Actinic keratoses, also called “AKs”, are dry, scaly patches that form on the skin after years of sun exposure. Actinic keratoses lesions can take a variety of appearances, but they are usually scaly (feel like sandpaper) and range in color from skin-toned to reddish-brown. The lesions may be as small as the head of a pin or as large as a quarter (or bigger, if left untreated).
Actinic keratoses develop on areas of the body that receive the most sun exposure, including the scalp, ears, face, lip, neck, forearms, and back of the hands.
A single actinic keratosis may appear at first, but most people with one actinic keratosis will develop others. Actinic keratoses can appear in groups and may occasionally itch or become tender, especially after sun exposure.
Actinic keratoses are most common in individuals with fair skin and long-term sun exposure. They take years to develop and usually appear after age 40. However, even younger people (including those with dark skin) can develop actinic keratoses if they live in very sunny climates.
Actinic Keratoses are Precancerous
Actinic keratoses are considered precancerous and have the potential to become a type of skin cancer called squamous cell carcinoma (SCC). Therefore, your dermatologist will be diligent in diagnosing, treating, and monitoring actinic keratoses. Also, since actinic keratoses result from chronic sun exposure, you are at risk for other types of skin cancer.
Fortunately, actinic keratoses are treatable when detected in the early stages. People at risk for actinic keratoses and skin cancer can reduce that risk by performing frequent self-exams and seeing their doctor for regular screenings.
Actinic Keratoses Treatment
Many options are available for the treatment of actinic keratoses. Your doctor will consider these factors when recommending the best treatment:
- The number, size, and location of actinic keratoses lesion(s)
- Results of past treatments, if treated before
- Your age and medical history, such immune system function
- Your personal preferences
Before choosing a treatment, your doctor may recommend that your lesion be biopsied, to make sure the growth isn’t cancerous. This is done by removing all or part of the actinic keratoses and examining the tissue under a microscope.
Your doctor may treat your actinic keratoses at different times using a combination of treatments.
Actinic Keratoses: Procedures
There are several dermatologic procedures that provide effective treatment of actinic keratoses. The type of procedure recommended will depend upon the location of the lesion and other variables. These procedures may be combined with other procedures or medications, such as Aldara, or 5-FU.
- Cryosurgery uses liquid nitrogen to freeze off the lesions. It is fast, has a high cure rate, and is well-tolerated by most people. There may be a very brief period of stinging when the liquid nitrogen is first applied, but anesthesia is not required.
- Shave removal is a procedure during which a scalpel is used to remove the lesion and obtain a specimen for testing.
- Curettage is often used to remove hard, thickened actinic keratoses. In this procedure, a small, round, sharp instrument (called a curette) is used to scrape the actinic keratosis, either removing a piece of it for biopsy or removing the entire lesion.
- Lasers deliver an intense light focused on the lesion, removing it along with the top layer of skin. The finely controlled nature of laser removal makes this a useful option for actinic keratoses on delicate skin, such as the lips (actinic chelitis), or in narrow, hard-to-reach places (such as behind the ears).
Actinic Keratoses: Medications
There are several safe and effective medications for the treatment of actinic keratoses. These medications may be combined with medications or procedures, such as Cryosurgery or Curettage.
- 5-fluorouracil, or 5-FU (Carac® and Efudex®)
- Solaraze (diclofenac)
- Zyclara (imiquimod), 3.75%
The active ingredient in Carac® and Efudex® is called fluorouracil (floor-oh-your-a-sill). For more than 40 years, fluorouracil has been used to safely and effectively treat actinic keratoses. Fluorouracil is believed to interfere with a cell’s ability to reproduce. Actinic keratoses lesions multiply at a faster rate than normal cells. As a result, the unhealthy cells absorb the fluorouracil faster than healthy, normal cells.
Solaraze® is a nonsteroidal anti-inflammatory therapy that is FDA approved for the topical treatment of actinic keratoses lesions. It is the first in a new class of therapy for actinic keratoses and can be used on all affected areas of the body. Solaraze® generally gets rid of actinic keratoses without being overly harsh to the skin.
These medications are generally prescribed for several weeks or months.
Medications may be used in combination with other treatment options. For instance, imiquimod (Zyclara) may be used in combination with cyrotherapy for improved outcomes.
Your personal treatment regimen may vary depending on the medication, the area to which it is applied, the number of lesions being treated, and your ability to tolerate any irritation or other side effects. This makes it important to closely follow your doctor’s specific instructions.
