Actinic Keratosis (AK)

Actinic keratoses (AKs) are dry, scaly patches that form on sun exposed areas of the skin, including the scalp, face, forearms, and back of the hands. A single lesion is called an "actinic keratosis" or "solar keratosis".

AKs are usually scaly, feel like sandpaper to the touch, and range in color from skin-toned to reddish-brown. AKs may be as small as the head of a pin or as large as a quarter (or bigger, if left untreated).

Most people with one actinic keratosis (AK) lesion will develop others. AKs can appear in groups and many may be undetected. They may occasionally itch or become tender, especially after sun exposure.

When AKs occur on the lip, they are referred to as actinic cheilitis. This type of AK appears as cracking, dried lips, often around the border of the lip.

Actinic Keratoses and Skin Cancer

AKs are considered PRECANCEROUS and have the potential to become a type of skin cancer called squamous cell carcinoma (SCC). In fact, 40-60% of SCCs begin as untreated AKs.

Therefore, your doctor will be diligent in diagnosing, treating, and monitoring AKs. Also, since AKs result from chronic sun exposure, those with AKs are at risk for developing other types of skin cancer, such as basal cell carcinoma or melanoma.

Fortunately, AKs are treatable when detected in the early stages. People at risk for AKs and skin cancer can reduce that risk by performing frequent skin self-exams and seeing their doctor for regular screenings.

Risk Factors for Developing Actinic Keratoses

AKs usually develop in people with light-colored skin and hair (blond or red hair), have freckles and have years of excessive sun exposure.

AKs are most common in men and women over 40 years old. However, even younger people (including those with dark skin) can develop AKs if they live in very sunny climates.

People with weakened immune systems due to underlying illness or the use of immunosuppressive medications are much more likely to develop AKs.

Treatment Options for Actinic Keratoses

There are many AK treatment options. After diagnosing your AKs, your doctor will consider these factors:

  • The number, size, and location of AK lesions
  • Results of past treatments, if treated before
  • Your age and medical history, such immune system function
  • Your personal preferences

Before choosing a treatment, your doctor may recommend a skin biopsy to be sure that your lesions aren't cancerous. This is done by removing all or part of the AK and examining the tissue under a microscope.

Topical Medications for Actinic Keratoses

There are several safe and effective medications for the treatment of AKs. All of these are applied to the skin and available by prescription-only.

Medications approved for the treatment of AKs include the following:

  • 5-fluorouracil or "5-FU" (Carac® or Efudex®)
  • Imiquimod, 5% (Aldara®) or 3.75% (Zyclara®)
  • Diclofenac sodium 3% (Solaraze®)
  • Ingenol mebutate (Picato®)

Each of these medications must be applied regularly as prescribed, over several days or several weeks.

Your personal treatment regimen may vary depending on the medication prescribed, the area to which it is applied, the number of lesions being treated, and your ability to tolerate any irritation or other side effects. This makes it very important to closely follow your doctors’s specific instructions.

Procedures to Treat Actinic Keratoses

Several dermatologic procedures are effective for AK treatment. Your doctor will recommend a procedure that is best suited to the location of the AK and other variables. These procedures may be combined with other AK treatments or medications.

  • Cryosurgery uses liquid nitrogen to freeze off the lesions. It is fast, has a high cure rate, and is well-tolerated by most people. There may be a very brief period of stinging when the liquid nitrogen is first applied, but anesthesia is not required.
  • Shave removal is a procedure during which a scalpel is used to remove the lesion and obtain a specimen for testing.
  • Curettage is often used to remove hard, thickened AKs. In this procedure, a small, round, sharp instrument (called a curette) is used to scrape the AK, either removing a piece of it for biopsy or removing the entire lesion.
  • Lasers deliver an intense light focused on the lesion, removing it along with the top layer of skin. The finely controlled nature of laser removal makes this a useful option for AK on delicate skin, such as the lips (actinic chelitis).
  • Photodynamic therapy uses a substance that is applied to the skin that makes the AK lesions very sensitive to light. A laser or light is then directed onto the skin that destroys the lesions.

Key Points About Actinic Keratosis Treatment

  • Be patient. Some AK treatments take longer than others, and some AKs may require more than one treatment.
  • During treatment, AKs may look worse before they look better. Some medications will make AKs appear that weren’t previously visible.
  • Be aware that your insurance company may require a higher co-payment for some medications or procedures. These higher costs may be offset by shorter healing time or other desired outcomes.

Whether your treatment is an in-office procedure that takes just minutes or a topical regimen that lasts several weeks, your doctor will monitor your skin’s condition to make sure the treatment is working and that side effects are manageable. 

Talk to your doctor if you are concerned about any side effects.

Actinic Keratoses Skin Care Tips

  • AVOID SUN EXPOSURE. The best way to avoid new AKs and skin cancer is to protect your skin from the sun and the damaging ultraviolet (UV) rays. If you can’t avoid spending time outdoors, make sun protection a priority. Use a broad-spectrum sunscreen with a minimum SPF of 30, and cover your skin with long-sleeved shirts, pants, and a wide-brimmed hat.
  • Avoid indoor tanning. Indoor tanning beds also expose the skin to damaging UV rays that increase the risk of developing AKs and skin cancer.
  • Perform skin self-exams. As someone who has already been diagnosed with an AK, you are likely to develop more AKs over time—therefore, it’s important to schedule yearly skin exams with your doctor. You may also be advised to perform regular skin self-exams. The goal is not only to detect new AKs but also to check for changes in existing skin lesions, such as bleeding or a change in size.