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Treatments and drugs
By Mayo Clinic staffIt's impossible to tell exactly which patches or lesions will develop into skin cancer. Therefore, actinic keratoses are usually removed as a precaution. Your doctor can discuss with you which treatment is appropriate for you. With most of these procedures, the treated area takes a few days to several weeks to heal.
Actinic keratosis treatment options may include:
- Freezing (cryotherapy). An extremely cold substance, such as liquid nitrogen, is applied to skin lesions. The substance freezes the skin surface, causing blistering or peeling. As your skin heals, the lesions slough off, allowing new skin to appear. This is the most common treatment, takes only a few minutes and can be performed in your doctor's office. Side effects may include blisters, scarring, changes to skin texture, infection and darkening of the skin at the site of treatment.
- Scraping (curettage). In this procedure, your surgeon uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which a pencil-shaped instrument is used to cut and destroy the affected tissue with an electric current. This procedure requires a local anesthetic. Side effects may include infection, scarring and changes in skin coloration at the site of treatment.
- Creams or ointments. Some topical medications contain fluorouracil (Carac, Fluoroplex, Efudex), a chemotherapy drug. The medication destroys actinic keratosis cells by blocking essential cellular functions within them. Another treatment option is imiquimod (Aldara), a topical cream that modifies the skin's immune system to stimulate your body's own rejection of precancerous cells. Diclofenac gel (Voltaren, Solaraze), a nonsteroidal anti-inflammatory topical drug, may help, too. Side effects may include skin irritation such as pain, itching, stinging or burning sensation, crusting, and sensitivity to sun exposure at the site of treatment.
- Chemical peeling. This involves applying one or more chemical solutions — trichloroacetic acid (Tri-Chlor), for example — to the lesions. The chemicals cause your skin to blister and eventually peel, allowing new skin to form. Skin peeling usually lasts for five to seven days. Other side effects may include stinging or burning sensation, redness, crusting, changes in skin coloration, infections and, rarely, scarring. This procedure may not be covered by insurance, as it's often considered cosmetic.
- Photodynamic therapy. With this procedure, an agent that makes your damaged skin cells sensitive to light (photosensitizing agent) is either injected or applied topically. Your skin is then exposed to intense laser light to destroy the damaged skin cells. Side effects may include redness, swelling and a burning sensation during therapy.
- Laser therapy. A special laser is used to precisely remove the actinic keratoses and the affected skin underneath. Local anesthesia is often used to make the procedure more comfortable. Some pigment loss and scarring may result from laser therapy.
- Dermabrasion. In this procedure, the affected skin is removed using a rapidly moving brush. Local anesthetic is used to make the procedure more tolerable. The procedure leaves skin red and raw-looking. It takes several months for the skin to heal, but the new skin generally appears smoother.
Talk to your doctor about your treatment options. The procedures have various advantages and disadvantages, including side effects, risk of scarring, and the number of treatment sessions required. Afterward you'll likely have regular follow-up visits to check for new patches or lesions.
References
- Jorizzo J, et al. Actinic keratosis. http://www.uptodate.com/home/index.html. Accessed Oct. 28, 2010.
- Actinic keratoses. American Academy of Dermatology. http://www.aad.org/public/publications/pamphlets/sun_actinic.html. Accessed Oct. 28, 2010.
- Shoimer I, et al. Current management of actinic keratoses. Skin Therapy Letter. 2010;15:5.
- Habif TP. Premalignant and malignant nonmelanoma skin tumors. In: Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Edinburgh, U.K.; New York, N.Y.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-7234-3541-9..00030-4--s0300&isbn=978-0-7234-3541-9&type=bookPage§ionEid=4-u1.0-B978-0-7234-3541-9..00030-4--s0300&uniqId=224808926-3#4-u1.0-B978-0-7234-3541-9..00030-4--s0300. Accessed Oct. 28, 2010.
- Duncan KO, et al. Epithelial precancerous lesions. In: Wolff K, et al. Fitzpatrick's Dermatology in General Medicine. 7th ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/content.aspx?aID=2981340. Accessed Oct. 28, 2010.
- Sunscreens/sunblocks. American Academy of Dermatology. http://www.aad.org/public/publications/pamphlets/sun_sunscreens.html. Accessed Oct. 28, 2010.
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