0.1% or 0.3% retinoic acid photodamaged on efficacy/safety Only 1 RCT to gel receptors (RAR) skin of retinoids in AK. support efficacy (DIFFERIN by with selectivity of gel. Galderma for RARβ and formulation Labs and RARγ, (0.1%) was not generic by independent of studied. Taro) trial for p53 Results were 4 wks then not supported twice daily by a larger which showed that topical tretinoin 0.1% cream was ineffective. Diclofenac Cyclooxygenase Well tolerated; Long treatment No recurrence Sodium inhibitor limited duration, delayed data inflammation, time to complete / 3% gel Shorter courses irritation and optimal healing (SOLARAZE are less erythema (up to 30 d by effective. end of tx) PharmaDerm) Seems to be Transdermal twice daily for better May be less systemic 60–90 d tolerated than effective than 5FU absorption is 5FU Recommended for low (Cp 20 ≤ face; shown to be ng/ml). ineffective on However, there areas (e.g., are warnings for scalp, arms, use in pts with forearms, hands) active gastrointestinal Dry skin, pruritus, ulceration or erythema, rash at bleeding and application site; severe renal or potential allergic hepatic reaction impairments. Thymidine >50 y of Inflammation lasts Topical depletion, experience; about 2 wk corticosteroids (5FU) decreased DNA 90% effective may be used Temporarily synthesis, cell in pts who can following 5FU 0.5% disfiguring with death tolerate it; 50% course to cream long healing time; responder rate reduce (CARAC erythema, for complete inflammation. by blistering, clearance of Valeant) necrosis, erosion More frequent AK once then doses and daily for 0.5%: Better reepithelialization longer tx 4 wk tolerated than takes about 4–6 duration with higher wk (including 2–4 1% cream may 1% strengths. wks of tx) be needed for cream tx of areas (generic Suggested other than face by Aqua) topical tx and neck. on entire alternative for face or AK in solid other organ affected transplant areas recipients twice daily for 2–6 wk 5% by
0.1% or 0.3% gel (DIFFERIN by Galderma Labs and generic by Taro) for 4 wks then twice daily retinoic acid receptors (RAR) with selectivity for RARβ and RARγ, independent of p53 photodamaged skin on efficacy/safety of retinoids in AK. Only 1 RCT to support efficacy of gel. formulation (0.1%) was not studied. Results were not supported by a larger which showed that topical tretinoin 0.1% cream was ineffective. Diclofenac Sodium 3% gel (SOLARAZE by PharmaDerm) twice daily for 60–90 d Cyclooxygenase inhibitor Well tolerated; limited inflammation, irritation and erythema Seems to be better tolerated than 5FU Long treatment duration, delayed time to complete / optimal healing (up to 30 d end of tx) May be less effective than 5FU Recommended for face; shown to be ineffective on areas (e.g., scalp, arms, forearms, hands) Dry skin, pruritus, erythema, rash at application site; potential allergic reaction No recurrence data Shorter courses are less effective. Transdermal systemic absorption is low (Cp ≤ 20 ng/ml). However, there are warnings for use in pts with active gastrointestinal ulceration or bleeding and severe renal or hepatic impairments. (5FU) 0.5% cream (CARAC by Valeant) once daily for 4 wk 1% cream (generic by Aqua) on entire face or other affected areas twice daily for 2–6 wk 5% by Thymidine depletion, decreased DNA synthesis, cell death >50 y of experience; 90% effective in pts who can tolerate it; 50% responder rate for complete clearance of AK 0.5%: Better tolerated than higher strengths. Suggested topical tx alternative for AK in solid organ transplant recipients Inflammation lasts about 2 wk Temporarily disfiguring with long healing time; erythema, blistering, necrosis, erosion then reepithelialization takes about 4–6 wk (including 2–4 wks of tx) Topical corticosteroids may be used following 5FU course to reduce inflammation. More frequent doses and longer tx duration with 1% cream may be needed for tx of areas other than face and neck. trial