Actinic Keratosis

An actinic keratosis (AK) is most often considered a precursor lesion to a squamous cell skin cancer. An AK forms when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor tanning. Most people get more than one AK and many patients with severely sun damaged skin may present with diffuse flaking and dryness of the face that does not improve with moisturizer. This is referred to as actinic field damage.

By seeing a board-certified dermatologist for skin cancer screening exams, the AKs can be identified and treated before they become skin cancer. If skin cancer does develop, it can be caught early when treatment often cures skin cancer.

Most AKs develop on areas of the skin subject to chronic sun exposure and present without symptoms, however, patients may notice the following skin changes:

  • Rough-feeling patch on the skin that cannot be seen.
  • Rough patch or growth that feels tender when rubbed.
  • Waxing and waning of the dry patch.
  • Itching or burning.
  • Lips may be involved and feel constantly dry.

There are many treatments for AKs. Some treatments Dr. Kittridge will perform in the office. Other treatments you she will prescribe for you to use at home.

In-office procedures:

  • Cryotherapy: Destroys visible AKs by freezing them with liquid nitrogen. The treated skin often blisters and peels off within a few days to a few weeks. When the skin heals, you may see a small white mark.
  • Chemical peel: This is a medical chemical peel. You cannot get this peel at a salon or from a kit sold for at-home use. Dr. Kittridge preforms a strong peel that penetrates to medium/deep layers of skin. Dr. Kittridge has undergone more extensive training in chemical peeling and is a member of the International Peels Society.
  • Curettage: Dr. Kittridge may carefully remove a visible AK with an instrument called a curette. After curettage, new healthier skin will appear.
  • Photodynamic therapy (PDT): A solution is applied to make the skin more sensitive to light. After a few hours, the treated skin is exposed to a visible light, such as blue or laser light. The light activates the solution and destroys AKs. As the skin heals, new healthy skin appears.

Dr. Kittridge may prescribe the following topical medicines that you can use at home to treat AKs:

  • 5-fluorouracil (5-FU) cream: This is topical chemotherapy medication that you apply to the skin. Patients typically apply 5-FU twice daily for 2 to 4 weeks. A person who has lots of damaged skin may need to use 5-FU longer or repeated, pulsed courses of treatment. 5-FU causes sun-damaged areas to become red, crusted, swollen and sore. As the skin heals, healthy skin appears. Sometimes, Dr. Kittridge will compound this medication with a topical vitamin D analogue that decreases the treatment time to less than a week in most cases.
  • Imiquimod cream: This cream helps boost your body’s immune system so that your body can get rid of the diseased skin cells. Most patients apply imiquimod for several weeks. Similar to 5-FU, imiquimod causes the skin to redden and swell. After you stop using the medicine, the skin heals.
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