Treatment Options for Actinic Keratosis

It is important to see a doctor if you suspect you have AK.  In most cases, especially in younger people, AKs remain benign or disappear on their own. Some AKs may progress to skin cancer (squamous cell carcinoma).

Once you have been diagnosed with AK, there are many options available for treatment:

Cryosurgery

This is the most widely used treatment. It is especially useful when a limited number of lesions are present. Liquid nitrogen is applied to the growths with a cotton-tipped applicator or spray device. This freezes them without requiring any cutting or anaesthesia. They subsequently blister or become crusted and fall off. The procedure may be repeated to ensure total destruction of premalignant cells. Some temporary redness and swelling can occur. In some patients, pigment may be lost resulting in a white scar.

Topical medications

5-fluorouracil (5-FU) works by blocking DNA synthesis and therefore preventing rapidly dividing cells from growing and multiplying resulting in cell death. The cream is applied for 2 to 4 weeks.

Imiquimod works by stimulating the body’s immune system. Imiquimod binds to immune cells in the skin causing the release interferon (natural defense chemicals) which destroy the precancerous AK lesion. The cream is applied from 4 to 16 weeks depending on the product used.

Ingenol mebutate is thought to work in 2 different ways: by a direct toxic effect on damaged cells and by stimulating the immune system to remove remaining damaged skin cells. The treatment is completed in 2 or 3 days.

Topical treatments can be rather painful and temporarily disfiguring due to inflammation and reddening and swelling of the area,  flaking and scabbing. The reactions begin within days after starting treatment and can occur throughout treatment period. Complete healing of lesions may take 1 to 2 months after stopping treatment.

Photodynamic Therapy (PDT)

PDT can be especially useful for lesions on the face and scalp. Topical 5-aminolevulinic acid (5-ALA) is applied to the lesions at the physician’s office. As soon as an hour later, those medicated areas can be activated by a special wavelength of light. This treatment selectively destroys lesions while causing minimal damage to surrounding normal tissue. Some redness and swelling can result.

Curettage and Electrodessication

The growth is scraped off with a curette and the site desiccated with an electrocautery needle. When treating AKs, the procedure is typically repeated a few times to help assure that all pre-cancerous cells are eliminated. Local anaesthesia is required.

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