Effects of diclofenac topical (actinic keratosis): A Synthesis of Findings from 29 Studies

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Original Abstract of the Article

Major Research Findings

Diclofenac is a topical medication used to treat actinic keratosis (AK), a common skin condition caused by sun exposure. Several studies have investigated the effectiveness of diclofenac in treating AK. 14 evaluated the combination of diclofenac and difluoromethylornithine (DFMO) for treating sun-damaged skin. While both treatments individually showed promise, this study found that the combination did not enhance the treatment effect, likely due to inflammation caused by both agents. 24 compared the effectiveness of diclofenac and imiquimod, finding both to be noninvasive, easy-to-apply, well-tolerated, and effective topical treatments for AK. 19 investigated the efficacy of diclofenac in treating AK, finding it to be effective, especially for grade 3 lesions, though further investigation is needed to determine if 12 weeks of treatment is sufficient. 15 reviewed the cumulative evidence on diclofenac's effectiveness and safety, finding it to be a safe and effective treatment for AK on both skin and mucosal lip. 5 explored the impact of a topical product containing piroxicam and sun filters on AK progression and field cancerization, concluding that the product significantly improved AK lesion count and RCM/dermoscopy scores. 11 described a novel approach for controlled and targeted delivery of a synthetic diclofenac prodrug using an electrospun polylactic acid (PLA) scaffold, showing promise for the treatment of AKs.

Benefits and Risks

Benefit Summary

Diclofenac has been shown to be an effective treatment for AK. 14 24 19 15 Studies indicate that diclofenac can reduce the number of AK lesions and achieve complete clearance in some patients. It is also noninvasive, easy to apply, and well-tolerated. 24

Risk Summary

The main risk associated with diclofenac treatment is local skin reactions. 14 19 Research suggests that diclofenac can cause symptoms such as redness, swelling, and itching. Diclofenac can also cause systemic side effects. 4

Comparison Across Studies

Commonalities

Multiple studies demonstrate that diclofenac is an effective topical treatment for AK. It is also shown to be noninvasive and easy to apply. 24 19 15

Differences

The effectiveness and side effects of diclofenac can vary across studies. 14 suggests that the combination of diclofenac and DFMO might not be more effective than individual treatments. In contrast, 24 indicates that both diclofenac and imiquimod are effective. 19 highlights the particular efficacy of diclofenac for grade 3 lesions. Diclofenac can cause side effects such as local skin reactions. 14 19

Consistency and Contradictions

While research indicates that diclofenac is effective in treating AK, its effectiveness can vary between studies. More research is needed to fully understand its efficacy. Diclofenac can cause side effects, such as local skin reactions. These side effects may not affect all patients, and their severity can vary. 14 19

Considerations for Practical Application

Always use diclofenac as directed by your doctor. Before starting diclofenac treatment, talk to your doctor about your medical history and any medications you are taking. If you experience any unusual symptoms while using diclofenac, consult your doctor immediately.

Limitations of Current Research

Many studies have been conducted with relatively small sample sizes, so the results may not be generalizable to all patients. Furthermore, many studies have focused on specific regions and ethnicities, and their findings may not apply to other populations.

Future Directions for Research

Larger, more diverse studies are needed to further investigate the effectiveness of diclofenac. Comparative studies comparing diclofenac with other AK treatments are also necessary.

Conclusion

Research indicates that diclofenac is an effective topical treatment for AK. However, it can cause side effects, such as local skin reactions. If you are considering using diclofenac, consult your doctor.

Literature analysis of 29 papers
Positive Content
27
Neutral Content
1
Negative Content
1
Article Type
7
1
1
6
28
1.

Plasma-diazepam in infants after rectal administration in solution and by suppository.

Author: KnudsenF U

Acute treatment
Diazepam solution
Febrile convulsions
Side effects unknown

Diazepam was given rectally as a solution (0.7 mg/kg) or a suppository (5 mg) to 20 infants with febrile convulsions. Diazepam in solution reached anticonvulsant plasma levels within 4 +/- 1 min, while suppository administration resulted in similar levels after 20-30 min. Rectal diazepam solution may be useful in the acute treatment of febrile convulsions, while the suppository form is less effective. The study suggests that rectal diazepam solution may be suitable for home use in case of recurrent febrile convulsions, but further research is needed to evaluate its anticonvulsant effects and side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

A single-blind, crossover comparison of the pharmacokinetics and cognitive effects of a new diazepam rectal gel with intravenous diazepam.

Author: CloydJ C, LalondeR L, BeniakT E, NovackG D

Easy administration
Rapid absorption
Well tolerated
Cognitive impairment

A new rectal diazepam gel (Diastat) is rapidly absorbed and well-tolerated, with mild cognitive effects that dissipate within four hours.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Treatment adherence with diclofenac 3% gel among patients with multiple actinic keratoses: an integrated low-intensity intervention program versus standard-of-care.

