How is actinic keratosis treated?
Treatment will depend on how many AKs you have, where they are, and whether you’ve had skin cancer. Be sure to let your dermatologist know if you’ve had a transplanted organ.
AKs can be easily and effectively removed. For treatment to be effective, the entire AK must be destroyed. This can leave skin feeling raw, red and swollen for a few days.
The standard treatments for AKs include:
- Cryosurgery is done by applying a very cold substance like liquid nitrogen to the AK. It usually falls off after a few days, although it may need a second treatment. It’s normal to have a blister, crusty spot or peeling where the AK was. As damaged cells slough off, new skin replaces it. Cryosurgery is done in the doctor’s office, takes only a few minutes, and you remain awake. It is the most common AK treatment. Side effects may include blisters, scarring, infection, and changes in skin color and texture.
- Chemical peel destroys the top layers of skin. Your skin will be red, swollen and sore until new skin grows in as the area heals. This procedure can be done in the doctor’s office. A medical-grade chemical peel should not be confused with a chemical peel done at a salon. The results are very different.
- Curettage may be used if your AK is very thick. The doctor scrapes the AK from your skin and then heats the area (electrodesiccation) to destroy any remaining AK cells.
- Photodynamic therapy is often used for patients who continue to develop AKs or their AKs return after being removed. A solution is applied to the affected area that makes your skin extremely sensitive to light. After an hour or so, the area is treated with either a red or blue light, which activates the solution and destroys the AKs. For at least 48 hours, you’ll need to stay indoors during daylight. UV light of any kind can cause a serious skin reaction. New healthier skin will grow in the affected area. Most patients require a second treatment about three weeks after the first. Side effects may include a burning sensation during treatment, or redness and swelling after treatment.
- Laser resurfacing may be recommended for actinic cheilitis, which is a precancerous growth on the lip. It removes the surface layer and new skin grows in after a week or so. Side effects can include scarring and color changes in the affected skin.
Your dermatologist may recommend at-home treatment if you have many AKs, or you have AKs that you can feel but not see. At-home treatment lets you treat multiple AKs. Some patients don’t like at-home treatment because they have to apply the medication even when it causes a skin reaction. It can be hard for some people to keep applying something that causes redness, scaliness and a burning sensation for several weeks. Your dermatologist may recommend both an in-office procedure and in-home treatment to get the best results for your skin
Medications approved by the Food and Drug Administration to treat AKs include:
- 5-fluorouracil (5-FU) cream is applied once or twice a day for up to 4 weeks. It’s usually prescribed for AKs on the chest, arms or back, but not the face because of the skin reaction. Pregnant women cannot use 5-FU cream because it can harm the fetus.
- Diclofenac sodium gel causes less of a skin reaction. It’s applied twice a day for up to three months. During the treatment, you must protect the treated skin from the sun.
- Imiquimod cream is often prescribed for the face because it’s only applied once or twice a week for up to 4 months. It produces less redness and crusting. An alternative way to use it every night for two weeks; rest your skin for two more weeks; then apply it every night for another two weeks.
Can actinic keratosis be prevented?
Yes, prevention is always easier, less painful, less expensive, and eliminates the risk of scarring when compared to treatment.
The best prevention is protection from ultraviolet rays from the sun or tanning beds. Limit your time in the sun, especially between 10 a.m. and 3 p.m.
Use sunscreen with an SPF of at least 30 on all exposed skin; use SPF 30 lip balm on your lips. Apply at least 15 minutes before sun exposure; reapply every two hours or whenever you swim or perspire a lot. Sunscreen can be used on anyone over six months of age. Babies should be kept out of the sun with shade, hats and clothing that covers them.
Cover your body with tightly woven clothing when in the sun. Wear a broad-brimmed hat. A ball cap does not provide enough protection.
Never use tanning beds.
Examine all your skin regularly and report changes in or development of new moles, freckles, bumps or other skin growths.
