Actikerall

What is Actikerall?

Actikerall is a solution that’s applied to the skin (cutaneous solution), which contains two active ingredients: fluorouracil and salicylic acid. Fluorouracil stops cell growth (this is called a ‘cytostatic effect’), while salicylic acid softens hard skin. We’ll explain what the grades mean a little further down, but it’s usually the go-to topical treatment for grade I or II actinic keratoses in adults with a healthy immune system.

Actinic keratoses, often called solar keratoses, are rough, scaly patches on the skin caused by excessive sun exposure. While they’re not life-threatening, they have the potential to progress into skin cancer. But early detection and treatment can minimise the risk.^[1]

One way to categorise actinic keratoses (AKs) is by using a grading system with three levels. Grade 1 is for AKs that are slightly raised (you can feel them better than you can see them), grade 2 describes moderately thick AKs that are easily felt and seen, and grade 3 is for very thick, rough or obvious AKs.^[2]

How does Actikerall work for actinic keratosis?

Actikerall has two active ingredients: fluorouracil and salicylic acid.

First, fluorouracil is a cytostatic agent with an antimetabolite effect. That means that it stops cells growing and metabolising in your body. It does this by mimicking thymine, and disrupting the production of DNA and RNA, which carry your genetic information, leading to cell growth inhibition.

Salicylic acid works by softening the thick, scaly patches on your skin. It does this by loosening and detaching corneocytes and breaking down the “filler” that’s holding them together (called intercellular cement). Corneocytes are tough, flattened skin cells that make up the outermost layer of the skin, known as the stratum corneum.

What doses of Actikerall are there for actinic keratosis?

Actikerall comes in one dose with 5mg of fluorouracil and 100mg of salicylic acid in every 1g (about 1.05 ml) of cutaneous solution. Unless your doctor advises you otherwise, you’ll usually apply Actikerall once a day until the actinic keratoses are gone or for a maximum of 12 weeks.

In areas where your skin is thinner, like around your eyes and temples, your clinician may recommend applying Actikerall less frequently. If you’re dealing with severe side effects, let your clinician know. They might advise you to cut back to using it three times a week, until things improve. Your clinician might also want to keep a closer eye on your treatment in this case.

How to use Actikerall for actinic keratosis

Always follow your clinician’s advice, but here are some general guidelines for applying Actikerall to your skin:

1. Gently peel off the white film left from the previous day’s application, unless this is your first time using the medication. You may find that using warm water for this helps.
2. To open the bottle, press down on the lid and turn.
3. Wipe off any extra solution from the brush by wiping it inside the bottle’s neck.
4. Apply the solution gently to your actinic keratoses once a day.
5. You can treat up to 10 actinic keratoses simultaneously, but don’t treat more than 25cm2 (5cm x 5cm) of your skin at one time.
6. Let the solution dry and form a film.
7. Don’t cover with a dressing.
8. Seal the bottle tightly to prevent it from drying out. If you notice Actikerall has dried out or contains crystals, stop using it.
9. Avoid applying to hairy skin, as it may cause the hair to stick together in the treated area, making it hard to remove the film. Consider shaving before you apply Actikerall on your skin.

Take care to avoid getting Actikerall in your eyes, mouth, nose, or genital areas, as it can cause irritation. It can also stain your clothes, fabric, and acrylic surfaces, so steer clear of them during application. And remember, Actikerall is flammable, so keep it away from open flames, lit cigarettes, or devices like hairdryers.

How long to leave Actikerall on my skin for?

Always follow your clinician’s advice for treatment application. But generally, you’ll apply Actikerall on your skin once a day, making sure the solution dries and forms a film on the affected skin area. So you should leave it on your skin until the next day’s application.

How long should I use Actikerall for?

Actikerall is used once daily on actinic keratoses until they’ve cleared, or for a maximum of 12 weeks (whichever is sooner). You might start seeing improvement as early as four weeks into the treatment, and it should continue to get better up to 12 weeks. Even after you’ve stopped using Actikerall, you may still see improvements for up to eight weeks. So, if you don’t notice any effect in the first four weeks, don’t worry; keep up with the treatment.

If you feel that Actikerall is either too strong or not strong enough, it’s a good idea to discuss this with your clinician. They can help make adjustments to your treatment as needed.