Actinic Keratoses (Solar Keratoses)
What is an Actinic Keratosis and how do I treat them?
An actinic keratosis (AK) is a pre-cancerous skin lesion that develops on the skin primarily on sun exposed areas. If you have more than one actinic keratosis you are said to have actinic keratoses. Most people who get these will have multiple. These spots often begin as rough scaly patches on the skin. Sometimes they can be sore or tender when rubbed or touched. Although they can occur on any sun damaged area of the skin, I mostly see them on the scalp, face, ears, back of the neck, arms, hands and the lower legs. If left untreated a small percentage of these will progress to a squamous cell carcinoma.
Patients that develop actinic keratoses will often develop multiple over a lifetime. It is important for these patients to be under the close watch of a Dermatologic provider so that these can be managed and treated before they progress to the more aggressive squamous cell carcinoma.
Risk factors for Actinic Keratoses are similar to that of basal cell carcinoma and squamous cell carcinoma and include sun exposure, sun burns, fair skin and genetics.
The best protection against developing actinic keratosis is education! Wearing sunscreen, protecting our younger generations, avoiding indoor tanning and being as careful as we can when playing or working outdoors is our best defense against developing any form of skin cancer.
- Apply a broad-spectrum sunscreen of SPF 30 or higher 20-30 minutes before sun exposure.
- Re-apply sunscreen every 60-90 minutes while in the sun.
- Avoid peak hours of the sun between 10am and 2pm.
- Wear sun protective clothing.
- Do not burn!
- Avoid indoor tanning.
- Examine your skin once a month for new or changing spots.
- Have a yearly skin examination to ensure your skin is in good health.
Treatment options for Actinic Keratoses include removing or destroying the lesions and/or topical therapies to treat the sun damaged skin.
- Cryotherapy: This is better known as freezing. I use liquid nitrogen to freeze away the actinic keratoses. This can sometimes cause discomfort and pain during the process but it is well tolerated by most patients. It is a great method because it works well and does not usually cause much scarring. Freezing causes the lesions to blister and over time they fall off as the skin heals. Check out the section on Procedure Care to learn how to take care of them after freezing.
- Topical Therapy: Actinic keratoses can be effectively treated by prescribed topical creams. One cream works as a topical chemotherapy (5-fluorouracil) while another works to stimulate the body's immune system (imiquimod) to fight the pre-cancerous lesions. A third cream, Picato works by causing the damaged cells to die off in the skin. All of these work very well, but can often lead to side effects of redness, crusting and scabbing in the area they are applied.
If you have actinic keratoses I will discuss with you the best approach to managing these lesions. Short and long term therapy should be considered to minimize the development of additional spots.