13.8.1.1 Photodamage (actinic keratosis)

ChoiceDrugDosage

1st choice
Lesion-specific treatment

Or

Smaller areas of field change

(e.g. area size of palm or most of forehead)

Fluorouracil 5% cream

(Efudix®)

Dose:
Apply thinly to the affected area 1-2 times daily; max area of skin to be treated at one time is 500cm2 ; usual duration of initial therapy is 1-2 weeks

Note-reduce frequency to 3-4 times per week in very sensitive skin where irritation is a significant issue

1st choice

Larger areas of field change

Diclofenac sodium 3% gel

(Solaraze®)

Dose: Apply thinly twice daily for 60-90 days (or as long as can be tolerated), max 8g daily

 

  • Refer to Primary Care Dermatology Society (PCDS) guidance for details on management, patient information leaflets and other treatment options.
  • Actinic keratoses are pre-malignant but transformation to squamous cell carcinoma is rare. Patients must be referred if diagnosis is uncertain or if lesions become thickened or tender.
  • Patients should be advised to use high SPF sunscreen and to minimise exposure of the skin to direct sunlight or sun lamps.
  • An emollient may be sufficient for mild lesions.
  • Fluorouracil cream is effective against most types of non-hypertrophic actinic keratosis.
  • Patients using diclofenac gel should be reviewed after 3 months and consideration given to switching to other therapies if therapy is unsuccessful.
  • Refer to PCDS for information on alternative treatment options including the products below (please note most of these products can cause skin irritation):
    • actikerall® (fluorouracil 0.5% together with salicylic acid 10%) can be used for low to moderately thick hyperkeratotic actinic keratosis
    • picato® gel (ingenol mebutate) for smaller areas of field change. It is a newer treatment with similar outcomes to fluorouracil 5% cream, but offers a very short treatment period (2 or 3 days depending on area affected). This product has been suspended whilst undergoing review.
    • aldara cream® (5% imiquimoid) for smaller areas of field change
    • zyclara® (3.75% imiquimoid) for larger areas of field change