Actinic Keratosis (AK)

Actinic keratosis (AK) is the most common precancerous skin condition diagnosed. They are also called solar keratosis and if left alone and not treated, a small percentage of these lesions can become squamous cell carcinoma. The AKs occur on sun exposed skin and are a sign of significant sun damage. Remember, tanning beds can cause just as much damage as the UV rays from the sun.

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. They may range in color but most are red or pink. They develop on any areas of sun exposed skin but are more common on the face, scalp, ears, neck shoulders and shins.

Prevention:

• Sun Avoidance – wearing a broad brimmed hat, long sleeves and long pants when out in the sun will protect your skin from sun damage. You especially want to avoid sun exposure when the sun’s UV rays are at their strongest which is between 10:00 am and 3:00 pm.
• Sun Block – Consistent use of good quality sunblocks like EltaMD have been shown to decrease the risk of developing AKs. We recommend at least an SPF of 30 or higher. 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.
• Avoid Tanning Beds – tanning beds cause just as much ultraviolet damage to the skin as being exposed to the sun’s ultraviolet rays. The UV rays from the tanning beds also age the skin by destroying collagen and elastin in the skin.

Treatment:

• Medications – there are multiple topical medications that can treat actinic keratosis. They will need to be used for a few weeks and can cause irritation, itching, burning and scaling for a few weeks. These tend to be used in patients with diffuse AKs over their face or chest.
• Photodynamic therapy – this is when a topical solution is applied to the skin and then allowed to incubate on the skin. The chemical solution is then activated by light. This can be natural sunlight or artificial lights in the clinic.
• Cryotherapy – this is a very common way to treat individual AKs and destroys them by freezing them. The treated skin may form a blister and the AK will fall off on its own. It is not a good choice for diffuse AKs and is better suited for individual AKs.
• Chemical Peels – the chemical peels need to treat actinic keratosis should only be performed in a physician’s office. These chemical peels are much more invasive than the light chemical peels you get at a spa or with an aesthetician.
• Electrodessication and curettage – this is where the affected area will be anesthetized and then an electrocautery unit is used to destroy the cells and then the cells are scraped off. This method has a higher incidence of scarring and skin color changes.
• Fractional Lasers – the Fraxel laser has FDA clearance for the treatment of actinic keratoses. Other fractional lasers such as DeepFX and ActiveFX have also shown improvement in AKs.
• Laser resurfacing – Full laser resurfacing can be beneficial to remove the atypical cells associated with the actinic keratoses. The resurfacing lasers are the Lumenis Ultrapulse CO2 and the Sciton Erbium laser. Full resurfacing has been shown to eliminate the actinic keratoses. Full resurfacing can only be used on the face.