Actinic Keratoses (AK)

The American Cancer Society predicts that one in six Americans will develop an actinic keratosis (AK) in the course of their lifetime. Fair skinned, older populations who sunburn easily are at the highest risk. It is estimated that 60% of people, older than 40 years of age, will have at least 1 actinic keratotic area on their body.

What are Actinic Keratoses?

Actinic keratoses, also known as solar keratoses, are rough, red, scaling skin lesions. AKs develop on sun damaged skin, and are often tender. Besides being unsightly, AKs are estimated to have a 10% risk of converting to a skin cancer, either a basal cell carcinoma or a squamous cell carcinoma.

What causes Actinic Keratoses?

Actinic keratoses result from chronic exposure to the sun’s ultraviolet rays. Overexposure to sunlight can damage one’s skin, resulting in the immediate symptom of a sunburn. However, after many years of exposure, this damage can cause the skin cells to grow abnormally fast. The resulting AK lesions are mostly likely to appear on the most sun-exposed areas: face, lips, ears, bald scalp, back of hands, neck and forearms.

What treatment options are available?

There are many treatment options available in the destruction of AK lesions. The best treatment choice depends on the location of your AK, the number of AK’s you have, your age, your skin color, your general health, and an assessment of the possibility that you might actually have skin cancer.

Cryosurgery
This most common method utilizes a liquid nitrogen spray that destroys tissue in the top layer of your skin. Cryosurgery is 98.8% effective for multiple skin lesions if the AK’s are superficial in nature. Short term or long term lightening or darkening of the skin can result with possible skin texture changes.

Surgical Removal
The AK can be removed by scrapping it with a round sharpened instrument called a curette. A scalpel blade can also be used to shave the AK and obtain a specimen for pathology testing. Bleeding can be controlled by electrocautery – a heat producing electric needle that seals blood vessels. Surgical removal can result in scarring and pigment changes.

Photodynamic Therapy
Photodynamic therapy involves the application of a photosensitizing drug, aminolevulinic acid, followed by its activation with blue wavelength light. Originally used as an alternative to cryosurgery and used on individual lesions, we now use this treatment as a regional application. The entire face is treated with the aminolevulinic acid and after a short absorption period the blue wavelength light is applied. In this way multiple AKs can be treated at once. Only mild redness and peeling is expected from a treatment, and some secondary improvement in skin tone and texture can also occur. A series of 3 treatments is usually performed.

Topical Chemotherapy
A good therapy for decreasing the number of AKs a person develops in the future, Imiquimod (Aldara) and 5-Fluorouracil (Effudex, Carac) creams are another option for treating and preventing AKs. Imiquimod is a biologic response modifying drug that enhances the activity of your natural immune attack on abnormal skin cells, as well as having an effect on the blood supply to tumors. It is used on an alternating-day protocol for four to 16 weeks. As Imiquimod does it work, patients develop significant redness, scabbing and some skin irritation.

Fluorouracil cream is directly toxic to abnormal skin cells. It is generally used daily for two to four weeks, and patients develop similar redness, scabs and skin irritation as with Imiquimod. It’s a less expensive medication with a longer track record. Both of these medications are used primarily on the face, and generally only when there are many AKs or a person has a darker skin type that would heal poorly from destructive treatments like Cryotherapy.

We also use these medicines in combination with Ingemol Mebutate gel to treat multiple AKs on the entire face, scalp or other areas in zonal treatments. These treatments are applied at home for two to 30 days depending on location and product