Actinic keratoses are intraepidermal skin tumors that appear in the context of a type of chronic actinic damage known as field cancerization. New treatments tend to cover not only clinically visible lesions, but also those that harbor subclinical dysplastic changes. Therefore, classic drugs such as imiquimod have returned to the fore because of their formulation, which is available in various concentrations,1 and the search for an optimal regimen that enables us to adapt the inflammatory reaction as much as possible to the clinical response.

In this article, Serra-Guillén et al.2 investigate a new regimen of imiquimod 5% cream for the treatment of actinic keratosis. The authors propose a concentrated regimen in which they apply the drug daily for 12 consecutive days with the aim of finding a better response to therapy and a shorter duration of local cutaneous responses. The data obtained show the regimen to be slightly more effective than that reported in the summary of product characteristics, albeit at the cost of poorer tolerance. Furthermore, the linear correlation between the severity of the local reactions and the degree of clinical response can help us to predict the response to imiquimod, which is sometimes quite erratic, depending on the patient. In this interesting article, our colleagues from Instituto Valenciano de Oncología use high-quality data to reinforce the trend observed in daily clinical practice and the philosophy of “no pain, no gain”, which we try to transmit to patients so that a correct understanding of the mechanism of action of this drug leads to appropriate adherence and, therefore, a successful outcome.