title: Treatment of multiple actinic keratoses with topical diclofenac 3% gel in organ transplant recipients: a series of six cases.
abstract: BACKGROUND
  Non-melanoma skin cancer (NMSC) represents a significant cause of morbidity in organ transplant patients; the relative risk of squamous cell carcinoma and actinic keratosis (AK) is 100 and 250 times higher, respectively, compared with immunocompetent patients.
  
  
  OBJECTIVE
  The aim of this study was to investigate the effects of 3% diclofenac gel on the clearance rates of multiple AKs in organ transplant recipients (OTRs).
  
  
  METHODS
  An open-label study was conducted in six patients (three kidney, one liver and two heart transplant patients) with histories of multiple NMSCs and extensive actinic keratoses (AKs). Patients were treated with diclofenac 3% gel, twice daily for 16 weeks. Complete and partial clearance rates of AKs were assessed after 16 weeks and biopsies were performed 4 weeks post-therapy on clinically typical AKs identified prior to the start of treatment.
  
  
  RESULTS
  Three out of six patients showed complete clinical and histological clearance after 16 weeks of treatment with diclofenac 3% gel. Two further patients showed a marked (> or = 75% lesion reduction) improvement in their overall AK lesion count in the treatment area. One patient showed a 30% lesion reduction in the area treated. Local adverse events at the site of application were very mild and included mild erythema and marginal erosion. No systemic side effects were reported.
  
  
  CONCLUSIONS
  Results suggest that diclofenac 3% gel may be useful in the treatment and control of multiple AK lesions in OTRs. Further studies are needed to investigate the efficacy and safety of this therapy for the local treatment of AK in greater numbers of immunosuppressed patients.
authors.affiliation: Department of Dermatology, Charité, Skin Cancer Center Charité, University Hospital of Berlin, Berlin, Germany. claas.ulrich@charite.de
authors.forename: C
authors.initials: C
authors.lastname: Ulrich
authors.forename: M
authors.initials: M
authors.lastname: Hackethal
authors.forename: M
authors.initials: M
authors.lastname: Ulrich
authors.forename: A
authors.initials: A
authors.lastname: Howorka
authors.forename: T
authors.initials: T
authors.lastname: Forschner
authors.forename: W
authors.initials: W
authors.lastname: Sterry
authors.forename: E
authors.initials: E
authors.lastname: Stockfleth
mesh_terms: D000287:Administration, Topical; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage*; D005782:Gels; D006801:Humans; D016867:Immunocompromised Host; D007642:Keratosis / Q000188:drug therapy*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D014180:Transplantation; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005782:Gels; D004008:Diclofenac