Actinic Keratosis Treatment Options Table

Skin gels (topical treatments)

How it works

ALDARA®

(imiquimod 5% cream)

Stimulates your body's immune system to fight off AK.

EFUDEX®

(fluorouracil 5% cream)

Stops the growth and destroys skin cells affected by AK.

PICATO®

(ingenol mebutate 0.015% and 0.05% gel)

Thought to be toxic to cells and promote a local inflammatory response.

ZYCLARA®

(imiquimod 2.5% and 3.75% cream)

Stimulates your body's immune system to fight off AK.

Dosing

ALDARA®

(imiquimod 5% cream)

Apply twice a week in a thin layer just before bedtime.

Treatment duration:

  • 16 weeks

EFUDEX®

(fluorouracil 5% cream)

Apply twice daily in a thin layer.

Treatment duration:

  • 2 to 4 weeks

The dose will vary for different patients.

PICATO®

(ingenol mebutate 0.015% and 0.05% gel)

Apply once daily to treatment area.

Treatment duration:

  • 2 days (body, arms, hands or legs)
  • 3 days (face or scalp)

ZYCLARA®

(imiquimod 2.5% and 3.75% cream)

Apply once daily in a thin layer just before bedtime.

Treatment duration:

  • 6 weeks total (two 2-week treatment cycles separated by 2 weeks with no treatment)

Side effects and safety information**

ALDARA®

(imiquimod 5% cream)

Common:
  • Skin redness; wearing away of the skin; flaking; dryness; itching; burning; crusting or scabbing (may get better over time or will stop once treatment is done).
Other:
  • Skin lightening or darkening (may be permanent).
Other safety info:
  • Check with your doctor if you are pregnant, are breast-feeding, have other AK treatments, have a weak immune system, or have other medical conditions.
  • If cream gets in eyes, rinse with plenty of water right away.

Contact your doctor if you have a severe skin reaction or flu-like symptoms.

EFUDEX®

(fluorouracil 5% cream)

More common:
  • Burning sensation where medication applied; increased skin sensitivity to sunlight; oozing; skin rash; skin soreness and tenderness.
Less common or rare:
  • Skin darkening; scaling; watery eyes.
  • Skin redness, soreness, scaling, and peeling can begin within 1 to 2 weeks of starting treatment, and may last for several weeks after treatment is stopped.
Other safety info:
  • Check with your doctor immediately if you have redness and swelling of normal skin, or a severe reaction from the sun.

Check with your doctor if you are pregnant, are breast-feeding, or have other skin problems.

PICATO®

(ingenol mebutate 0.015% and 0.05% gel)

Most common:

Skin redness, flaking, scabbing and crusting; swelling; blister or ulcer; hard or thickened skin; peeling skin.

  • Can start within 1 day of treatment and may get worse for up to 1 week after you have stopped using it.
  • Usually gets better within 2 weeks (for face and scalp) to 4 weeks (for body, arms, hands and legs) from when you started treatment.
Common:
  • Pain; itching; skin irritation or infection at the treatment area; swelling around the eyes; headache.
Other safety info:
  • Not studied in children.
  • Check with your doctor if you are pregnant, are breast-feeding, or have had other AK treatments.
  • Talk to your doctor if skin reactions do not improve.
  • If gel is accidentally swallowed, drink plenty of water and seek medical care immediately.
  • Make sure that the skin has healed from the other treatments or surgery before applying Picato® gel.

ZYCLARA®

(imiquimod 2.5% and 3.75% cream)

Very common:
  • Redness, scabbing or crusting; flaking or dry skin; swelling; small open sores; drainage; itching; irritation; pain.
Common:
  • Headache; tiredness; nausea; fever; loss of appetite; dizziness; activation of herpes; pain; diarrhea; swollen lymph nodes; joint aches; skin irritation; difficulty sleeping.
Other safety info:
  • May cause flu-like symptoms.
  • Not studied in children.
  • Check with your doctor if you are pregnant, are breast-feeding, have other AK treatments, have other skin growths, or have a weak immune system.
  • If cream gets in mouth, eyes, or nose, rinse well with water right away.
  • Contact your doctor if you have flu-like symptoms or serious diarrhea.
  • If your skin breaks down, if you get skin sores in the first week of treatment, or if you get any skin reactions that affect your daily activities or do not go away, stop using the medication right away and call your doctor.

Tips

ALDARA®

(imiquimod 5% cream)

  • Always use ALDARA® as prescribed by your physician.
  • Wash treatment area and hands with soap and water before applying.
  • Leave cream on for 8 hours and do not get it wet. After 8 hours, wash treated area with soap and water.
  • Do not rub cream in eyes, lips, or nostrils.
  • Avoid sun exposure (wear sunscreen and protective clothing) during treatment.
  • Store away from heat and moisture; do not freeze; keep away from children and pets.

EFUDEX®

(fluorouracil 5% cream)

  • Always use EFUDEX® as prescribed by your physician.
  • Wash and dry the affected area before applying.
  • Apply with a glove or a cotton-tipped applicator.
  • Do not get in the eyes, nose, or mouth.
  • Avoid sun exposure (wear sunscreen and protective clothing) during treatment and for 1 to 2 months afterward.
  • Store away from heat, moisture, and direct light; keep away from children and pets.

