13.5.2 Photodamage

The 2007 British Association of Dermatologists guidelines suggest that ‘no therapy’ or ‘emollient only’ are reasonable options for mild actinic keratoses. Where treatment is warranted, the table below specifies the formulary treatment options.

MHRA safety update: Ingenol mebutate gel (Picato▼): suspension of the licence due to risk of skin malignancy

Actinic keratosis Grade 1	Actinic keratosis Grade 2	Actinic keratosis thick, hyperkeratotic lesions Grade 3	Small superficial basal cell carcinomas
Diclofenac 3% gel (Solaraze®)	Fluorouracil 5% cream (Efudix®)	Liquid Nitrogen/ curettage	Imiquimod 5% cream (Aldara®)
	Moderately thick hyperkeratotic actinic keratosis Fluorouracil 0.5%/ salicylic acid 10% solution (Actikerall®)
	For face, scalp, genital areas Imiquimod 5% cream (Aldara®)

Diclofenac

Excipients include benzyl alcohol

Solaraze 3% gel

Pack
50 gram

Fluorouracil + Salicylic acid

Actikerall 5mg/g / 100mg/g cutaneous solution

Pack
25 ml

Fluorouracil

Excipients include hydroxybenzoates (parabens)

Efudix 5% cream

Pack
40 gram

Imiquimod

Excipients include benzyl alcohol, cetyl alcohol, stearyl alcohol, hydroxybenzoates (parabens), polysorbate 60

Aldara 5% cream 250mg sachets

Pack
12 sachet

Ameluz

For use in licensed indications only - Click on EMC link to see Summary of Product Characteristics

Ameluz 78mg/g gel

Pack
2 gram

First Line Drugs
Second Line Drugs
Specialist Initiated Drugs
Specialist Only Drugs
Mixed Status