188.8.131.52 Photodamage (actinic keratosis)
Smaller areas of field change
(e.g. area size of palm or most of forehead)
Fluorouracil 5% cream
Note-reduce frequency to 3-4 times per week in very sensitive skin where irritation is a significant issue
Larger areas of field change
Diclofenac sodium 3% gel
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. Do not prescribe
- aldara cream® (5% imiquimoid) for smaller areas of field change
- zyclara® (3.75% imiquimoid) for larger areas of field change