Actikerall® to treat warts

Actikerall® is a clear solution to be applied to the affected area of skin – 1g of Actikerall® contains 5mg fluoroucil, which destroys some skin cells and 100mg salicylic acid, which makes skin shed more easily. Its full name is Actikerall® 5mg/g + 100mg/g cutaneous solution.

In adults, Actikerall® is used to treat a skin condition called actinic keratosis.

At Great Ormond Street Hospital (GOSH), we use Actikerall® to treat very stubborn warts – a common kind of skin growth – which have failed to respond to more conventional treatments. Actikerall® is ‘unlicensed’ for use in children. You can be assured that your doctor has only prescribed an ‘unlicensed’ medicine because he or she thinks that the medicine will benefit your child and no licensed alternative is available.

How is Actikerall® used?

Actikerall® is usually applied directly to the affected areas of skin, once a day for up to 12 weeks or so. Before applying to your child’s skin, you check that the liquid has not dried up or formed crystals. If the liquid looks different or you can see crystals, please do not use it and return it to your pharmacist for disposal.

  • Shake the bottle well.
  • Take the top off the bottle and remove excess liquid from the brush by wiping it on the neck of the bottle.
  • Apply the liquid to the wart and a very small area of surrounding skin.
  • Leave to dry to a white film without covering.
  • Put the top back on the bottle and tighten.

Before applying the next dose of liquid, you need to remove the previous day’s dose. The manufacturers advise simply peeling off the white film that forms, but you may need to use tweezers or a cocktail stick to gently lift off the edge so you can grasp it with your fingers. Warm water can also be used to remove the film but this is less effective at removing it all before the next dose.

Who should not use Actikerall®?

People with the following conditions should discuss using Actikerall® with their doctor:

  • Hypersensitivity to Actikerall® or any of its ingredients.
  • Pregnant, could be pregnant, planning to become pregnant or breastfeeding.
  • Existing kidney problems.

What are the side effects?

Side effects tend to occur where the liquid is applied and can include:

  • redness
  • inflammation
  • itching
  • bleeding
  • flaky skin
  • scab formation

If you are concerned about any of these side effects, please discuss with your doctor.

Actikerall® and interactions with other medicines

Some medicines can react with Actikerall®, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicine, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or any herbal or complementary medicines. The following medicines are known to react with Actikerall®:

  • anti-virals including brivudine
  • phenytoin – anti-epileptic 

Important information

  • Keep all medicines in a safe place where children cannot reach them, in a cool, dry place away from direct sunlight or heat.
  • Actikerall® is flammable, that is, it can catch fire if used near a naked flame. Never apply it to your child by candlelight, near an open fire or while smoking a cigarette. Once the lquid has been applied to your child’s skin, they should also avoid naked flames, such as candles or open fires.
  • Actikerall® can stain fabrics or acrylic surfaces, such as acrylic baths.
  • Actikerall® should only be used for three months after opening – write the date you opened the bottle on the label to remind you. 
  • If your doctor decides to stop treatment with Actikerall® or the medicine passes its expiry date, return any remaining medicine to the pharmacist. Do not flush it down the toilet or throw it away.
Compiled by: 
The Pharmacy and Dermatology departments in collaboration with the Child and Family Information Group
Last review date: 
December 2018
Ref: 2018F1531


Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.