Varicose Veins Masthead

Actinic Keratosis

What are actinic keratoses?
Actinic keratoses (AKs for short), or solar keratoses, develop after repeated exposure to the sun. Your skin "remembers" all the sun damage it has had since you were a child including sun bathing, playtime, yard work, vacations, sporting activities, and sunlight that hit your skin going to and from your normal daily activities. AKs are scaly or crusty spots on the skin that may be tan, pink or red. They feel rough and are often easier felt than seen. They may itch or be prickly or feel tender.

Should actinic keratoses be treated?
Yes. Actinic keratoses can be the first step in the development of skin cancer, and, therefore, are precursors of cancer or precancers. To be on the safe side, AKs are treated to prevent them from developing into more serious things, such as squamous cell carcinomas.

How are AKs treated?
The most common method of treatment is to freeze them with liquid nitrogen. This is only uncomfortable for a few minutes and causes the skin to separate between normal skin and the AK. The AK will peel off when the skin underneath is healed. This can take a few weeks. People with extensive AKs may be treated with a cream (such as Efudex or Aldara) for a number of weeks. The skin may become red and raw. Levulan is a solution that is applied to the affected skin in the office. The Levulan incubates and then, a light source is used to activate it, removing AKs, over a few days. There are also other less commonly used treatments. New is Picato gel, a 2-3 day topical treatment for small areas.

Can AKs be prevented?
Yes and no. Even if you could avoid ALL sun exposure in the future, you probably will still see AKs develop because of the damage already done. You can avoid aggravating the problem by protecting yourself from the sun. This includes wearing protective clothing, wearing a sunscreen with an SPF of 30 or higher, using medical grade skin care, and limiting outdoor activities between 10 am and 4 pm. Some patients also come in for annual Levulan & light treatment.

Helpful Hints When Using Actinic Keratosis Medication: Read Carefully
Do not use if you are pregnant or nursing.
Inform us if you have a history of cold sores or fever blisters if you are using medication on your lips or face.
Apply only a small amount to the affected area - you do not need to apply thickly.
It is normal for there to be irritation (redness and peeling) and mild discomfort with the medication. If it becomes bothersome, discontinue the cream for 3-4 days, and then attempt to restart.
Call the office and stop the medication if there is severe pain or severe irritation (such as crusting, bleeding, or sores).
Use the prescribed ointment, over-the-counter 1% hydrocortisone ointment, or Aquaphor healing ointment once irritation is significant and for a few weeks after treatment is over to help decrease irritation more rapidly.
It is good to protect the skin from sun as much as possible during treatment and healing (it is ok to use sunblock, moisturizers, and makeup if they don't sting).
Redness dramatically improves over a few weeks but may take a few months or more to fully fade.
Call the office if any lesions (pink dry or scaly areas or bumps) persist after skin has healed from the medication reaction. Healing usually takes 2-3 weeks.