Actinic Keratosis

How Do Dermatologist Diagnose Actinic Keratosis?

Dermatologists diagnose an actinic keratosis by closely examining the skin.  If your dermatologist finds a growth that is thick or looks like skin cancer during the exam, your dermatologist will likely perform a skin biopsy.  Your dermatologist can safely perform a skin biopsy during an office visit.

When found early and treated, skin cancer is often cured.

How Do Dermatologists Treat Actinic Keratoses?

There are many treatments for actinic keratoses.  Some treatments your dermatologist can perform in the office.  Other treatments you will use at home.  The goal of treatment is to destroy the actinic keratoses.   Some patients receive more than one type of treatment.  Treatments for actinic keratoses include:

In-Office Procedures:

Cryotherapy:  Destroys visible actinic keratoses by freezing them.  The treated skin often blisters and peels off within a few days to a few weeks.  This is the most common treatment.  When the skin heals, you may see a small white mark.

Chemical Peel:  This is a medical chemical peel.  You cannot get this peel at a salon or from a kit sold for at-home use.  This strong peel destroys the top layers of skin.  The treated area will be inflamed and sore, but healthy new skin will replace it.

Curettage:  Your dermatologist carefully removes a visible actinic keratosis with an instrument called a curette.  After curettage, your dermatologist may use electrosurgery to remove more damaged tissue.  Electrosurgery cauterizes (burns) the skin.  New healthier skin will appear.

Photodynamic Therapy (PDT):  A solution is applied to make the skin more sensitive to light.  After a few hours, the treated skin is exposed to a visible light, such as blue or laser light.  The light activates the solution and destroys AKs.  As the skin heals, new healthy skin appears.

Laser Resurfacing:  Much like a chemical peel, a laser can remove the surface layer of the skin.  This destroys AK cells.  After treatment, the skin will be raw and sore.  The skin heals within one or two week, revealing healthier new skin.

Prescription medicine:

Your dermatologist may prescribe a medicine that you can use at home to treat actinic keratoses.  Medicines that dermatologists prescribe include:

5-fluorouracil (5-FU) cream:  This is chemotherapy that you apply to the skin.  It causes temporary redness and crusting.  Patients typically apply 5-FU twice daily for 2 to 4 weeks. A person who has lots of damaged skin may need to use 5-FU longer.  5-FU causes sun-damaged areas to become raw and irritated.  As the skin heals, healthy skin appears.  Another treatment such as cryotherapy may be necessary to treat thick AKs.

Diclofenac Sodium Gel: This is a non-greasy gel.  You apply it to skin with lots of AKs.  Patients apply the medicine twice a day for about 2 to 3 months.  During this tie, you must protect your skin from the sun.  You will see the best results about 30 days after you stop applying the gel.  Some AKs can remain.  Your dermatologist will treat these, often with cryotherapy.

Imiquimod Cream:  This cream helps boost your body’s immune system so that your body can get rid of the diseased skin cells.  You will apply this cream to your skin as directed by your dermatologist.  Most patients apply imiquimod for several weeks.  Imiquimod causes the skin to redden and swell.  After you stop using the medicine, the skin heals.

Ingenol Mebutate Gel: This gel works in two ways.  It boosts the body’s immune system.  It also is a type of chemotherapy for the skin.  One formula is used to treat AKs on the head and scalp and is applied for 3 days in a row.   The other formula treats AKs on the legs, arms, and torso.  Patients apply this formula for 2 days in a row.  Both formulas can cause rapid redness and swelling.  As the skin heals, the redness and swelling clear.

Researchers continue to look for new treatments for actinic keratoses.  No one treatment works on all actinic keratoses.

Outcome

Some people get only a few actinic keratoses.  These lesions often clear with treatment.

If you have many actinic keratoses, you need to be under a dermatologist’s care.  Actinic keratoses  form in skin that has been badly damaged by the sun or indoor tanning.  This damage often causes people to get new actinic keratoses for life.  Left untreated, AKs may turn into squamous cell carcinoma, a type of skin cancer.  With frequent checkups, this skin cancer can be found early and removed.  When found early and treated, most skin cancers can be cured.  Your dermatologist will tell you how often you should return for checkups.  Some patients need a checkup once every 8-12 week. Others return for a checkup 1 or 2 times per year.

You should keep every appointment.  If skin cancer develops, the sooner it is detected and removed, the better the outcome.

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Useful Tips

An actinic keratosis (AK) forms on skin that has been badly damaged by ultraviolet (UV) rays.  The sun and indoor tanning expose us to these harmful rays.  If you have been diagnosed with AKs, dermatologists recommend the following:

Protect your skin from the sun.  By protecting your skin from the sun, you can help prevent new actinic keratoses from forming. This also will help make your treatment more effective.  Dermatologists offer these tips to their patients who have AKs.

Avoid the midday sun.  You can do this by scheduling outdoor activities for earlier in the morning (before 10 a.m.) and later in the afternoon (after 2 p.m.).

Apply sunscreen every day – even on cloudy days and in the winter.  Apply sunscreen to all skin that clothing will not cover.

Three Things your sunscreen must offer:

1. SPF (sun protection factor) of 30 or higher.
2. UVA/UVB protection (label may say “broad-spectrum”).
3. Water resistance.

Protect your lips.  Apply a lip balm that contains sunscreen.  The lip balm also should offer an SPF of 30 or greater and UVA/UVB protection.

Protect your skin with clothing.  Whenever possible wear:

— A wide-brimmed hat
— Long sleeves
— Pants

To see how well your clothes will protect you, hold each garment in front of bright light.  If you see light through the cloth, harmful light from the sun can penetrate the cloth.  You should select another garment.  You also could wear that garment but apply sunscreen first to the skin that the garment will cover.

Do not use tanning beds or other indoor tanning devices.  Tanning beds and sun lamps emit UV rays that can be stronger than the rays from the sun.  This can cause new AKs.

Check your skin as often as your dermatologist recommends.  If you notice a growth on your skin that has any of the following traits, contact your dermatologist right away:

— Starts to itch or bleed.
— Becomes noticeably thicker.
— Remains after treatment.
— Changes in size, shape, or color.

Keep all appointments with your dermatologist.  Left untreated, actinic keratoses can turn into a type of skin cancer called squamous cell carcinoma.  With early detection and treatment, skin cancer has a high cure rate.

Because actinic keratoses develop on skin that has been badly damaged by UV rays, you also have a higher risk for developing other types of skin cancer, including melanoma.  Keeping your appointments helps to find skin cancer early when a cure is likely.

Realize that new actinic keratoses may form.  Actinic keratoses form on badly damaged skin.  Some people will continue to develop new actinic keratoses for life, even when they protect their skin from the sun.  This does not mean that sun protection and treatment are not working.

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