Actinic Keratosis Treatment

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Actinic Keratosis Treatment

What is actinic keratosis (ak-TIN-it ker-uh-TOE-sis)?

Actinic keratosis (AK) is a scaly or rough patch of skin that’s more common on the face, lips, ears, forearms, scalp, neck and back of the hands. These are places that receive a lot of sun exposure over the years. It is years of sun exposure that cause AKs. More common after age 40, they are one of the most common skin problems that dermatologists treat. Sometimes AKs go away without treatment but return with more exposure to ultraviolet rays. AK removal is the best way to get back your healthy skin. 

Should I worry about actinic keratosis?

If you have AKs removed early, they shouldn’t be a cause for concern. However, if left untreated, they can develop into squamous cell carcinoma, a more serious type of skin cancer. Up to 10% of AKs develop into squamous cell cancer.

Causes

What causes actinic keratosis?

AKs are caused by frequent exposure to intense ultraviolet rays from the sun or tanning beds. 

Although anyone can develop AKs, your risk for developing them increases if you:

  • Have had a lot of sun exposure and/or sunburns
  • Frequently use a tanning bed
  • Have light skin, fair hair (red or blond), and blue or green eyes
  • Easily freckle or burn 
  • Are over age 40
  • Live in a sunny climate
  • Work outdoors or spend lots of time outdoors
  • Have a weak immune system

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up

Symptoms

What are the symptoms of AKs?

AKs vary in how they look, their size, and the number on your skin. There’s usually more than one AK. Most of them have several of these symptoms:

  • Dry, rough or scaly area of skin, usually less than one inch in diameter
  • The surface can be flat, slightly raised, or a hard, wart-like bump
  • Color can be red, brown or pink
  • May itch, burn, bleed or crust over

Diagnosis

How is actinic keratosis diagnosed?

A dermatologist can usually diagnose AK by looking at your skin. If he/she has any doubt, a skin biopsy may be done by taking a small sample of your skin to look for signs of AKs or other skin cancers.

The exam will include a skin cancer check. People who have AKs are at a higher risk for other types of skin cancer because of skin damage from ultraviolet rays. AK patients may need their skin checked once a year to find AKs or other skin cancers early when they are more easily treated. Having many AKs means your skin is severely damaged and you are likely to get more AKs.

Treatment

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.

References

Clinic. (Jan. 2021). Actinic Keratosis. Retrieved 8-27-21, {https://www.mayoclinic.org/diseases-conditions/actinic-keratosis/symptoms-causes/syc-20354969}
Mayo Clinic. (Jan. 2021) Actinic Keratosis Diagnosis and Treatment. Retrieved 8-27-21, {https://www.mayoclinic.org/diseases-conditions/actinic-keratosis/diagnosis-treatment/drc-20354975}
American Academy of Dermatology. (Feb. 2021). Actinic Keratosis: Diagnosis and Treatment. Retrieved 8-27-21, {https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-treatment}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Affordable –
with or without insurance

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up