Treatments Available For Precancerous Actinic Keratoses- Robin Lewallen M.D. FAAD

If you have an actinic keratosis (AK) on your skin, you are not alone. It is estimated that more than 40 million Americans develop actinic keratoses (AKs) each year. AKs are one of the most common conditions treated by dermatologists.

These precancerous skin growths occur after ultraviolet radiation causes significant DNA damage to your skin cells. Your body may repair some of this damage; however, over many years, this damage can build up and cause precancerous changes to your skin.

 Actinic keratoses can progress into skin cancer called squamous cell carcinoma. Early detection and treatment of actinic keratoses is an important way to reduce the development of squamous cell carcinoma.

In office treatments for precancerous actinic keratoses (AKs):

  • Cryosurgery: During cryosurgery, your dermatologist freezes the AK with liquid nitrogen (–320°F). The goal is to get the AK to fall off. Redness, swelling, and blistering after cryosurgery is common. Some AKs need more than one cryosurgery treatment before they fall off.
  • Photodynamic therapy (PDT): This may be recommended for a patient who continues to get new AKs, has numerous AKs, or AKs that return after treatment. This procedure is a bit time-consuming because it consists of 2 parts.
    • During the first part of treatment, a solution that makes your skin extremely sensitive to light (aminolevulinic acid) is applied to the area with AKs. You’ll sit in the office with this on your skin for 2-3 hours. 
    • During the second part of the treatment, you’ll be treated with a blue light for approximately 16 minutes. The light activates the solution, which can destroy the AKs. As the treated skin heals over 2-7 days, you’ll see new, healthier skin.For 48 hours after treatment, you’ll need to avoid the outdoors during daylight. Most patients with AKs need 2 PDT treatments, with the second treatment given 3-8 weeks after the first.
  • Curettage: If you have an extremely thick AK, this may be the best treatment. During this procedure, your dermatologist first scrapes the AK from your skin, using a technique called curettage. Your dermatologist may follow this with electrodesiccation, which heats the treated area to destroy any remaining AK cells. This procedure may also be done in conjunction with PDT.
  • Laser resurfacing: This may be a treatment option for actinic cheilitis, a precancerous growth on the lip. It works by removing the surface layer of the skin. After treatment, the skin will feel raw and sore. When it heals in 1 or 2 weeks, you will see new, healthier skin. Laser resurfacing can also be done over the entire face. This option is not commonly used alone as it is not as effective as other treatments. Laser treatments are not covered by insurance so patients must pay out of pocket for this procedure. However, laser resurfacing can be a great part of your overall treatment plan by your dermatologist.
  • Chemical peel: This is a medical-grade chemical peel used to destroy the top layers of skin. This option is not commonly used alone as it is not as effective as other treatments. Chemical peels are not covered by insurance so patients must pay out of pocket for this procedure. However, chemical peels can be a great part of your overall treatment plan by your dermatologist.
    In-home treatments for precancerous actinic keratoses with prescription:

    • 5-fluorouracil (5-FU) cream (Efudex, Carac, Tolak): This is a highly effective topical chemotherapy medication that alters the DNA of the cell. You apply this once or twice a day for 2 to 4 weeks. Sometimes your dermatologist may add a medicine called calcipotriene which may reduce the number of days needed for treatment.
    • Tirbanibulin ointment (Klisyri): This is a highly effective topical chemotherapy that blocks microtubules. Microtubules are similar to the “bones” or “skeleton” of the cell and are crucial for cell division. Tirbanibulin was recently approved for the treatment of AKs on the face and scalp. You apply this medication for five days in a row. You want to apply this ointment carefully and avoid applying this ointment around your eyes or on your lips.
    • Diclofenac sodium gel (Solaraze): This topical nonsteroidal anti-inflammatory drug (NSAID) tends to cause less of a skin reaction than 5-FU, but it is usually less effective than 5-FU. You will need to apply it twice a day for 2 to 3 months. While using this medication, you must protect your treated skin from the sun.  
    • Imiquimod cream (Aldara): Imiquimod is in a class of medications called immune response modifiers. It activates the immune system in the areas applied. It should be applied twice a week for 16 weeks.

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