From the Guidelines
For dermal ablation, the most effective cream is 5% fluorouracil (5-FU) cream, which has been shown to be more effective than placebo for complete actinic keratosis (AK) clearance at 6 months 1.
Key Characteristics of 5-FU Cream
- Concentration: 5%
- Application: Twice daily for 4 weeks
- Efficacy: More effective than placebo for complete AK clearance at 6 months (38% vs 17%, respectively; P < .01)
- Skin Irritation: More than 90% of patients treated with 0.5% 5-FU experience irritation
Alternative Options
- Imiquimod cream: 5% concentration, applied 3 times a week for 4 or 8 weeks
- Diclofenac cream: 2.5% concentration, applied twice daily for 90 days
Important Considerations
- Patients should be aware of potential skin irritation and temporary skin blanching, redness, or mild swelling at the application site
- The cream should not be applied to broken skin, mucous membranes, or used in patients with known allergies to the active ingredients
- For extensive procedures, consultation with a healthcare provider is recommended to determine appropriate dosing
- The combination of 5-FU with calcipotriol has been shown to be more effective than 5-FU alone for complete AK clearance 1
From the FDA Drug Label
For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders The salicylic acid cream is used for dermal ablation of excessive keratin in hyperkeratotic skin disorders, such as:
- Verrucae
- Ichthyoses
- Keratosis palmaris and plantaris
- Keratosis pilaris
- Pityriasis rubra pilaris
- Psoriasis 2
From the Research
Dermal Ablation Creams
- Trichloroacetic acid (TCA) and glycolic acid are commonly used for dermal ablation in chemical peels 3, 4, 5, 6, 7
- TCA peels are effective in treating photodamaged skin, actinic keratoses, and superficial acne scars 3, 5
- Glycolic acid peels are also effective in treating photodamaged skin, frictional melanosis, and melasma 3, 4, 6
Comparison of TCA and Glycolic Acid Peels
- TCA peels were found to be slightly more efficacious in removing actinic keratoses than glycolic acid peels 3
- TCA peels were also found to be marginally superior to glycolic acid peels in treating frictional dermal melanosis 4
- However, glycolic acid peels were found to have fewer side effects than TCA peels and had the added advantage of facial rejuvenation 6
Specific Concentrations and Treatment Regimens
- A study compared the efficacy of 15% TCA and 50% glycolic acid peels in treating frictional melanosis, with four peels done every 15 days 4
- Another study compared the efficacy of 20-35% glycolic acid and 10-20% TCA peels in treating melasma, with graded concentrations used every 15 days 6
- A study also compared the efficacy of 25% TCA and 30% salicylic acid peels in treating mild-to-moderate acne vulgaris, with peels done at 2-week intervals for 12 weeks 7