Medication

Diclofenac Gel (Solaraze)

Diclofenac 3% gel is the gentlest prescription field treatment for actinic keratoses. It asks for two to three months of twice-daily use and causes far less reaction than 5-fluorouracil. It also generally clears less. It is not the same product as over-the-counter Voltaren arthritis gel.
At a Glance

Diclofenac sodium 3% gel, originally sold as Solaraze, is a topical anti-inflammatory used as a field treatment for actinic keratoses. It is applied twice a day for 60 to 90 days. The appeal is tolerability: most people get mild dryness and some redness rather than the raw, crusted weeks that 5-fluorouracil produces. The trade-off is that it works slowly and usually clears less thoroughly. The brand has largely disappeared from US pharmacy shelves, and generic 3% gel can be surprisingly hard to find or expensive.

Key Facts

AKASolaraze (brand, largely withdrawn in the US), diclofenac sodium gel 3%
Drug ClassTopical NSAID (nonsteroidal anti-inflammatory drug)
Rx or OTCPrescription. It is not the same thing as over-the-counter Voltaren Arthritis Gel, which is 1% diclofenac and is not a treatment for actinic keratosis.
Typical CourseTwice daily for 60 to 90 days
Time to WorkSlow. The full result may not show until about a month after you finish.
Evidence LevelModerate. It works, but less completely than 5-fluorouracil, and it needs months of consistency.
ImportantAvoid if you have had asthma, hives or a severe reaction to aspirin or another NSAID.

How It Works

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Diclofenac blocks cyclo-oxygenase, the enzyme that makes prostaglandins — the chemical messengers behind inflammation, pain and fever. It is the same mechanism as ibuprofen, just delivered to a patch of skin rather than swallowed.

Why that clears precancerous spots is not fully worked out. The leading explanation is that sun-damaged cells lean on the COX-2 pathway to keep growing and to avoid the normal self-destruct signal. Take that support away for long enough and the abnormal cells die off while healthy skin carries on. There is probably also an effect on the tiny blood vessels feeding the lesions.

The practical consequence of that mechanism is the thing you will notice most: nothing dramatic happens. There is no cell-killing burn phase. The gel quietly withdraws support from abnormal cells over weeks, which is why the course is long and why stopping at six weeks because "nothing is happening" wastes the effort.

What It Treats

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Moderate evidence
Clearance rates are lower than 5-FU or imiquimod, and the course is long. Its advantage is tolerability, which makes it an option for people who would not complete a more aggressive treatment.

Who It's For & Who It's Not

Who it's for

People with mild to moderate actinic keratoses who cannot afford visible downtime — a public-facing job, a wedding, no flexibility in the calendar.

People who tried 5-fluorouracil, found the reaction intolerable, and would rather trade thoroughness for comfort.

People with thin, fragile or easily irritated skin, where a strong field treatment is likely to be a problem.

Anyone who can genuinely commit to applying a gel twice a day for two to three months.

Who it's not for

Anyone who has had asthma, hives, swelling or a severe allergic reaction after aspirin or another NSAID.

Anyone with thick, tender, growing or bleeding lesions. That needs a biopsy and a stronger treatment.

People with heavy, widespread field damage who want the most complete clearance available. That is 5-fluorouracil or photodynamic therapy territory.

Anyone in the last trimester of pregnancy. NSAIDs are avoided from around 30 weeks. Discuss earlier pregnancy with your doctor.

People who know they will not keep up a twice-daily routine for three months. Half a course of diclofenac gel does very little.

How to Take It

How to take it
  • Apply a thin layer to the whole treated area twice a day — roughly a pea-sized amount for an area about the size of a playing card. Smooth it in gently; do not rub hard.
  • Cover the field, not just the individual spots. Like all field treatments, it is aimed at the damage you cannot see as much as the damage you can.
  • Wash your hands afterward unless you are treating your hands.
  • Keep it away from your eyes, lips and nostrils.
  • Do not cover with a dressing. Let it dry before clothing touches it — it can leave a slight residue.
How long
  • Sixty to ninety days is the course. Ninety days is what most dermatologists use for a stubborn field.
  • Do not judge it at week four. Do not judge it at week eight, either. The skin often continues to improve for about a month after the last application, so the honest verdict comes roughly four months after you start.
Making it survivable
  • The difficulty here is not discomfort, it is boredom. Three months of twice-daily gel is a long time. Tie it to teeth-brushing, keep the tube visible, and set a phone reminder for the first few weeks.
  • A plain moisturizer over the top is fine and helps with the dryness most people get.

What to Avoid

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A note on systemic risk: oral NSAIDs carry warnings about heart attack, stroke, stomach bleeding and kidney effects, and those warnings appear on the label of this gel too. Absorption from a topical gel is low, but it is not zero, and the class warnings apply — worth mentioning to your doctor if you have heart, kidney or ulcer history.

