Diclofenac 3% gel
| Twice daily for 60–90 days, maximum 8 g per day. | Grade 1 AK with or without field change. | Pruritus (41%), rash (40%), xerosis, and erythema.Caution – Usually well tolerated but after the course has been completed AK tend to recur. | 19%–70% |
5-flurouracil 5% cream
| Once daily for 3–4 weeks or twice daily for up to 3 weeks (lower limbs may require longer treatment duration).Cycle can be repeated a month later if AK persists. | All grades of AK with or without field change. | Local irritation, pain, dryness, erythema, erosion, or oedema.Tip - Test on a small area first and then, if tolerated, treat further sections of field damage.Tip - Side effects can be minimalised by reducing the frequency of application, taking short breaks in the course of treatment or, if needed, applying topical corticosteroid such as clobetasone butyrate.Tip – Application of urea-based emollients before applying 5-flurouracil can enhance the effect.Caution – Ulceration and slow healing are possible on lower legs. | 70%–78% |
5-flurouracil 0.5% cream with salicylic acid 10%
| Once daily for up to 12 weeks (maximum area of treatment is 25 cm2 at one time). | Grade 2 and 3 AK without field change.Moderately thick hyper-keratotic AK lesions. | Local inflammatory reaction.Caution - Patients with severe hand arthritis or limited hand dexterity will find it difficult to use the applicator to apply the treatment and peel off the film. | 55%–77% |
Imiquimod (5% cream) | Apply at night and washed off 8 hours later, three times a week for 4–6 weeks. | Non-hyper-keratotic and non-hypertrophic AK on face and scalp in immunocompetent patients.Second line treatment for AK resistant to 5-flurouracil. | Severe erythema, scabbing, crusting, erosions, ulceration, and flu-like symptoms (rare).Tip - Side effects can be minimalised by reducing the frequency of application, taking short breaks in the course of treatment, using lower strength 3.75% imiquimod cream, or applying a topical corticosteroid such as clobetasone butyrate. | 50%–84% |