Author: PerinoFrancesca, FattoriAlice, PiccerilloAlfredo, BianchiLuca, FargnoliMaria C, FrascionePasquale, PellacaniGiovanni, CarboneAnna, CampioneElena, EspositoMaria, RossiMaria T, CasariAlice, Calzavara-PintonPiergiacomo, PerisKetty

Adherence

Diclofenac 3% gel is effective for treating actinic keratosis (AK), but nonadherence to prolonged treatment regimens is common. This study evaluated the efficacy of an integrated low-intensity intervention program versus standard-of-care for improving adherence to diclofenac gel 3% treatment in patients with multiple AK.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.

Language : English

4.

Systemic toxicity to betamethasone ointment.

Author: AliyevRahim, FinstererJosef

Systemic side effects

Topical betamethasone, a steroid medication used to treat actinic keratosis, can cause systemic side effects. One patient developed fatigue, vertigo, nausea, and other symptoms after starting topical betamethasone. All symptoms disappeared within 48 hours after stopping the medication.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

5.

Effects of topical piroxicam and sun filters in actinic keratosis evolution and field cancerization: a two-center, assessor-blinded, clinical, confocal microscopy and dermoscopy evaluation trial.

Author: AgozzinoMarina, RussoTeresa, FranceschiniChiara, MazzilliSara, GarofaloVirginia, CampioneElena, BianchiLuca, MilaniMassimo, ArgenzianoGiuseppe

AK Treatment

This two-center, assessor-blinded, prospective trial evaluated the effect of a topical product containing piroxicam and sun filters (ACTX) on actinic keratosis (AK) lesions. ACTX significantly reduced AK lesion number and improved RCM/dermoscopy severity scores.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Treatment of actinic keratosis through inhibition of cyclooxygenase-2: Potential mechanism of action of diclofenac sodium 3% in hyaluronic acid 2.5.

Author: ThomasGareth J, HerranzPedro, CruzSusana Balta, ParodiAurora

AK treatment
None mentioned

This study reviewed the role of COX-2/PGE2 pathway in tumorigenesis, particularly in cutaneous squamous cell carcinoma and actinic keratoses (AKs).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

PHOTODYNAMIC TREATMENT WITH NANOEMULSIFIED 5-AMINOLEVULINIC ACID AND NARROW BAND RED LIGHT FOR FIELD CANCERIZATION DUE TO OCCUPATIONAL EXPOSURE TO ULTRAVIOLET LIGHT IRRADIATION.

Author: WollinaU, GaberB, KochA

AK treatment
Erythema

This prospective study evaluated the efficacy and safety of photodynamic therapy (PDT) for treating field cancerization caused by occupational ultraviolet light exposure. PDT using nanoemulsified 5-aminolevulinic acid and narrow-band red light irradiation achieved high clearance rates with minimal side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Cost-effectiveness of Ingenol Mebutate Gel for the Treatment of Actinic Keratosis in Greece.

Author: AthanasakisKostas, BoubouchairopoulouNadia, TarantilisFilippos, TsiantouVasiliki, KontodimasStathis, KyriopoulosJohn

Cost-effective treatment

Ingenol mebutate (IM) was cost-effective for treating actinic keratosis (AK) compared to diclofenac and imiquimod.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Electrospun poly-l-lactide scaffold for the controlled and targeted delivery of a synthetically obtained Diclofenac prodrug to treat actinic keratosis.

Author: PiccirilloGermano, BochicchioBrigida, PepeAntonietta, Schenke-LaylandKatja, HindererSvenja

Targeted AK treatment

This study develops and characterizes an electrospun polylactic acid (PLA) scaffold loaded with a synthetic diclofenac (DCF) prodrug for the treatment of Actinic Keratosis (AKs). The prodrug was successfully synthesized by binding DCF to a glycine residue via solid phase peptide synthesis (SPPS) and incorporated into an electrospun PLA scaffold. The drug encapsulation was verified using multiphoton microscopy (MPM) and its scaffold release was spectrophotometrically monitored and confirmed with MPM. The scaffold was further characterized with scanning electron microscopy (SEM), tensile testing, and contact angle measurements. Its biocompatibility was verified by performing a cell proliferation assay and compared to PLA scaffolds containing the same amount of DCF sodium salt (DCFONa). The effect of the electrospun scaffolds on human dermal fibroblasts (HDFs) morphology and metabolism was investigated by combining MPM with fluorescence lifetime imaging microscopy (FLIM). The obtained results suggest that the obtained scaffold could be suitable for the controlled and targeted delivery of the synthesized prodrug for the treatment of AKs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

14.

Phase IIB Randomized Study of Topical Difluoromethylornithine and Topical Diclofenac on Sun-Damaged Skin of the Forearm.

Author: JeterJoanne M, Curiel-LewandrowskiClara, StrattonSteven P, MyrdalPaul B, WarnekeJames A, EinspahrJanine G, BartelsHubert G, YozwiakMichael, BermudezYira, HuChengcheng, BartelsPeter, AlbertsDavid S

Chemopreventive efficacy
Cutaneous inflammation
Local cutaneous effects

A randomized study investigating the combination of topical DFMO and diclofenac for treating sun-damaged skin showed that the combination did not enhance the activity of diclofenac. Both agents caused inflammation, which might have masked any potential benefits.

Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

16.

Clinical Response to Ingenol Mebutate in Patients With Actinic Keratoses.

Author: BatallaA, FlórezÁ, FealC, PeónG, AbaldeM T, Salgado-BoqueteL, de la TorreC

Actinic keratosis treatment
Local reactions

Ingenol mebutate is an effective treatment for actinic keratosis with a similar rate of local reactions to other treatments. Its short treatment regimen leads to better adherence.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

18.

Comparative study of actinic keratosis treatment with 3% diclofenac sodium and 5% 5-fluorouracil.

Author: SegattoMajoriê Mergen, DornellesSérgio Ivan Torres, SilveiraVera Bauer, FrantzGabriela de Oliveira

Effective treatment
High patient satisfaction
Crusts
Edema
Erythema
Itching
Lower tolerability

A randomized controlled trial of 28 patients with actinic keratosis found that 5-Fluorouracil was more effective than diclofenac sodium in reducing the number of lesions. However, 5-Fluorouracil was associated with lower tolerability, with more erythema, edema, crusts, and itching.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

20.

Interventions for actinic keratoses.

Author: GuptaAditya K, PaquetMaryse, VillanuevaElmer, BrintnellWilliam

Cosmetic improvement
Skin cancer prevention
Symptom relief

Actinic keratoses are precancerous lesions caused by sun exposure. This review discusses the various treatment options for actinic keratoses, including individual lesion-based and field-directed therapies, and their relative efficacy, safety, and cosmetic outcomes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

21.

Diclofenac sodium 3% gel for the management of actinic keratosis: 10+ years of cumulative evidence of efficacy and safety.

Author: MartinGeorge M, StockflethEggert

AK treatment

Diclofenac sodium 3% gel (Solaraze®) has been used to treat actinic keratosis (AK) for more than 10 years.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

22.

Recurrence rates and patient assessed outcomes of 0.5% 5-fluorouracil in combination with salicylic acid treating actinic keratoses.

Author: StockflethEggert, ZwingersThomas, WillersChristoph

Reduced AK recurrence
Local side effects

Topical 0.5% 5-FU/SA demonstrated superior sustained clinical efficacy versus diclofenac/HA with acceptable tolerability. Patient satisfaction was high.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

23.

Modes of action of diclofenac 3%/hyaluronic acid 2.5% in the treatment of actinic keratosis.

Author: MaltuschAdrienne, Röwert-HuberJoachim, MatthiesCarmen, Lange-AsschenfeldtSusanne, StockflethEggert

Actinic keratosis treatment

This study evaluates the potential molecular and cellular main modes of action of topically applied diclofenac in the treatment of actinic keratoses (AKs).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

24.

Comparison of topical 3% diclofenac sodium gel and 5% imiquimod cream for the treatment of actinic keratoses.

Author: AkarsuS, AktanS, AtahanA, KoçP, ÖzkanS

Treatment of AK

Topical diclofenac sodium plus hyaluranon (DFS) and 5% imiquimod (IMQ) each had considerable efficacy in the treatment of actinic keratosis (AK). However, the efficacy of DFS seemed to decrease after cessation of treatment.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

25.

Imiquimod 3.75% cream (Zyclara) for the treatment of actinic keratoses.

Author: QuistSven R, GollnickHarald P

Actinic keratosis treatment

Actinic keratosis is a premalignant disease with a high incidence that strongly predicts the development of squamous cell carcinoma. Several treatment options exist, including topical treatments, cryotherapy, and surgical procedures.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

27.

Results of a randomized, placebo-controlled safety and efficacy study of topical diclofenac 3% gel in organ transplant patients with multiple actinic keratoses.

Author: UlrichClaas, JohannsenAntje, Röwert-HuberJoachim, UlrichMartina, SterryWolfram, StockflethEggert

AK clearance
SCC prevention
Erythema
Swelling

This study evaluated the efficacy and safety of diclofenac gel for treating actinic keratosis (AK) in organ transplant recipients (OTRs). Diclofenac gel resulted in a 41% complete clearance rate of AK lesions compared to 0% in the vehicle group. While 55% of patients experienced recurrent AK, no patient developed invasive squamous cell carcinoma (SCC) within 24 months of follow-up.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

29.

Enhanced death ligand-induced apoptosis in cutaneous SCC cells by treatment with diclofenac/hyaluronic acid correlates with downregulation of c-FLIP.

Author: FeckerLothar F, StockflethEggert, BraunFrank K, RodustPaul M, SchwarzConstanze, KöhlerAnja, LeverkusMartin, EberleJürgen

Apoptosis induction
Sensitization of neoplastic keratinocytes

Diclofenac/hyaluronic acid (HA) is a topical treatment for actinic keratosis. This study found that diclofenac/HA enhances death ligand-mediated apoptosis in certain squamous cell carcinoma (SCC) cell lines. This suggests that diclofenac/HA may be effective in treating AK by sensitizing neoplastic keratinocytes to apoptosis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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