The treatment of actinic keratosis depends on the specific case and severity of the symptoms. Possible options for treatment include topical creams and gels, cryotherapy, curettage and excision. Each of these is covered in more detail below.
It is not always necessary to treat or remove the patches characteristic of actinic keratosis. If they are not causing troublesome symptoms for the patients, the best course of action may be to implement a watchful waiting technique to assess for further changes. In this case, patients should be advised to seek further medical advice if they notice any changes in the affected area, such as rapid grow of patches, bleeding, pain or the formation of an ulcer.
Topical creams and gels may be used to treat actinic keratosis as they remove the abnormal skin patches by causing necrosis of the cells. They can easily be applied to the affected areas of the skin, which should be done daily for several weeks.
The exact dosage and application depend on the formulation being used. There are several products available that may be used including:
- Creams: 5-fluorouracil cream or imiquimod cream
- Gels: diclofenac gel or ingenol mebutate gel
It is important to wash hands well both before and after the application of cream of gel. Side effects such as weeping or blistering of the skin may occur due to the effect of the cream or gel on the normal skin cells in the area.
In many cases, removal of the actinic keratosis is suggested. This is most commonly due to concerns that it may develop into squamous cell carcinoma, although it may sometimes be performed for cosmetic purposes.
Cryotherapy, which involves freezing patches of skin with liquid nitrogen, works by causing the damaged skin cells to blister and shed.
Curettage is the scraping of the abnormal skin patches with a curette so that they can be removed. It is usually performed with local anesthesia to reduce sensation as the cells are scraped away. This method is ideal for thicker patches or early cancers. Cautery is a technique often performed after curettage, which uses heat to stop bleeding after the removal of the cells, usually leaving behind a small scar.
Excision is a technique used to cut the skin patch out, usually when there is a suspicion that it may be cancerous. This may be done under local anesthetic with a scalpel, and the wound can then be closed with stitches.
With both curettage and excision, a skin sample is usually taken from the part that is removed and examined under a microscope to confirm the diagnosis as cancerous and guide further treatment recommendations.
There are also several other types treatments that can sometimes be used in the treatment of actinic keratosis. Photodynamic therapy (PDT) uses a light source to activate a photosensitive cream applied to the area that leads to necrosis of the cells. Additionally, laser resurfacing can be used to remove the skin patches with a laser beam.
Following treatment for actinic keratosis, it is essential that patients protect their skin from future exposure to UV radiation, as this can worsen the condition and cause the formation of new patches.
It is recommended that patients avoid staying outside in the sun between 10 am and 2 pm, when the UV radiation is strongest. If being in the sun is necessary, they should wear appropriate protective clothing, such as a long-sleeved shirt and wide-brimmed hat. The application of sunscreen is also important, even on cloudy days.
Finally, patients should keep an eye on their skin for any changes and seek medical advice if they notice anything out of the ordinary.
Reviewed by Afsaneh Khetrapal BSc (Hons)