Treating Actinic Keratoses

Actinic keratoses (AKs) are common, pink to red, scaly bumps on sun exposed skin. They are focal areas where skin cells have accumulated DNA damage from the sun that causes them to grow faster than normal and exfoliate poorly. It is estimated that 1 in 1000 AKs becomes a squamous cell carcinoma (SCC) each year. Because of this, AKs are commonly designated "precancers."

Some AKs bleed, burn, or sting. Other AKs exist in the skin undetected. Even if they are asymptomatic, the main rationale for treating AKs is to reduce the risk that they will subsequently become a SCC (prevent skin cancer).

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What are the treatments for actinic keratoses?

  • Liquid nitrogen (LN2)

    When someone has a few AKs or particularly large AKs, the easiest way to treat them is with LN2. Appropriate use of LN2 kills superficial lesions, leaving behind healthy surrounding skin to repopulate the surface.

  • Topical medications

    If several AKs exist, which is common, a topical medication is the preferred treatment. These topical options all work similarly in that they only target the cancerous cells, all precancers in the treated area rather than just a few like LN2, and leave behind healthy cells and unscarred skin. Our experience and scientific studies have shown an additional cosmetic benefit to treating AKs with a full field topical medicine, and you can read more about the cosmetic benefits of efudex here.

    There are several prescription topical medicines that can be used to treat individual lesions or field areas of AKs, including those with 5-fluorouracil (for example, Efudex®), imiquimod, diclofenac (Solaraze®), and ingenol mebutate (Picato®). Their regimens and efficacy rates vary, but all work to slowly, selectively kill AKs as an in-home regimen.

  • Photodynamic therapy (PDT)

    PDT is an office-based procedure for the treatment of AKs that involves application of a prescription medicine (Levulan® Kerastick®) to the skin followed by exposure to a special blue light. This may need to be repeated for optimal results. Rockwall Dermatology does not offer a PDT treatment option.

Individual results may vary.

What can I do to help prevent actinic keratoses?

Most of the attributable risk for AKs and skin cancer is ultraviolet radiation from the sun. AK and skin cancer prevention is achieved with these tips:

  • Cover all skin possible with clothing, hats, and sunglasses.
  • Seek shade when possible.
  • Avoid sun during hours of peak ultraviolet rays (10 AM - 4 PM).
  • Use sunscreens on all exposed skin daily using SPF 30 sunscreen that is broad-spectrum. Of all active ingredients, zinc oxide is the most broad-spectrum and effective agent in sunscreens.

Dr. Saucier recommends annual or biannual skin exams for at-risk patients. If you have AKs or desire a skin exam, call our office and schedule an appointment with her.

Medical Dermatology

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