Actinic keratosis
Dermatology Pathways: Actinic keratosis BAD Patient Information: Actinic keratosis
Generally, no treatment indicated except for emollients and sunscreen.
Care should be taken when prescribing diclofenac gel. Only the 3% strength is licensed for use in actinic keratosis.
For fluorouracil 5% the total area of skin being treated at any one time should not exceed 500cm2.
Fluorouracil + Salicylic acid (Actikerall) can be useful for hyperkeratotic areas up to a maximum area of 25cm2.
Tirbanibulin (Klisyri) is licensed for the field treatment (up to 25cm2) of non-hyperkeratotic, non-hypertrophic actinic keratosis of the face or scalp.
Imiquimod – Note different preparations.
Prescribing Notes:
- Actinic keratosis (AK) are pre-malignant but transformation to squamous cell carcinoma is rare. Patients must be referred if diagnosis is uncertain or if lesions become thickened or tender.
- Fluorouracil 0.5% / salicylic acid 10% cutaneous solution (Actikerall) can be used in immunocompetent patients with slightly palpable and/or moderately thick hyperkeratotic actinic keratosis (grade I/II). It is an alternative to first line options of fluorouracil cream where the addition of salicylic acid 10% is deemed beneficial. For use in patients with <10 isolated lesions of actinic keratoses where cryotherapy is unsuitable.
- Imiquimod 3.75% cream (Zyclara) or Imiquimod 5% cream (Aldara) can be used on specialist advice based on the size or number of lesions which may limit the efficacy and/or acceptability or following unsuccessful treatment with cryotherapy, diclofenac 3% gel or fluorouracil cream. It should be used for nonhyperkeratotic, non-hypertrophic AK on the face or scalp.
History Notes
27/05/2026
Regional formulary chapter launched.
History Notes
27/05/2026
Regional formulary chapter launched.