DermHelpCentral

Nicotinamide

Nicotinamide, a form of vitamin B3, is an over-the-counter tablet that has the potential for preventing and resolving actinic keratosis (AK) and sun-induced aging that are caused by sun exposure.

Guidelines for Using Nicotinamide:The recommended dosage for preventing and treating AK is 500 mg twice daily. It is intended for long-term use given its preventive effects.

Sun Protection: Nicotinamide should be part of a comprehensive sun protection strategy that includes the use of a sunscreen, protective clothing, and avoiding excessive sun exposure.

Monitoring: Regular follow-ups with your healthcare provider are essential to monitor the effectiveness and any potential side effects of the supplementation.

Standard Dosage: 500 mg of oral nicotinamide twice daily  Be careful to avoid Niacin.  Niacin and niacinamide are not the same.  Niacin can cause unpleasant flushing and has not been studied for actinic keratoses.

Side Effects: Nicotinamide is generally well-tolerated, but some individuals may experience mild gastrointestinal discomfort or flushing.

 

Reference: Effect of Nicotinamide in Skin Cancer and Actinic Keratoses Chemoprophylaxis, and Adverse Effects Related to Nicotinamide: A Systematic Review and Meta-Analysis FULL TEXT

 

Fluorouracil / calcipotriol cream: "FU/Cal"

Fluorouracil / calcipotriol cream: "FU/Cal" is a useful addition to our therapeutic tool chest for Actinic Keratoses and early skin cancers. We found a useful fact sheet with clear instructions from The Spot Check Clinic in Melbourne, Australia.

See: Fluorouracil/Calcipotriol Cream

Topical Fluorouracil for Actinic Cheilitis

Topical (5-fluorouracil [5-FU]) as a 5% solution was used to treat isolated actinic keratoses of the lips as well as diffuse actinic damage of the lower lip. Although producing considerable temporary discomfort, final results proved excellent, with recurrences in only two of 12 patients treated. Preliminary biopsy of suspicious infiltrated areas is mandatory, as is careful follow-up to ensure complete healing. Topical fluorouracil is an alternative to surgical excision of the vermilion border of the lip in those patients with severe diffuse actinic damage of the lips.

Full article: Download Topical 5FU for Cheilitis

 

Use and Cost of Actinic Keratosis Treatment for Medicare 2007 - 2015

See article in JAMA Dermatology

CONCLUSIONS AND RELEVANCE This study’s findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.

Download Yeung JAMA AKs

Actinic Keratosis: Decision Aid

Actinic Keratoses (AKs) are rough spots that are common on sun-exposed skin of light-skinned individuals.  Most AKs are not worrisome and treatment is often optional. They are frequently treated by a number of modalities by many dermatologists.  This decision aid may help you in deciding if and how you want your AKs treated.  You can also view (and print)) this decision aid as a PDF. Download Actinic Keratoses Decision Aid DF

About Blu light: cost of procedure, not always covered by insurance

Cost of 5FU cream or imiquimod if insurance does not cover.  GoodRx can save you money

The Cochrane Report on Interventions for Actinic Keratoses is worth reading.  Despite the marketing hype, there is little difference between the modalities.  An informed patient can make the choice of which modality suits her or his needs and expectations best.

There is no evidence that treating most actinic keratosis will prevent the development of dangerous squamous cell carcinomas.  The decision to treat rests on how much the keratoses bother the patient or worries a concerned dermatologist.  Treatment can allay some patients’ anxiety.  Treatment should not be done to make one’s physician feel better or get richer.  It is clear that in many cases, actinic keratosis are grossly over-treated.

Liquid Nitrogen Treatment

Prepared by Rhianna Flanagan, Massachusetts College of Pharmacy

Liquid nitrogen (LN₂), sometimes called cryotherapy, a cold, liquefied gas with a temperature of 196° below Celsius (-321°F),  is used primarily to freeze and destroy superficial skin lesions such as warts and  keratoses.  It causes stinging and mild pain as the growth is being frozen and then thaws.  The discomfort usually lasts a few minutes when keratosis are being treated, but considerably longer when it is warts, since warts need to be frozen for longer than keratosis.

After LN₂ treatment your skin will become swollen and red; it may even blister. Then a scab (crust) will form. It will fall off by itself in 1 - 3 weeks. The skin growth will come off with the scab, leaving healthy new skin.

No special care is needed after the liquid nitrogen treatment. Just ignore it. You may wash as usual and use makeup and other cosmetics. If your clothing irritates the area, cover it with a small bandage..

Sometimes the cryotherapy treatment fails. If the growth is not cured by LN₂ , please make a return appointment.

See handouts on warts and actinic keratosis.

Actikerall for Actinic Keratoses

This is a new product for actinic (solar} keratoses that may be better tolerated than 5% % fluorouracil cream and more effective than Solareze (topical diclofenac).

It is indicated for "topical treatment of slightly palpable and/or moderately thick hyperkeratotic actinic keratosis (grade I/II) in immunocompetent patients.

Not available in the U.S. yet, but there are probably ways to obtain it.

Product Details from the Web:

Almirall Ltd

Drug Name:	ACTIKERALL
Legal Class:	POM
Drug Class:	Actinic keratoses treatments
How Supplied:	Fluorouracil 0.5%, salicylic acid 10%
Price:	Soln, 25ml=£38.30.
Indications:	Topical treatment of slightly palpable and/or moderately thick hyperkeratotic actinic keratosis (grade I/II) in immunocompetent patients.
Adults:	Apply to lesion once daily for up to 12 weeks. Leave to dry to a film, do not cover; peel off film before reapplying. Max area to be treated at any one time, 25cm2. Optimal effect, up to 8 weeks after treatment.
Children:	Not recommended.

General Warnings for Fluorouracil + salicylic acid
Contraindications:	Renal impairment. Pregnancy, lactation.
Precautions:	Avoid contact with eyes and mucous membranes. Sensory disturbances (eg, diabetes). Areas with thin epidermis; apply less frequently and monitor closely. May stain textiles or acrylics.
Interactions:	Phenytoin, methotrexate, sulfonylureas.
Side Effects:	Local reactions, skin exfoliation, headache.