Sun and sunbeds
Diclofenac can make treated skin more sensitive to ultraviolet light, and sun is what caused the problem in the first place. Hat, shade and daily sunscreen.
Other NSAIDs, if you react to them
If aspirin or ibuprofen has ever caused you asthma, hives or swelling, do not use this.
Open wounds, infected skin or eczema-affected areas
Apply to intact skin only.
Occlusive dressings
Eyes and mucous membranes
Rinse thoroughly if it gets in your eye.
Late pregnancy
NSAIDs are avoided from about 30 weeks of pregnancy onward.
Stacking irritants
Retinoids, acids and scrubs on top of a three-month course of anything will eventually irritate the skin. Keep the routine simple.

Side Effects

Common and expected
  • Dryness and flaking in the treated area. The most common complaint by far.
  • Itching.
  • Mild redness, usually much milder than with 5-fluorouracil.
  • Rash or contact dermatitis at the application site. Sometimes this is a genuine allergy to the gel base.
  • Tingling or a mild burn on application.
  • Sensitivity to sun in the treated area.
Tell your doctor
  • A rash that spreads, blisters, or gets steadily worse rather than settling — that suggests allergic contact dermatitis rather than expected irritation.
  • Any spot in the field that stays thick, tender or crusted through the whole course. That needs looking at, not more gel.
  • Stomach pain, black stools, or unusual swelling in the legs. Unlikely from a topical gel, but worth reporting if you have heart, kidney or ulcer history.
Stop and get care
  • Wheezing, facial or throat swelling, or hives after applying it — a possible NSAID allergy.
  • Chest pain, sudden weakness on one side, slurred speech, or difficulty breathing. Very unlikely with a topical NSAID, but these are the class warnings and they are worth naming.

How Long Until It Works

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Slowly, and with a delay at the end.

Most people notice very little for the first month or two. The visible change — rough spots flattening, the sandpaper feel going — usually comes late in the course and keeps improving for around 30 days after the final application.

So the real assessment point is about four months from the day you started. Judging it earlier is the most common reason people abandon it convinced it did nothing.

Expect partial clearance. Some spots flatten completely, some improve, some do not budge. Leftovers are usually frozen off afterward.

What Happens When You Stop

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Improvement continues for roughly a month after your last application, then stalls where it lands.

There is no rebound and no withdrawal. Sun damage is cumulative, so new actinic keratoses will keep appearing over the years, and repeat treatment — the same gel or something stronger — is normal.

If you stop halfway through, you have probably not got much. Unlike 5-fluorouracil, where a partial course still does real work, diclofenac gel depends on the long exposure.

Who should not take it+

Do not use it if:

You have had asthma, hives, swelling or a severe reaction to aspirin or any NSAID

You are 30 weeks pregnant or beyond

You are allergic to diclofenac or to any component of the gel base

You have a thick, tender, growing or bleeding lesion that has not been diagnosed

FAQ+
Is this the same as Voltaren gel from the drugstore?No, and this confusion is common enough to be worth stating flatly. Over-the-counter Voltaren Arthritis Gel is 1% diclofenac, formulated for joint pain, and it is not a treatment for actinic keratosis. The product for sun damage is a 3% gel in a hyaluronan base, prescription only. Do not substitute one for the other.
Can I still get it?It has become harder. The Solaraze brand has largely gone from the US market and generic 3% gel supply has been inconsistent, so pharmacies sometimes cannot fill it or quote an unexpectedly high cash price. Ask before you commit to a three-month plan, and ask about a discount card. Your dermatologist may steer you to 5-fluorouracil or Klisyri partly for this reason.
Why does it take three months when Klisyri takes five days?Different mechanisms. Klisyri and 5-FU kill abnormal cells quickly and you get an inflammatory reaction as a result. Diclofenac slowly withdraws the biochemical support those cells rely on. Slow and gentle is the whole point — and also the whole limitation.
Does it work as well as 5-FU?Generally not. In practice, 5-fluorouracil clears more lesions more completely. Diclofenac gel is chosen when tolerability matters more than thoroughness. That is a reasonable choice, but it should be a knowing one.
Will my face go red and crusty?Very unlikely to the degree 5-FU causes. Most people get dryness, flaking and some mild redness. If you develop a spreading, blistering rash, that is more likely an allergy to the gel and needs stopping.
Can I use it on my arms and hands?Yes. It is used on any sun-damaged field. Arms, hands and legs respond more slowly than the face to every AK treatment, including this one.
Can I use it with sunscreen and moisturizer?Yes, and you should. Apply the gel first, let it settle, then moisturizer and sunscreen over the top.
What if some spots are left at the end?Normal. Leftover spots are usually treated individually with cryotherapy, and anything thick or tender gets a biopsy.
Is it safe for my heart?Absorption from the skin is low, but the NSAID class warnings about cardiovascular risk are still printed on the label. If you have heart disease, kidney disease or a history of ulcers, mention this gel to the doctor who manages those conditions.
Can I use it while pregnant?Not from about 30 weeks onward. Earlier in pregnancy it is a conversation with your doctor, and in most cases treating actinic keratoses can simply wait until after delivery.