Also known as solar keratosis, actinic keratoses (AK) affect more than 10 million Americans. These precancerous growths on the skin are caused by exposure to the sun over time in fair-skinned, susceptible individuals. They are characterized by rough dry lesions or patches that appear on sun-exposed areas of the skin, such as the face, back of hands, arms, scalp or shoulders. The lesions may be red, pink, gray, brown or skin colored. Lesions often begin as flat, scaly areas and develop into a rough-textured horny surface. Sometimes AKs easier felt than seen, and they often feel like low grit “sand paper.”

Actinic keratoses can develop into squamous cell carcinoma (SCC), and some experts consider them the first step in a progression to SCC, a common and sometimes serious skin cancer. Treatment is therefore mostly to prevent transformation to cancer.

Treatment Options:

  • Cryosurgery- extremely cold liquid nitrogen is used to destroy the AK.
  • Shave removal- after numbing the skin, a scalpel or flat blade is used to shave the lesion off
  • Electrodessication and currettage- after numbing the skin, small spoon-like blade is used to scrape off the diseased skin followed by electrocautery to burn the remaining abnormal cells and stop the bleeding
  • Chemical peels- acid is applied to the skin and destroys the outer layer of the skin, which in term removes the AKs.
  • Photodynamic therapy- a topical agent is applied to the treatment area that sensitizes the skin to either blue or red light and the area is then exposed to a light source. The energy from the light source causes the AKs to be destroyed
  • Topical therapy- there are several types of topical therapy and they all cause redness and inflammation along with varying degrees of scabbing and crusting. The response depends on the amount of AK lesions present and the agent used.
    • 5-fluorouracil (Efudex, Carac, Fluoroplex) - this is chemotherapy in a tube. The medication directly kills the abnormal cells. This is the oldest available agent of the topical agents and one of the most effective.
    • Imiquimod (Aldara, Zyclara) – this medication causes the body’s immune system to attack the AK lesions.
    • Diclofenac (Solaraze) - this is an anti-inflammatory medication (NSAID) the inhibits and/or reduces AK by blocking a biochemical pathway
    • Ingenol mebutate (Picato) – this plant extract induces cell death.