What is actinic keratosis?

Actinic keratosis (AK) is one of the most common skin conditions, estimated to affect more than 409 million Americans each year. AKs are considered precancerous skin growths caused from chronic ultraviolet (UV) exposure. People get UV exposure from tanning beds, sunlamps, or the sun. This is likely to be true because AKs tend to appear on skin that’s been most exposed to the sun. When an AK forms on the lips, it is called actinic cheilitis. Some AKs and actinic cheilitis can turn into a type of skin cancer called squamous cell carcinoma.

What are the signs and symptoms of AK?

AK typically appears as a rough-feeling or sandpaper-like patch on skin that has had lots of sun. It is typically easier to feel than it is to see. They often appear in clusters and can be scaly or raised with a red, pink, skin-colored, or gray background. They typically never heal or sometimes they heal and return. On the lips, they can appear as white patches. Sometimes, an AK can appear like an animal’s horn. In this case, it indicates that a person has a higher risk of developing a type of skin cancer called squamous cell carcinoma. Sometimes, AKs can itch, burn, sting, cause pain or bleed.

Who is at risk for developing AK?

Several risk factors increase the risk of developing AK. The risk factors are:

• Fair skin (burns easily and rarely tans)
• Naturally red or blond hair
• Light-colored eyes
• History of chronic sun exposure
• Age > 50 years old
• History of tanning bed use
• History of a weakened immune system
• Some genetic disease that increase susceptibility to sunburn

How is AK diagnosed?

Your board-certified dermatologist will examine your skin carefully and ask questions about your health, medications, and symptoms. They may even touch your face closely feeling for rough patches. Most often your dermatologist can diagnose AK by looking and feeling your skin. Rarely, a skin biopsy may be needed. A skin biopsy is where a small piece of tissue is removed and examined under a microscope.

How is AK treated?

Treatment for AK depends on several factors:

• How many AKs you have
• Where the AK(s) appear on your body
• What the AK(s) look like
• Whether you have had skin cancer
• Your other medical conditions

You can often complete treatment in 1 or 2 office visits. The procedures that dermatologists use to treat AKs include:

• Cryotherapy – A common treatment for AKs, this procedure can treat 1 to several AKs that you can clearly see. During cryotherapy, your dermatologist destroys the AK by spraying it with an extremely cold substance, such as liquid nitrogen
• 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. This treatment is effective when there are several AKs
• Curettage – If you have an extremely thick AK, your board-certified dermatologist may recommend scraping the AK from your skin
• Photodynamic therapy (PDT) – This treatment is effective when there are several AKs or too many to treat individually. In this two-part 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. Most patients with AKs need 2 PDT treatments, with the second treatment given 3 weeks after the first
• Laser resurfacing – A special medical grade laser can be used to remove the surface layer of the skin. After treatment, the skin will feel raw and sore, but eventually will heal with new, healthier skin

Additionally, there are several at-home treatment for actinic keratosis your board-certified dermatologist may recommend. These are all prescription medications approved by the US. Food and Drug Administration (FDA) to treat AKs:

• 5-fluorouracil (5-FU) cream – You apply this once or twice a day for 2 to 4 weeks. This will lead to an intense reaction that will eventually heal into smooth, healthier skin
• Diclofenac sodium gel – This medication tends to cause less of a skin reaction than 5-FU, but it can still be very effective. You will need to apply it twice a day for 2 to 3 months
• 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 lots of redness and crusting. You may need to apply it for 12 to 16 weeks
• Ingenol mebutate gel – This requires the shortest treatment time. To treat your face or scalp, you’d apply it for 3 days. On other parts of your body, you’d apply it for 2 days
• Calcipotriene cream – This cream has been shown to increase the effects of 5-FU and also shortens the amount of time needed to treat. Your dermatologist may recommend this cream in conjunction with 5-FU

To effectively treat the AKs, your dermatologist may prescribe both a procedure and medication that you apply at home.