From the Guidelines
The standard SIG instructions for Actikerall (fluorouracil and salicylic acid) for treating warts involve applying a 5% fluorouracil cream daily with occlusion for 4–12 weeks. According to the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1, the treatment should be applied directly to the wart, covering the affected area and a small margin of surrounding healthy skin. The guidelines suggest that the treatment should continue until the wart has completely cleared or for a maximum duration of 12 weeks.
Key points to consider when prescribing Actikerall for warts include:
- Applying the medication once daily to the affected area
- Using the applicator brush attached to the bottle cap to cover only the wart and a small margin of surrounding healthy skin
- Allowing the solution to dry completely, forming a film over the treated area
- Avoiding application to mucous membranes, eyes, or healthy skin beyond the immediate wart area
- Expecting mild skin irritation, redness, and peeling at the application site as indications that the medication is working
It's essential to note that the British Association of Dermatologists' guidelines provide a strength of recommendation for various treatments, including salicylic acid and fluorouracil, which are components of Actikerall 1. The guidelines recommend salicylic acid as a first-line treatment for hand warts, with a strength of recommendation A, and fluorouracil as an alternative treatment option.
In clinical practice, it's crucial to consider the patient's individual needs, medical history, and potential interactions with other medications when prescribing Actikerall for warts. Additionally, patients should be informed about the potential side effects and the importance of adhering to the prescribed treatment regimen to ensure optimal outcomes.
From the Research
SIG Instructions for Actikerall
The standard SIG (prescription instructions) for Actikerall (fluorouracil and salicylic acid) for treating warts are not directly stated in the provided studies. However, based on the available evidence, here are some general guidelines:
- Apply Actikerall cream once or twice daily, under occlusion, for 6 weeks 2
- Assessment of treatment response and side effects should be performed at baseline, treatment completion, and 3- and 6-month follow-ups 2
- Patients should be instructed to apply the cream carefully, avoiding exposure to the eyes, mouth, and other mucous membranes
- Treatment response may not differ between once or twice daily applications 2
Possible Side Effects and Precautions
- Patients may experience side effects such as pain, redness, and irritation at the application site
- Actikerall should be used with caution in patients with a history of sensitivity to fluorouracil or salicylic acid
- Patients should be advised to avoid using Actikerall on broken or irritated skin
Comparison with Other Treatments
- Cryotherapy with liquid nitrogen has been shown to be effective in treating common warts, with cure rates ranging from 39% to 54% 3, 4
- Topical salicylic acid application has been shown to be effective in treating plantar warts, with cure rates ranging from 24% to 46% 5, 3
- Monochloroacetic acid application has been shown to be an effective alternative to cryotherapy for common and plantar warts, with cure rates ranging from 43% to 46% 4