Actinic keratoses often feel different before they look different. Many people notice a rough, scaly patch on the skin that doesn’t go away, even when it’s small or barely visible.
These lesions are common, especially in areas that have seen years of sun exposure. While actinic keratoses are usually not dangerous, they are considered pre-cancerous, which means evaluation and monitoring are important.
Solar keratosis, AKs
Precancerous — most common type
Professional evaluation and treatment
What Is Actinic Keratosis?
Actinic keratosis, often abbreviated as AK (also called solar keratosis), is a rough, dry, or scaly patch of skin caused by long-term exposure to ultraviolet (UV) radiation. It is the most common precancerous skin condition diagnosed.
How they develop: Actinic keratoses tend to start off as small patches that can often be felt before they are seen. They can feel like sandpaper on the skin even though there is minimal visible lesion. Over time, these lesions can become more prominent — they may become slightly raised with a rough texture.
Appearance:
Common locations (sun-exposed areas):
Why Actinic Keratosis Develops
Actinic keratosis develops as a result of cumulative sun damage over time.
How UV damage leads to AKs: Ultraviolet radiation causes changes in skin cells that can lead to abnormal growth. These changes build slowly, often over many years of sun exposure. The damaged cells don’t behave normally, forming the rough, scaly patches characteristic of AKs.
UV sources:
Important to know: The UV rays from tanning beds also age the skin by destroying collagen and elastin. AKs are a sign of significant sun damage, which also increases risk for skin cancer.
Actinic keratoses are closely related to other signs of chronic sun exposure, such as solar elastosis, and are more common in people with a history of significant sun exposure.
Why Actinic Keratosis Should Be Evaluated
Unlike many benign skin growths, actinic keratoses have the potential to progress into skin cancer if left untreated.
The risk: A small percentage of untreated actinic keratoses can become squamous cell carcinoma, a type of skin cancer. While not every AK becomes cancerous, it’s not possible to predict which ones will.
Warning signs that require evaluation:
Why professional evaluation matters: Only a qualified provider can properly diagnose actinic keratosis and determine whether treatment or monitoring is appropriate. Early treatment reduces the risk of progression to skin cancer.
How to Prevent Actinic Keratosis
Prevention is essential — both to avoid new AKs and to support treatment results.
Sun avoidance: Wearing a broad-brimmed hat, long sleeves, and long pants when out in the sun will protect your skin from sun damage. Avoid sun exposure when UV rays are strongest — between 10:00 AM and 3:00 PM.
Daily sunscreen: Consistent use of good quality sunblocks like EltaMD has been shown to decrease the risk of developing AKs. We recommend at least SPF 30 or higher.
Coverage tip: If you need to cover your body, it takes the amount of a full shot glass to get the sun protection listed on the sunblock. Most people significantly under-apply.
Avoid tanning beds: Tanning beds cause just as much ultraviolet damage to the skin as natural sun exposure. They also accelerate skin aging by destroying collagen and elastin.
What to Expect During a Consultation
A consultation at Lazaderm is focused on safety, education, and clarity.
During your visit, your provider will:
If treatment is recommended, the process and healing expectations will be explained clearly before proceeding.
Setting Realistic Expectations
Actinic keratosis treatment is focused on reducing cancer risk, not cosmetic improvement alone.
What to understand:
The goal is to remove precancerous cells and reduce your risk of skin cancer while supporting overall skin health.
Evaluation is the first and most important step when actinic keratosis is suspected. Treatment options depend on the number of lesions, their location, and your medical history. Some treatments are better for individual spots, while others are designed to treat larger areas with diffuse damage.
Topical medications can treat actinic keratosis, particularly when there are diffuse AKs over larger areas like the face or chest.
How they work: Prescription creams or gels are applied to the affected areas for several weeks. The medication targets and destroys abnormal cells.
What to expect: These treatments will need to be used for a few weeks and can cause irritation, itching, burning, and scaling during the treatment period. This reaction is expected and indicates the medication is working.
Best for:
Your provider will prescribe the appropriate medication and explain the treatment timeline.
Photodynamic therapy uses a combination of a topical solution and light activation to destroy abnormal cells.
How it works: A topical photosensitizing solution is applied to the skin and allowed to incubate. The chemical solution is then activated by light — this can be natural sunlight or artificial lights in the clinic. The activation destroys the precancerous cells.
Best for:
PDT can also improve overall skin appearance in the treated area.
Chemical peels can treat actinic keratosis, but the peels used for AKs are significantly different from cosmetic peels.
Important distinction: The chemical peels needed to treat actinic keratosis should only be performed in a physician’s office. These medical-grade peels are much more invasive than the light chemical peels you might get at a spa or with an aesthetician.
How they work: Stronger chemical solutions penetrate deeper into the skin to destroy abnormal cells while promoting healthy cell regeneration.
Best for:
Fractional lasers offer an effective treatment option for actinic keratosis with FDA clearance.
FDA-cleared option: The Fraxel laser has FDA clearance specifically for the treatment of actinic keratoses. Other fractional lasers such as DeepFX and ActiveFX have also shown improvement in AKs.
How they work: Fractional lasers treat tiny columns of skin while leaving surrounding tissue intact. This destroys abnormal cells while promoting healthy skin regeneration and collagen remodeling.
Best for:
Full laser resurfacing can be beneficial to remove the atypical cells associated with actinic keratoses, particularly for patients with extensive sun damage.
Options available:
Our preference: We prefer the Sciton Erbium laser as it has less risk of causing permanent pigmentation changes to the skin.
Results: Full resurfacing has been shown to eliminate actinic keratoses while also dramatically improving overall skin quality, texture, and tone.
Important limitation: Full resurfacing can only be used on the face. It requires more significant downtime but provides the most comprehensive treatment for extensive facial sun damage with multiple AKs.
Best for:
Your provider will recommend the most appropriate treatment based on your specific situation.
For individual AKs: Cryotherapy or electrodesiccation
For diffuse AKs across larger areas: Topical medications, photodynamic therapy, or chemical peels
For facial AKs with overall sun damage: Fractional lasers or full resurfacing
Combination approaches: Some patients benefit from combining treatments — for example, cryotherapy for prominent individual lesions plus topical medication for surrounding areas with early changes.
Ongoing care: Regardless of treatment choice, regular skin checks and consistent sun protection are essential parts of long-term management.
If you have a rough or scaly skin lesion that hasn’t healed, professional evaluation is important. Actinic keratosis is the most common precancerous skin condition — early detection and treatment can reduce your risk of skin cancer.
