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Actinic Keratosis
An Actinic Keratosis is a pre-cancerous lesion on the skin. It is a rough, scaly patch that develops after years of skin exposure. People with skin badly damaged by ultraviolet (UV) light develop AKs and have a higher risk of getting skin cancer. If you have many AKs, it's a good idea to be under a dermatologist's care. Your dermatologist can watch for signs of new AKs and skin cancer. When found early and treated, skin cancer is highly treatable.
The procedures that dermatologists use to treat AKs include:
Cryotherapy: During cryotherapy, your dermatologist freezes the AK. The goal is to get the AK to fall off after a few days. Some AKs need more than one treatment before they fall off. To freeze the AK, your dermatologist will apply a very cold substance like liquid nitrogen to the AK. Your dermatologist can do this during an office visit while you remain awake. After cryosurgery, you may see crusting or a blister on your treated skin. This is normal and expected.
Chemical peel: This is a medical-grade chemical peel used to destroy the top layers of skin. You cannot get this type of chemical peel at a salon or from a kit sold for home use. After a medical-grade chemical peel, the treated skin will be red, swollen, and sore. As the area heals, you will see new healthy skin.
Curettage: This may be the best treatment if you have an extremely thick AK. During this procedure, your dermatologist first scrapes the AK from your skin using a technique called curettage. Your dermatologist may follow this with an electrodesiccation, which heats the treated area to destroy any remaining AK cells.
Photodynamic therapy: This may be recommended for a patient who continues to get new AKs or has AKs that returns after treatment. This procedure is a bit time-consuming because it consists of 2 parts. During the first part of treatment, a solution that makes your skin extremely sensitive to light is applied to the area with AKs. You'll sit in the office with this on your skin for about 60 to 90 minutes. Afterward, you'll be treated with either a blue or red light. The light activates the solution, which can destroy the AKs. As the treated skin heals, you'll see new, healthier skin. For 48 hours after treatment, you'll need to avoid the outdoors during daylight. The UV light, even on a cloudy or snowy day, can cause a serious skin reaction. Your dermatologist will explain how to protect your skin so you can get home. Most patients with AKs need 2 PDT treatments, with the second treatment given three-four weeks after the first.
Laser resurfacing: This may be a treatment option for actinic cheilitis, a pre-cancerous growth on the lip. It works by removing the surface layer of the skin. After treatment, the skin will feel raw and sore. When it heals in 1 or 2 weeks, you see new, healthier skin.
At-home treatments for actinic AK's
When you treat at home, you'll need to apply medication to your skin as directed. The downside of applying medication to your skin at home is that some patients say staying consistent is challenging. This is because you must use the medication as often as your dermatologist recommends to be effective. Even when the medication causes a skin reaction, indicating that it's working, you'll need to keep applying it. After you finish treatment, you'll see new, healthier skin.
The medications dermatologists prescribe include the following, which have all been approved by the US. Food and Drug Administration (FDA) to treat AKs:
5-fluorouracil (5-FU) cream: This is a topical treatment that you apply once or twice daily for 2 to 4 weeks. This medication tends to cause significant redness and irritation.
Diclofenac sodium gel: This medication tends to cause less skin reaction than 5-FU, but it can still be very effective. You will need to apply it twice daily for 2 to 3 months. While using this medication, you must protect your treated skin from the sun. Your dermatologist can tell you the best way to protect your skin.
Imiquimod cream: This can be a good option for the face because you can apply it once (or twice) a week, so you don't get much redness and crusting. You may need to apply for it for 12 to 16 weeks. If 12 to 16 weeks is too long, you may be able to use the medication a bit differently. You'd apply imiquimod every night for two weeks. For the next two weeks, you'd give your skin a break. Then you'd use it again every night for two weeks.
Tirbanibulin ointment: This may be an option for treating AKs on your face and scalp. You apply this medication for five days in a row. After five days, the treatment ends. You want to apply this ointment carefully. Spread it evenly over the skin that your dermatologist says to treat.
It's best to diagnose and treat AKs early before they become cancerous.