Actinic Keratosis: Need-to-Know Info

Featured Article, Other Skin Conditions, Skin Center
on January 14, 2013

Did you know that you can actually feel and, sometimes, even see the earliest sign of skin cancer? Called actinic keratosis (AK), these red or pink blemishes typically pop up on areas of the skin that have been routinely exposed to the sun, namely the face, lips, back of the hands and scalp (if you’re bald).

AKs are the third most common skin problem treated by dermatologists, reports the American Academy of Dermatology. What’s more, an estimated 58 million Americans have actinic keratosis, according to the Skin Cancer Foundation. That’s a lot of sun damage and plenty of potential skin cancers. Some 10 percent of AKs will eventually progress to squamous cell skin cancer, less serious than melanoma, but still dangerous: An estimated 700,000 cases of squamous cell cancer are diagnosed each year and some 2,500 Americans die from it.

AK is the consequence of unprotected sun exposure during your childhood and teen years. “Dermatologists joke that the skin has a memory like an elephant,” says dermatologist Dr. Ellen Marmur, founder of Marmur Medical in New York City and an associate clinical professor of dermatology and genetics and genomic sciences at Mt. Sinai Medical Center. But—thankfully—you’re not doomed to pay for your sun sins of the past. Here’s what you need to know about actinic keratosis now.

RELATED: What You Should Know About Skin Cancer

How to ID an AK. “An AK is typically a little rough, sand-paperish-like red or pink spot on an sun exposed area of skin,” says Marmur. An AK on the lips may feel like a spot that is constantly chapped. AKs can also be tan or flesh-colored and raised. In rare cases, an AK can resemble a hard, curled mini horn.

It’s unusual to develop only one AK. “AKs appear in crops,” says Marmur. So if you have one AK, you’ll probably get more down the road.

Don’t “wait and see.” If you suspect you have an AK, see a dermatologist. A 2007 study published in the journal Dermatologic Surgery and co-authored by Marmur found that it takes about two years for an untreated AK to progress to squamous cell cancer.

And while some will progress to skin cancer, others will clear up on their own. But since there is no way to tell which AK will do what, each and every AK must be treated.

Treatment options. How an AK is treated will depend upon how many you have, where they are and how compliant you’ll be with treatment. “The goal is to find the sweet spot, to treat these things in a way that is effective, acceptable and tolerable ” says Marmur. AK treatments include:

  • 5-fluorouracil ointment. This chemotherapeutic cream, known as 5-FU, stops the growth of abnormal cells. Applied to the lesions once or twice a day for two to four weeks. 5-FU may cause redness, swelling and crusting and can be uncomfortable. It may take up to three weeks for these side effects to clear up.
  • Imiquimod 5% cream. Also used to treat genital warts (though in a different concentration), this cream is applied to the AK twice a week for up to 16 weeks. A lower-concentration cream can be applied in an accelerated six-week dosing regimen. It can cause redness, skin irritation and flu-like symptoms.
  • Diclofenac. A non-steroid anti-inflammatory cream, diclofenac is combined with hylauronic acid in a preparation that is used twice a day for up to 90 days. Side effects include itching, redness, dry skin, burning, tingling and sometimes sun sensitivity.
  • Ingenol mebutate. Approved by the U.S. Food and Drug Administration in 2012, this topical gel comes in two different concentrations. One concentration is applied daily for two days to AKs on the trunk and limbs; the other is applied daily for three days to AKs on the face and scalp. Side effects include redness, swelling, crusting and ulcerations.
  • Crysosurgery. During this procedure, liquid nitrogen is applied to the AK. It freezes the lesion, causing it to crust and fall off. Redness and swelling can occur. A downside; “It can leave permanent white spots, which patients hate,” says Marmur.
  • Laser surgery. A special laser can remove the AK and affected tissue beneath it. Since the procedure can be uncomfortable, you may need local anesthesia. Skin discoloration and scarring can occur.
  • Photodynamic therapy. Topical-5 aminolevulinic acid (5-ALA) is painted on the AK and then the area is exposed to a special light that destroys the AK. Some redness and swelling may result. “Since the doctor does this treatment, compliance is 100 percent,” notes Marmur. Another plus: “AKs are markers of sun damage in an entire area,” explains Marmur. “If you have one AK on your forehead, you probably have 10 that are invisible.” Dermatologists call this the “field” effect.  With photodynamic therapy, “the whole area can be treated,” says Marmur. “You can get very pro active, which is wonderful.”
  • Chemical peel. Applying trichloroacetic acid (TCA) or another chemical to the AK causes it to slough off but the treatment can irritate skin.
  • Combination therapies. Sometimes a combination of treatments will be more effective than one alone. For example, Marmur may perform a chemical peel and, a week later, photodynamic therapy. “The peel allows the medicine to better penetrate the lesion,” says Marmur.

Post-treatment TLC. Follow-up visits to the dermatologist are a must for anyone who has been treated for actinic keratosis. Marmur, for instance, sees patients every three to six months following AK treatment. “Many studies on treatments other than surgery show a 50 to 85 percent cure rate,” says Marmur. “But most of these studies have a follow-up time of three to six months.” That AK on your lip or face might come back at nine months, for instance.

And don’t assume that one treatment will get rid of an AK. “Patients must know it is going to take more than one treatment,” she says. “You want to kill that AK,” she says. “It’s easier to get rid of it early than when it is more developed.”

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