- General measures for all patients (1):
- moisturisers two to three times a day to help differentiate early AK from dry scaly arease of normal skin
- larger number of AK lesions – Nicotinamide 500 mg BID, which has shown to reduce number of AK and non-melanoma skin cancer
- Lesion specific treatment – few lesions or larger numbers that are widely distributed (ie dotted around the face, scalp and hands etc) (1):
- treat the individual lesions and not the surrounding skin
- cryotherapy - involves single freeze-thaw cycle of approximately ten seconds; in order to avoid the risk of ulcers, avoid the gaiter area
- 5-fluorouracil (5-FU) cream (Efudix®) twice daily for 3-4 weeks
- Patients should be advised to expect a relatively mild degree of redness and discomfort during the treatment period
- 5-FU 0.5% and salicylic acid 10% (Actikerall®) moderately thick hyperkeratotic actinic keratosis, used once a day for 6-12 weeks
- 3% diclofenac gel in sodium hyaluronate (Solaraze®) twice a day for 12 weeks
- field change – multiple AK associated with a background of erythema, telangiectasia and other changes seen in sun-damaged skin (1)
- treatments should be applied to whole area of field change and not just the individual lesions
- smaller areas of field change (e.g. an area the size of a palm or most of the forehead)
- 5% imiquimod cream (Aldara cream) – use three nights a week; generally effective in terms of clearance, and cosmetic appearance
- 5- FU cream (Efudix cream) – once a day for four weeks
- Photodynamic therapy (PDT) –single treatment often provides effective treatment
NOTE: MHRA alert has noted an increased incidence of skin tumours in some clinical studies when using ingenol mebutate; as of February 2020, licence of ingenol mebutate has been suspended as a precautionary measure while the European Medicines Agency (EMA) continues to investigate the concerns about a possible increased risk of skin malignancy (2,3)
- For larger areas of field change consider:
- 3% diclofenac gel – use twice daily fior 8-12 weeks; generally well tolerated
- 3.75% imiquimod cream (Zyclara cream) – once daily for two weeks, followed by two week treatment-free, then once daily for two weeks
Systemic therapies (only used by specialists) include treatments such as oral retinoids are used for chemoprevention of non-melanoma skin cancers in high-risk patients for both immunocompetent and immunosuppressed patients, including patients with xeroderma pigmentosum
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