Review Article

American Journal of Clinical Dermatology

, Volume 14, Issue 4, pp 273-277

First online:

Pharmacotherapeutic Management of Actinic Keratosis: Focus on Newer Topical Agents

  • Aman SamraoAffiliated withDivision of Dermatology, University of California-Habor Medical Center
  • , Clay J. CockerellAffiliated withDepartment of Dermatology, University of Texas, SouthwesternDepartment of Pathology, University of Texas, SouthwesternDermpath Diagnostics Email author 

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access


Actinic (solar) keratoses (AK) have the potential for malignant transformation and are the second most common diagnosis in dermatologic practices. No well-established clinical criteria are available to determine which AK are more likely to undergo malignant transformation; therefore, many dermatologists utilize field-directed approaches to treat all visible and subclinical AK on an affected skin surface. Current topical therapeutic agents require lengthy treatment regimens and are less well tolerated than many newer and investigational agents. We review and compare the efficacy and tolerability of well-established topical agents for the management of AK in the United States including 5-fluorouracil, imiquimod 5 % cream as well as the newer 2.5 and 3.75 % formulations, diclofenac 3 % gel, photodynamic therapy, and the recently approved ingenol mebutate gel and discuss the therapeutic potential of investigational agents. Cryotherapy and 5-fluorouracil are efficacious at treating AK but less tolerable than imiquimod cream, particularly at its lower concentrations. The newer agents, diclofenac gel and ingenol mebutate, appear to be more tolerable than cryotherapy and 5- fluorouracil; however, comparative studies regarding efficacy are not available.