Field Treatments for Actinic Keratoses

Posted on: February 15th, 2023 by Our Team

We specialize in skin examinations and cancer detection at Phoenix Surgical Dermatology Group. With the hot sun and a plethora of outdoor activities in Phoenix and Scottsdale, we see high rates of skin cancer and pre-malignant lesions. One particular lesion we see quite a bit of is actinic keratoses.

Actinic keratoses (AKs) are precancerous skin lesions caused by sun exposure. They typically appear as scaly, red, or pink patches on the skin and are most commonly found on areas of the skin that have been exposed to the sun, such as the face, ears, and hands. While AKs are not cancerous, they can progress to squamous cell carcinoma (SCC), a type of skin cancer.

There are several different field therapies available for the treatment of AKs. These treatments are designed to cover a large area of skin. They are typically used in cases where there are multiple AKs present. Field therapies can be divided into two categories: topical and physical.

Topical therapies:

Topical therapies are medications that are applied directly to the skin. They are typically used to treat visible AKs and can be easily accessed.

1. 5-fluorouracil (5-FU): 5-FU is a chemotherapy medication applied to the skin. It works by inhibiting the production of DNA, which prevents the growth of abnormal cells. It is typically used once or twice daily for several weeks. Common side effects of 5-FU include skin irritation, redness, and dryness.
2. Imiquimod: Imiquimod is a topical immune response modifier applied directly to the skin. It works by activating the immune system to attack abnormal cells. It is typically used three times per week for several weeks. Common side effects of imiquimod include skin irritation, redness, and dryness.
3. Diclofenac: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) applied to the skin. It works by reducing inflammation and relieving pain. It is typically used once or twice daily for several weeks. Common side effects of diclofenac include skin irritation, redness, and dryness.

Physical therapies:

Physical therapies are treatments that use bodily energy to destroy abnormal cells. They are typically used to treat AKs that are not visible or are difficult to access with topical therapies.

1. Cryotherapy: Cryotherapy, also known as cryosurgery, is a treatment that uses extreme cold to destroy abnormal cells. It is typically performed using liquid nitrogen, which is applied to the AKs using a cotton swab or spray. Cryotherapy is a quick and relatively painless procedure with minimal downtime. Common side effects include skin irritation, redness, and blistering.
2. Photodynamic therapy (PDT): PDT is a treatment that uses a photosensitizing agent, such as aminolevulinic acid (ALA), and a particular light source to kill abnormal cells. The photosensitizing agent is applied to the skin, and the light source activates it. PDT is typically performed in two or three treatments, spaced about one month apart. Common side effects of PDT include skin irritation, redness, and dryness.
3. Laser therapy: Laser therapy is a treatment that uses a concentrated beam of light to destroy abnormal cells. Several different types of lasers are available, each of which is designed to target specific types of cells. Laser therapy is typically performed in a series of treatments about four to six weeks apart. Common side effects of laser therapy include skin irritation, redness, and swelling.

Which treatment is right for me?

When choosing a field therapy for the treatment of AKs, several factors must be considered.

1. Location of the lesions: The location of the AKs can influence the treatment choice. For example, topical therapies are typically used to treat AKs that are visible and easily accessible. In contrast, physical therapies generally are used to treat AKs that are not visible or are difficult to access with topical treatments.
2. The number of lesions: The number of AKs present can also influence the treatment choice. For example, if only a few AKs are present, topical therapy may be the most appropriate treatment. However, physical therapy such as cryotherapy or photodynamic therapy may be more effective if many AKs are present.
3. Patient preference: It is crucial to consider the patient’s choice when choosing a field therapy for treating AKs. Some patients may prefer topical therapy due to its convenience and ease of use, while others may prefer physical therapy due to its more dramatic results.
4. Side effect profile: Each field therapy has its own potential side effects. It is essential to consider the side effect profile of each treatment and how it may affect the patient’s quality of life.
5. Cost: Field therapies can vary in price, which is an essential factor to consider when making a treatment decision. It is important to discuss treatment costs with a healthcare provider and to view all available treatment options before making a decision.

It is important to note that no single field therapy is the “best” treatment for AKs. The most appropriate treatment will depend on the individual patient’s needs and goals. Therefore, consulting with a qualified healthcare provider is essential to determine the best treatment plan for your individual needs and goals. We are at the forefront of skin cancer prevention at Phoenix Surgical Dermatology Group. We can offer multiple treatment modalities to treat actinic keratoses.