised Patients” (IM‑PAKT) panel was established to build upon general recommendations from the PAKT consensus. The panel identified current gaps in guidance for AK care in ICPs, offered practical care approaches based on typical ICP scenarios, and highlighted the need to adapt AK management to optimize care and improve treatment outcomes in ICPs. In particular, der‑ matologists should establish collaborative and transparent relationships with patients’ multi‑ disciplinary teams to enhance overall care for patients’ comorbidities: given their increased risk of progression to malignancy, earlier assess‑ ments/interventions and frequent follow‑ups are vital. The panel also developed a novel “triage” tool outlining effective treatment follow‑up and dis‑ ease surveillance plans tailored to patients’ risk profiles, guided by current clinical presentation and relevant medical history. Additionally, we present the panel’s expert opinion on three fic‑ tional ICP scenarios to explain their decision‑ making process for assessing

FAQs

Why are immunocompromised patients at higher risk for AK progression?

Significant immunosuppression is described as a risk factor for AK development and subsequent progression to squamous cell carcinoma, with ICPs—particularly transplant recipients—having more advanced presentations and higher malignancy risk.

What is the purpose of the IM-PAKT expert panel?

The IM-PAKT panel was established to build on general PAKT recommendations, identify gaps in AK guidance for ICPs, and provide practical, scenario-based care approaches tailored to ICP needs.

How does the panel propose managing follow-up and disease surveillance?

The panel developed a triage tool that outlines effective treatment follow-up and disease surveillance plans tailored to patients’ risk profiles, guided by clinical presentation and relevant medical history.

Sep 22, 2026

Upload by Oliver