Diclofenac & Actinic Keratoses
I just read about using this to treat AKs, and possibly some types of superficial skin cancers, but I haven't seen any commentary here on the site apart from a single passing reference.
Has anyone used it?
I believe until recently it wasn't available over-the-counter in the US so maybe it's slipped under the radar there.
I saw that the 3% gel, Solaraze, has been withdrawn (sorry to hear that, Solaraze). But a 2% preparation is easily available as topical Voltaren, usually recommended for muscle and joint pain.
Having been using Fluorouracil (Efudex/Efudix) plus Calcipotriol (Davonex/Daivonex) in various combinations for the past 10 months to treat various body areas, I was wondering about the advantages of moving between different medications, whether one might catch something the other one(s) haven't.
This, in turn, has been the result of treating my arms and chest, and head and ears, and finding that areas that I'd treated very intensely - and painfully - subsequently reacted as if they hadn't been treated at all when I overlapped treatment areas (eg, top of arms/shoulders and upper chest, head/neck and ears). I was very disappointed atn how strongly some of these areas reacted given that they'd been treated only a few months earlier. Not the result I was hoping for.
I also understand that Diclofenac is used over a 2-3 month period and that it has a less severe reaction and is less effective overall but that it does work, at least to some degree.
I'd love to hear from other members about their experiences with this medication.
...Such a great question!
I did a quick search in the community for Diclofenac. It doesn't look like we have any specific articles about users' experience with it. Hopefully, someone will respond to your question and share their experience soon. I am also curious to know how it works for others.
Have you checked in with your doctor regarding the intense reaction you had with the subsequent treatments? When I have used Efudex, I usually wait at least a year in between treatments on the same area and haven't overlapped an area within a few months' time. I wonder if you are getting a strong reaction because the area hasn't fully healed from the previous treatment. I know that it takes my skin quite a few months to stop showing redness.
Please keep us posted on your progress! We are here for you!
April, SkinCancer.net, ModeratorHonestly, April, my doctor is a pretty good cutter and not bad overall, but like a lot of comments here, the patients often end up knowing more about fluorouracil, etc than their carers.
What I find quite disturbing is the lack of hard information about what is quite a serious, strong drug that has very different effects on different people at different times. You'd think that after 50-odd years of use there would be very thorough, non-clinical (ie, readable by a patient) documentation about the very thing you've mentioned here and elsewhere: subsequent treatment reaction variation.
I tend to agree with you; possibly what is happening is that, because the previously-treated skin is still healing, and therefore good cells are multiplying quite quickly, the drug is causing these cells to breakdown as well as any additional AKs or cancers. The fact that the skin is still red probably indicates residual inflammation (rather than a pigment effect) which means more blood is in the area feeding cell reproduction. (Hey, I sound like I know what I'm talking about, anyway, right?!)
Also, I've noticed that the fluorouracil reaction is often more pronounced in areas of increased blood flow, thinner skin and/or lower fat. Whether this is due to the drug dispersing more in fatty tissue, cells being slower to reproduce in low blood-flow areas, or what, I don't know.
By the way, I'm also beginning to doubt the 4-day Harvard study combo treatment (with calcipotriol); I think it can assist with kicking the reaction off but I've not seen the same kind of AK clearance rates with the combo after 4 days as with 3 weeks of fluorouracil-only. The study did seem to compare the use of each over only the four days, not one against the other over their recommended treatment periods. Anyway, as I've mentioned elsewhere, I do use the combo for about half of the treatment period but end up using fluorouracil only in the last week or so, partly because it's easier - and less painful - to smear on than the gluey combo in those final stages.Well, after 5+ weeks of applying the Diclofenac (as 2% Voltaren) to a small test area on my stomach, hardly anything has happened. Maybe a little bit of reddening but otherwise virtually zero reaction.
Having said that, I've read that the treatment period is 2-3 months (I'll continue for the full 3 months for the test) and that most of the beneficial reaction occurs after you stop, so I'll report back after the full trial....Gosh, 3 months sounds like such a long time, but it makes sense that you haven't had much of a reaction so far. Looking forward to hearing that you got some great results! Best of luck! April, SkinCancer.net, Moderator
up until a week ago, I was using Soloraze cream on my chest for 3 months for AK
However, at my review a week ago, my doctor told me he would have expected better results,,
I have now been using efudex for 1 week,,
I started of with 2 AKs ,, around 2 weeks of using Soloraze I had about 50 of them😩 it wasn’t getting any worse after that but wasn’t getting any better so I now have this new cream
So far, after only 1 week, a couple of the AKs have blistered & popped,, it’s not as itchy & looks better,,, but,, I believe it will be at its worst after a couple of weeks using efudex,, so I’m a bit scared 😳
Interesting. My understanding of Solaraze is that 1) the reaction isn't as severe/painful as Efudex and 2) a lot of the reaction occurs after treatment ceases. Personally, I'd be a bit hesitant to go straight into an Efudex treatment after Solaraze as I think you might end up with a pretty severe "double" reaction. (Just my own unprofessional opinion.)
My chest reaction using fluorouracil/calcipotriene was very severe (I think I posted a picture) and not fun at all. I hope yours isn't as bad but if it is, stick with it as one thing you know is that those AKs have to go and this regimen gets rid of around 80-90% of them. (The efficacy of Solaraze after 90 days is supposed to be around the same, btw.)
Solaraze is 3% diclofenac plus 2.5% hyaluronic acid. The latter is what differentiates it from straight diclofenac as used in things such as Voltaren, which is what I've been using for nearly 2 months in a test area with virtually zero reaction. (The hyaluronic acid keeps the diclofenac in the upper skin layers rather than penetrating deeper which is what you want for a muscular anti-inflammatory.) If I can find Solaraze here (Mexico) I'll switch over to that. The studies I've read indicate that, although the treatment period is much longer, because the reaction severity and pain are lower, it is a better tolerated treatment.
