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Actinic Keratosis

What are all these rough spots?

Actinic keratosis, solar keratosis and “AK” are all referring to a premalignant (pre-skin cancer) condition that is caused by too much cumulative sun exposure.  It’s not uncommon to have multiple AKs at one time.  Both men and women with fair skin and those with multiple sun burns throughout their lives are more at risk of developing an AK.  These premalignant cells typically cause a red rough spot to appear on the skin.  A lot of times it feels like sand paper when you touch it and sometimes that is the only way you know it’s there.  They don’t always have color; only texture.  It’s not uncommon to find these spots on your scalp, forehead, nose, lips, cheeks, ears, chest, forearms, and tops of hands.  As you can see these can pop up anywhere on your body where there has been too much sun exposure.

Because actinic keratosis is a premalignant skin condition it does have the potential to turn into a common form of skin cancer; specifically, squamous cell carcinoma (SCC).  The good news is not all actinic keratoses turn into squamous cell skin cancer, but some do.  This is the reason it is important to treat these spots before they transform into a skin cancer.

 

Treatment Options

Treatment for actinic keratosis is fairly straight forward.  There are treatments that you can do at home and some require a trip to the office.  Some at home treatments include fluorouracil (Efudex), imiquimod (Aldara), and ingenol mebutate (Picato).  These creams are applied anywhere from days to weeks and typically reserved for patients who have numerous AKs rather than just a few.  Side effects are common, such as red irritated skin that can turn into scabs.  Afterwards, once your skin has a chance to recover from treatment, typically you are left with much smoother skin and most importantly, less AKs.  Unfortunately, this is not a guarantee you’ll never have another AK again.

An in-office treatment can include liquid nitrogen cryotherapy.  This is the most popular treatment for AKs.  It is quick, the cure rate is high, and most patients tolerate it just fine.  The treated area turns red, sometimes blisters, and in about 14 days resolves.  Another treatment you need to come into the office for is photodynamic therapy, PDT or “Blue Light”.   This is a multi-step process where a photosensitizing medication is applied to the treatment area and then activated by the blue light.  This is typically used for the face, scalp, and ears.  Expect a sunburn afterwards and healing times anywhere from one to a couple weeks.

Combine Treatment Options

Sometimes multiple therapies are combined to give the best outcomes.  For instance, you may be asked to use Efudex for 5 days and then immediately be treated with PDT.  Or maybe some thicker AKs will be thinned out with a curette before PDT.  Everyone is different and each treatment is tailored to the specific patient to obtain the best possible outcome.  Remember that it is important to continue to follow up with your skin care provider on a regular basis even after treatment.

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