From the Guidelines
Topical treatments for solar keratosis (actinic keratosis) should include 5-fluorouracil (5-FU) cream or imiquimod cream as first-line options, due to their strong recommendations and moderate to good quality of evidence. These treatments have been shown to be effective in managing actinic keratosis, with 5-FU working by interfering with DNA synthesis in rapidly dividing cells and imiquimod stimulating the immune system to target abnormal cells 1.
Treatment Options
- 5-FU (Efudex, Fluoroplex) is typically applied twice daily for 2-4 weeks
- Imiquimod (Aldara, Zyclara) is usually applied 2-3 times weekly for 4-16 weeks
- Diclofenac 3% gel (Solaraze) requires application twice daily for 60-90 days, but has a lower quality of evidence and is conditionally recommended
- Ingenol mebutate (Picato) offers a shorter treatment course, but may cause significant skin irritation and has limited evidence in certain populations 1
Considerations
- Treatment selection depends on the number and location of lesions, patient compliance considerations, and previous treatment responses
- Patients should apply these medications only to affected areas, avoid sun exposure during treatment, and use sunscreen regularly
- The primary patient-focused considerations for the treatment of AKs are the associated symptoms, the risk of progression to keratinocyte carcinoma, tolerability, burden of treatment, and the cosmetic appearance of the AKs before, during, and after treatment 1
Evidence Quality
- The recommendations for 5-FU and imiquimod are based on moderate to good quality of evidence, while diclofenac has a lower quality of evidence 1
- The evidence for ingenol mebutate is limited, and it may not be suitable for all patients 1
- The guidelines suggest that treatment options should be individualized based on patient characteristics and preferences, and that shared decision-making between the patient and clinician is important 1
From the FDA Drug Label
Fluorouracil Cream USP is recommended for the topical treatment of multiple actinic or solar keratoses. The topical treatment for solar keratoses is fluorouracil cream USP, as stated in the drug label 2.
- Key points:
- Fluorouracil cream USP is used for the treatment of multiple actinic or solar keratoses.
- It is also useful in the treatment of superficial basal cell carcinomas when conventional methods are impractical.
From the Research
Topical Treatment for Solar Keratosis
The following topical treatments are mentioned in the studies:
- 5-fluorouracil (5-FU) 3, 4, 5, 6
- Imiquimod (IQ) 3, 5, 6
- Diclofenac 3, 5, 6
- Ingenol mebutate (IM) 3, 5
- Retinoids 3
- Resiquimod 3
- Betulinic acid 3
- Piroxicam 3
- Dobesilate 3
Treatment Efficacy
The efficacy of these treatments varies, with some studies suggesting that daily application of 5% 5-FU cream is more effective than weekly application at clearing actinic keratoses from the scalp and face 4. Inflammation is also likely to be required to achieve a therapeutic effect 4.
Treatment Selection
The choice of treatment depends on various factors, including patient age, general health, and the thickness, size, and localization of the lesion 5. Each treatment option has its advantages and disadvantages, and they all have a place in the management of actinic keratosis 6.