Arsenical Keratosis Medication

Updated: Mar 17, 2023
  • Author: Chih-Shan Jason Chen, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Medication Summary

The goal of pharmacotherapy is to reduce morbidity and to prevent complications.


Retinoid-like Agents

Class Summary

These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration.

Isotretinoin (Amnesteem, Sotret, Claravis)

Isotretinoin is an oral agent that treats serious dermatologic conditions. It is a retinoic acid analog that is the synthetic 13-cis isomer of naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization. The dose and duration of treatment for arsenical keratosis have not been established.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy. It may be administered at 0.5-2 mg/kg/d PO (usually 1 mg/kg/day) for 15-20 weeks.

Acitretin (Soriatane)

Acitretin is a retinoic acid analog, like etretinate and isotretinoin. Etretinate is the main metabolite and has demonstrated clinical effects close to those seen with etretinate. The mechanism of action is unknown. It may be administered at 25 or 50 mg/day PO initially given as a single dose with the main meal, and then 25-50 mg/day orally after an initial response to treatment; terminate therapy when lesions have resolved sufficiently.


Antineoplastics , Antimetabolite

Class Summary

These agents inhibit cell growth and proliferation.

Fluorouracil topical (Efudex, Carac, Fluoroplex)

Topical fluorouracil is useful in treating arsenical keratoses and Bowen disease. It interferes with DNA synthesis by blocking the methylation of deoxyuridylic acid and inhibits thymidylate synthetase, which subsequently reduces cell proliferation. Apply twice daily sparingly to cover lesions; therapy may be required for 10-12 weeks.


Topical Skin Products

Class Summary

The agent imiquimod has been reported to show some efficacy. However, the mechanism of action of imiquimod cream in treating precancerous keratosis is unknown.

Imiquimod (Aldara, Zyclara)

Imiquimod induces secretion of interferon alpha and other cytokines; the mechanisms of action are unknown. Apply overnight for 3-5 nights per week; wash off in 6-10 hours.