Actinic Keratosis

What is Actinic Keratosis?

Actinic Keratosis (plural: Actinic Keratoses, AK) are premalignant lesions of the skin that, when left untreated, can potentially develop into skin cancer. The primary cause for AK is chronic sun damage. There are different stages of AK, ranging from mild or moderate to severe, being more or less scaly and varying in color from skin color to pink or reddish. AKs often occur as multiple lesions on skin areas frequently exposed to the sun, e.g. the face, scalp, neck, ears and hands.

Who is affected with Actinic Keratoses?

Since the damage caused by frequent sun exposure is accumulated over many years, people in the second half of their life are most frequently affected with actinic keratoses (age 40 and older). The fact that tanning has been very popular for decades has led to an increase in AK with more and more people being affected as they grow older. But not only sun worshippers are at risk. Even if you have not been sunbathing, simple outdoor activities, e.g. gardening, walks in the sun or working outside, can amount to enough damage that may put you at risk for AK. In particular fair skinned people and those with a compromised immune system, e.g. organ transplant recipients, are more likely to develop AKs.

Why treat Actinic Keratoses?

AK is the most frequent precancer. It can potentially develop into squamous cell carcinoma (SCC), the second most common skin cancer, which can become life threatening if untreated and may require surgery.

What does Actinic Keratosis look and feel like?

In the early stages, actinic keratoses may not be very prominent when looking in the mirror. These lesions or plaques are felt as a rough surface, similar to that of sandpaper. Early AKs may be easier felt than seen. The skin may be scaly and of red or brownish color. This appearance can be accompanied by itching. The size of a plaque can range from as small as a freckle to the size of a thumbnail or larger. As the disease progresses, multiple actinic lesions can cover larger areas of the skin, on the surface and beneath, resulting in premalignant fields.

Actinic Keratosis Treatment

There are many effective treatments for removing actinic keratosis. Common treatments for actinic keratosis include freezing (liquid nitrogen treatments aka cryosurgery), prescription topical chemotherapy medications, or photodynamic “red light” therapy.

What is photodynamic therapy?

Photodynamic therapy (PDT) is a highly effective, non-invasive, irradiation-free light therapy to treat AK’s on the face and scalp.  

This procedure is performed in the office with the application of a topical solution called Ameluz followed by exposure to a red light device. This causes selective destruction to the precancers in the area that is treated. Following the treatment patients typically experience redness and must avoid the sun for 48 hours post-treatment. Some peeling may occur, but overall the procedure is well tolerated. A significant reduction in the number of precancers is seen after 1 treatment, but your dermatology provider may recommend a second treatment depending on the amount of photo-damage you have in a given area.