Diclofenac gel for actinic keratoses

What is diclofenac? gel in hyaluronic acid?

Current 3% diclofenac gel in 2.5% hyaluronic acid (Solaraze®, Bioglan Pharma, Florida, USA) is used as a field treatment for actinic keratosis (AK) It is available in the US, Canada, and several European Union countries, but is not marketed in New Zealand (2015).

How does diclofenac gel work?

The active ingredient in the gel, diclofenac sodium, is a non-steroidal anti-steroid.inflammatory drug (NSAID) NSAID provide anti-inflammatory and anti-neoplastic (anti-Cancer) Benefits.

• How diclofenac gel works in the treatment of AK is not fully understood.
• Diclofenac is a powerful inhibitor of inducible cyclooxygenase (COX-2), resulting in reduced prostaglandin synthesis.
• Sun damage and AKs have been linked to elevated prostaglandins in exposed skin.

How is diclofenac gel given?

Treatment is usually done during the winter months. Diclofenac gel is for use on the skin only and contact with the eyes should be avoided.

• The gel should be stored at room temperature.
• Determine which areas should be treated with diclofenac gel. The amount of diclofenac gel needed depends on the size of the injury site.
• Typically 0.5 g of gel (one finger unit) is used at each 5 cm x 5 cm site of injury.
• No additional gel should be applied if an application is missed.
• The gel is applied twice a day for 60 to 90 days and then suspended.

After treatment

• Wash your hands after applying diclofenac gel.
• Avoid exposure to the sun, sunscreens, cosmetics, and other topical medications.

Keratoses may continue to improve for up to 30 days after stopping treatment. Any injury that does not respond to treatment should be reevaluated.

Precautions when using diclofenac gel for actinic keratoses

Diclofenac sodium gel should not be used or used with caution in patients with any of the following conditions:

• Known hypersensitivity to diclofenac, benzyl alcohol, polyethylene glycol monomethyl ether 350 and / or sodium hyaluronate.
• Sensitivity or allergy to aspirin
• Active peptic ulcer or a severe kidney or liver disorder.
• Open skin wound or infected skin.

Anaphylactoid Reactions may occur in patients without prior exposure to diclofenac.

Possible pharmacological interactions with diclofenac gel

• No specific interaction studies have been conducted between diclofenac sodium gel and other topical or oral agents.
• Some diclofenac enters the bloodstream after application to the skin.
• There is an increased risk of adverse effects if NSAIDs or aspirin are taken orally at the same time.

Than adverse events What can diclofenac gel cause?

In general, adverse events have been mild to moderate in severity. The most common reported adverse events (> 1%) are application site reactions, including itching, dry skin, redness, and contact dermatitis

Use in pregnancy

• The safety of diclofenac sodium gel has not been established during pregnancy.
• Diclofenac should not be used during pregnancy unless the benefits to the mother justify the potential risk to the fetus.
• Diclofenac should be avoided in late pregnancy because premature closure of the fetal ductus arteriosus may occur.

Use in a nursing mother

• Many drugs are excreted in human milk. It is not known whether diclofenac or its metabolites they are excreted in human milk.
• Nursing mothers should avoid using diclofenac gel.

Pediatric use

• The safety and efficacy of diclofenac gel have not been established in children.
• Actinic keratoses rarely affect children.