Management cont.
For larger areas of field change consider the following treatments;
Solaraze ® gel (3% diclofenac in sodium hyaluronate)
- Use twice a day for 12 weeks. Review patient four weeks after treatment has finished to assess response
- Advantages are generally well-tolerated and so can be used on any sized area
- Disadvantages are most dermatologists view Solaraze as a milder treatment, which may not be as effective as some of the other treatments and so is best used where the AK are thin. Once treatment is complete any remaining AK can then be managed with the treatments referred to in step three above
Zyclara ® cream (3.75% imiquimod cream)
- Apply once daily for two weeks, followed by a two week treatment-free period, and then a further once daily application for two weeks (ie six weeks in total, but only four weeks of treatment)
- There tend to be less adverse effects compared with using Aldara ® cream (5% imiquimod)
- The side-effects of imiquimod are similar to those of 5-FU, including severe erythema, scabbing and crusting and erosions or ulceration. Flu-like symptoms can also arise and are more likely if multiple sachets are used at each treatment or if it is being used for superficial BCC with more frequent applications than is typically the case for AK. An instance of post-treatment eruptive keratoacanthomas has been reported. Side effects are very individual, with no way of predicting which patients will manifest what. The clinical response is largely in proportion to the side-effects, and those terminating treatment early due to extreme soreness may still get a good response. Side-effects are generally well tolerated, but it is important to counsel the patient carefully in order to anticipate those who have more extreme clinical reactions.
Erosive pustular dermatosis of the scalp
- Is an uncommon condition affecting UV-damaged areas of the scalp in older patients. The risk appears to be increased with the subsequent treatment of actinic keratoses, especially with cryotherapy
- Clinically there is varying degrees of scarring associated with yellow-brown crusts, pustules, lakes of pus, erosions and ulceration
- The primary treatment is super-potent topical steroids (16)
Side effects of topical treatments and management of these;
Patients should be provided with advice on how to manage side-effects, with strategies including a break in treatment, altering the frequency of application, use of emollient and in some instances application of topical steroid.