Actinic Keratoses
As we age, our skin changes as a result of photodamage from years of exposure to the sun. Actinic keratoses (AKs) are precancerous, scaly skin spots that do not heal. Often these lesions are red, crusty and tender to the touch. AKs are not cancer, but it is important because about 10% of AKs do evolve into squamous cell carcinoma. More than 40 million Americans develop AKs every year. AKs commonly develop on skin that has been unprotected or poorly protected from the sun, tanning beds and sunlamps. AKs develop in the outer most layer of the skin.
What are the signs and symptoms of AKs?
AKs develop when the skin has been seriously damaged by the sun’s ultraviolet radiation. AKs are often mistaken for age spots. However, AKs should not be ignored. They appear as rough patches of skin. They may look like pimples or irritated skin. If a person has many rough spots, it may look like an acne breakout or a rash. The rough patches may be red, pink, skin-colored, yellow, brown, tan or gray. Most often an AK causes no other symptoms, but it can itch, burn, bleed and be painful.
If the AK is on the lips, it is called actinic cheilitis (“key-lite-is”) and looks like badly chapped lips. Actinic cheilitis can also cause white patches on the lips. An AK can even appear as a firm, thick knob like an animal horn (“cutaneous horn”). AKs on the lips, ears and nose, and cutaneous horns have a greater risk of transforming into squamous cell carcinoma.
Who is at risk for AKs?
Anyone over 30 is at risk for developing precancerous AKs, but at particular risk are those who have:
- Fair skin
- Blond or red hair
- History of sunburns
- History of outdoor tanning or tanning bed use
- Weak immune systems
- Had an organ transplant
- Outdoor jobs
- Live in sunny climates
We will examine your skin and look for signs of skin cancer including scaly patches of skin or AKs. AKs should be treated to prevent skin cancer.
What are the treatments for AKs?
To be successful the treatment must obliterate the AKs to prevent them from becoming cancerous. The choice of treatment depends on how many AKs you have, where they are located, what they look like, whether you have had skin cancer before, and your other medical conditions.
Topical medications include the following creams that are applied for several weeks:
- 5-Fluorouracil (5-FU) cream applied to the lesions on your face, chest, arms, and back. You can expect redness, swelling and crusting skin as the medication destroys the sun-damaged cells.
- Diclofenac sodium gel
- Imiquimod cream
- Ingenol Mebutate gel
- Patients who use any of these topicals must protect the treated skin from the sun.
In addition to topical medications Dr. Heather Higgins may recommend a procedure such as:
- Cryotherapy – freezing with liquid nitrogen
- Professional medical grade chemical peels
- For thick AKs, it may be necessary to scrape them. This procedure is called curettage.
- Photodynamic Therapy (PDT) is a procedure to apply a chemical solution that makes sun-damaged skin sensitive to light. The pretreated skin is then treated in-office with red or blue light. The light activates the solution and destroys the AKs.
- Laser skin resurfacing
Contact our office to schedule a consultation with dermatologist Dr. Heather Higgins.
