Actinic keratosis: Diagnosis, treatment, and outcome

How do dermatologists diagnose actinic keratosis?

Dermatologists diagnose an actinic keratosis (AK) 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 AKs?

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

In-office procedures:

  • Cryotherapy: Destroys visible AKs 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 AK 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 1 or 2 weeks, revealing healthier new skin.

Prescription medicine:

Your dermatologist may prescribe a medicine that you can use at home to treat AKs. 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 time, 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 AKs. No one treatment works on all AKs.

Outcome

Some people get only a few AKs. These AKs often clear with treatment.

If you have many AKs, you need to be under a dermatologist’s care. AKs form in skin that has been badly damaged by the sun or indoor tanning. This damage often causes people to get new AKs 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 to 12 weeks. 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.

Learn more about actinic keratosis:

References:

Bhatia ND. “Medical Management of Actinic Keratoses.” Focus session presented at the 2011 American Academy of Dermatology Summer Academy Meeting: New York City. Aug 2011.

Dinehart SM. “The treatment of actinic keratoses.” J Am Acad Dermatol 2000 Jan; 42: 25-8.

Feldman SR, Fleischer AB, Jr., Williford PM et al. “Destructive procedures are the standard of care for treatment of actinic keratoses.” J Am Acad Dermatol 1999 Jan; 40: 43-7.

Moy RL. “Clinical presentation of actinic keratoses and squamous cell carcinoma.” J Am Acad Dermatol 2000 Jan;42:S8-10.

Odom R. “Managing actinic keratoses with retinoids.” J Am Acad Dermatol 1998 Aug; 39: S74-8.

Rigel DS, Cockerell CJ, Carucci J et al.“Actinic Keratosis, Basal Cell Carcinoma, and Squamous Cell Carcinoma.” In: Bolognia JL, Jorizzo JL, Rapini RP, et al. editors. Dermatology, 2nd ed. Spain, Mosby Elsevier; 2008. p. 1645-6

Salasche SJ, Levine N, Morrison L. “Cycle therapy of actinic keratoses of the face and scalp with 5% topical imiquimod cream: An open-label trial.” J Am Acad Dermatol 2002 Oct; 47: 571-7.

Stockfleth E, Meyer T, Benninghoff B et al. “A randomized, double-blind, vehicle-controlled study to assess 5% imiquimod cream for the treatment of multiple actinic keratoses.” Arch Dermatol 2002 Nov; 138: 1498-502.

Swanson N, Abramovits W, Berman B et al. “Imiquimod 2.5% and 3.75% for the treatment of actinic keratoses: results of two placebo-controlled studies of daily application to the face and balding scalp for two 2-week cycles.” J Am Acad Dermatol; 2010 Apr;62(4):582-90.

Zalaudek I, Giacomel J, Schmid K et al. “Dermatoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: A progression model.” J Am Acad Dermatol. 2011 Aug 10.

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