PICATO®

(ingenol mebutate 0.015% and 0.05% gel)

  • Always use PICATO® as prescribed by your physician.
  • Use a new tube for each application.
  • Gently rub the gel on affected skin, and let it dry for 15 minutes.
  • Wash your hands after applying.
  • Do not touch or wash the area for 6 hours.
  • Do not cover with a dressing or bandage.
  • Do not apply right after showering or less than 2 hours before bedtime.
  • Do not apply near the eyes, on the inside of nostrils, ears or on the lips.
  • Store in refrigerator (2°C to 8°C); keep away from children and pets.

ZYCLARA®

(imiquimod 2.5% and 3.75% cream)

  • Always use ZYCLARA® as prescribed by your physician.
  • Wash treatment area and hands with mild soap and water before applying. Allow the area to dry.
  • Do not apply in or around eyes, lips, and nostrils.
  • Do not apply to areas larger than either the face or the balding scalp.
  • Wash your hands with mild soap and water after applying.
  • Leave cream on for 8 hours and do not get it wet. Do not cover the treated areas.
  • After 8 hours, wash treated area with mild soap and water.
  • Avoid sun exposure (wear sunscreen and protective clothing) during treatment.
  • Store at room temperature (15°C to 25°C) do not freeze; keep away from children and pets.

**This is not a complete list of all side effects and safety information. For more information, speak to your doctor.

This table lists topical (skin) medications for AK. Other treatments, such as doctor's office procedures, can be used to treat AK. To find a treatment that's appropriate for you, speak to your doctor.

Treatment procedures

How it works

Chemical peels

Chemical peels use trichloroacetic acid or similar chemicals to remove the top layer of actinic skin. The top skin layers slough off and are usually replaced within 1 week.

Cryotherapy

Liquid nitrogen is a substance that is extremely cold. It is used by your doctor to freeze and destroy the actinic keratosis cells locally.

Curettage

Curettage involves using a surgical tool (curette) to scrape off the actinic lesion.

Dermabrasion

Dermabrasion uses a physical medical instrument to abrade the area to remove the top layer of skin.

Electrosurgery

Electrosurgery uses electric current instead of a blade to cut and cauterize the actinic lesion.

Laser therapy

Laser therapy uses a laser to resurface the top layer of skin.

Photodynamic Therapy

A topical cream/gel is first applied to the skin. These molecules make the skin more sensitive to certain wavelengths of light. After the cream/gel has been applied and absorbed, light or laser is shined upon the area to destroy the top layer of skin.

Shave excision

Shave excision similarly uses a surgical blade to cut out the actinic lesion.

Frequency of treatment

Chemical peels

  • Number of treatments may vary depending on condition. More than 1 treatment may be needed. Frequency and number of treatments required will be personalized by your physician given your individual situation.

Cryotherapy

  • Performed at a doctor's office in a single appointment.
  • Number of treatments may vary depending on condition. More than 1 treatment may be necessary. Frequency and number of treatments required will be personalized by your physician given your individual situation.

Curettage

  • Performed at a doctor's office in a single appointment.
  • Number of treatments may vary depending on condition. More than 1 treatment may be necessary. Frequency and number of treatments required will be personalized by your physician given your individual situation

Dermabrasion

  • Performed at a doctor's office in a single appointment.
  • Number of treatments may vary depending on condition. It may be warranted to employ 2 to 3 cycles. Frequency and number of treatments required will be personalized by your physician given your individual situation.

Electrosurgery

  • Performed at a doctor's office in a single appointment.
  • Number of treatments may vary depending on condition. It may be warranted to employ 2 to 3 cycles of therapy. Frequency and number of treatments required will be personalized by your physician given your individual situation.

Laser therapy

  • Performed at a doctor's office in a single appointment.
  • Number of treatments may vary depending on condition. More than 1 treatment may be needed. Frequency and number of treatments required will be personalized by your physician given your individual situation.

Photodynamic Therapy

  • Number of treatments may vary depending on condition. Frequency and number of treatments required will be personalized by your physician given your individual situation.
  • The treatment lasts over a 2-day period

Shave excision

  • Number of treatments may vary depending on condition. More than 1 treatment may be needed. Frequency and number of treatments required will be personalized by your physician given your individual situation.

Side effects and safety information**

Chemical peels

  • Skin irritation
  • Scarring
  • Changes in skin colour of treatment area
  • Acne
  • Infection

Cryotherapy

  • Pain during procedure
  • Permanent change in skin colour of treatment area
  • Blisters
  • Scarring
  • Skin texture changes
  • Infection

Curettage

  • Infection
  • Scarring
  • Anaesthetic related side-effects
  • Permanent change in skin colour of treatment area

Dermabrasion

  • Redness and swelling
  • Bleeding
  • Acne
  • Enlarged pores
  • Changes in skin colour of treatment area
  • Infection
  • Scarring

Electrosurgery

  • Infection
  • Scarring
  • Anaesthetic related side-effects
  • Permanent change in skin colour of treatment area

Laser therapy

  • Redness and swelling
  • Bleeding
  • Acne
  • Enlarged pores
  • Changes in skin colour of treatment area
  • Infection
  • Scarring

Photodynamic Therapy

  • Skin irritation
  • Skin redness
  • Swelling
  • Burning sensation of treatment area
  • Pain
  • Crusting following treatment
  • Ulceration
  • Scaling
  • Permanent change in skin colour of treatment area

Shave excision

  • Infection
  • Scarring
  • Anaesthetic related side-effects
  • Permanent change in skin colour of treatment area

**This table lists doctor's office procedures that can be used to treat AK. To find a treatment that's appropriate for you, speak to your doctor.

This table lists doctor's office procedures that can be used to treat AK. To find a treatment that's appropriate for you, speak to your doctor.

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