Photodamage

Drugs also used for actinic keratosis not listed here:

• Imiquimod: see section 13.7 Preparations for warts and callouses

Fluorouracil

• Cream 5% (£32.90 = 40g)

Indications

• Actinic keratosis - for treatment of field changes

Dose

• Apply thinly to the affected area once or twice daily; usual duration of initial therapy 3–4 weeks
• Maximum area of skin treated at one time should not exceed 500cm2 (approximately 23 x 23cm) (Efudix 5% cream SmPC). Local specialist advice is areas of treatment should not exceed 5cm x 5cm. Divide into sections for larger fields

Note

1. Patient should be advised not to smoke or go near naked flames - risk of severe burns. Fabric (clothing, bedding, dressings etc) that has been in contact with this product burns more easily and is a serious fire hazard. Washing clothing and bedding may reduce product build-up but not totally remove it.

Tirbanibulin

• Ointment 10mg/g (£59.00 = 5 x 250mg sachets)

Indications

• Actinic keratosis
  • Treatment of mild to moderate field changes of the face and scalp in adults

Dose

• Apply once daily for 5 days. A thin layer of ointment should be applied to cover the treatment field of up to 25cm² (5cm x 5cm)
  • Each sachet is for single use only and should be discarded after use

Notes

1. Tirbanibulin may offer an alternative option in those who suffer unacceptable side effects with fluorouracil 5% cream
2. Assess response approximately 8 weeks after treatment starts. Consider other treatment options if complete clearance is not demonstrated. The SmPC states there is no clinical data available for more than one treatment course, as such if recurrence occurs or new lesions develop in the treatment zone, alternative treatment options should be considered.
3. Refer to SmPC for advice on women of childbearing potential
4. The routine commissioning of tirbanibulin is accepted in Devon for the field treatment of mild to moderate (non-hyperkeratotic, non-hypertrophic) actinic keratosis of the face or scalp in adults (see Commissioning Policy for more details)

Actikerall

(Fluorouracil 5mg/g with salicylic acid 100mg/g)

• Cutaneous solution (£38.30 = 25ml)

Indications

• Actinic keratosis - for treatment of individual lesions

Dose

• Apply once daily for up to 12 weeks; maximum area of skin treated at one time, 25cm2 (e.g. 5cm x 5cm)

Note

1. Patient should be advised not to smoke or go near naked flames - risk of severe burns. Fabric (clothing, bedding, dressings etc) that has been in contact with this product burns more easily and is a serious fire hazard. Washing clothing and bedding may reduce product build-up but not totally remove it.

Methyl-5-aminolevulinate 160mg/g cream (Metvix) with Photodynamic Therapy (PDT)

Indications

• Actinic keratosis

Notes

1. For further information see Treatment of Actinic Keratoses