What are the alternatives to Efudex (fluorouracil) for treating actinic keratoses?

From the Guidelines

Imiquimod 5% cream is a highly effective alternative to Efudex (fluorouracil) for treating actinic keratoses, with a complete clearance rate of 50% and a strength of recommendation A, level of evidence 1++ 1. Alternatives to Efudex (fluorouracil) for treating actinic keratoses include several effective options, including:

• Imiquimod 5% cream (Aldara) applied 2-3 times weekly for 4-16 weeks, stimulating the immune system to target abnormal cells 1
• Diclofenac 3% gel (Solaraze) applied twice daily for 60-90 days, working as an anti-inflammatory with fewer side effects than Efudex 1
• Ingenol mebutate gel (Picato) offering a shorter treatment course of just 2-3 days, with 0.015% strength for face/scalp and 0.05% for trunk/extremities 1
• Cryotherapy providing immediate treatment in a single office visit by freezing lesions with liquid nitrogen 1
• Photodynamic therapy combining a photosensitizing agent (aminolevulinic acid or methyl aminolevulinate) with light exposure to selectively destroy abnormal cells in 1-3 sessions 1 Treatment choice depends on lesion location and number, patient compliance, cost considerations, and tolerance for side effects like skin irritation, which varies significantly between these options. Some key considerations when choosing an alternative to Efudex include:
• The strength of recommendation and level of evidence supporting each option
• The potential for side effects and the need for careful patient counseling
• The importance of considering the individual patient's needs and preferences when selecting a treatment option
• The need for ongoing monitoring and follow-up to ensure effective treatment and prevent recurrence 1

From the Research

Alternatives to Efudex (Fluorouracil) for Treating Actinic Keratoses

Alternatives to Efudex (fluorouracil) for treating actinic keratoses include:

• Imiquimod 5% cream 2, 3, 4, 5
• Diclofenac 3% gel 2, 6
• Photodynamic therapy 2, 3, 6
• Cryosurgery 2, 6
• Curettage with electrosurgery 2
• Ingenol mebutate gel 3

Efficacy of Alternatives

The efficacy of these alternatives has been studied in various trials:

• Imiquimod 5% cream has been shown to be effective in treating actinic keratoses, with an average efficacy rate of 70 +/- 12% 5
• Diclofenac 3% gel has been shown to be an effective alternative therapy for actinic keratoses 2
• Photodynamic therapy has been shown to be effective in treating actinic keratoses, but its efficacy is lower than that of fluorouracil 3
• Cryosurgery and curettage with electrosurgery are ablative therapies that can be effective in treating actinic keratoses, but they may have more side effects than topical therapies 2, 6
• Ingenol mebutate gel has been shown to be less effective than fluorouracil in treating actinic keratoses 3

Comparison of Alternatives

Comparisons of these alternatives have been made in various studies:

• A study comparing imiquimod 5% cream, fluorouracil 5% cream, photodynamic therapy, and ingenol mebutate gel found that fluorouracil was the most effective treatment 3
• A meta-analysis comparing imiquimod 5% cream and fluorouracil found that imiquimod may have higher efficacy than fluorouracil for actinic keratosis lesions located on the face and scalp 5