Actinic Keratoses are thought to affect 58 million people in the US. That is a staggering number. Up to 10% of these lesions may become skin cancers. Most commonly they become squamous cell skin cancers, but occasionally they may become a basal cell skin cancer. It is for this reason that dermatologist recommend treatment of these lesions.
Cryotherapy & Freezing
The most common treatment for actinic keratoses is cryotherapy or freezing. This treats individual lesions. The advantage of this is that it is performed by a physician at the office. It is done quickly. the healing process lasts about 1 week. The disadvantage is that it only treats individual lesions not the entire area is treated. Generally, the spots that are obvious are just the tip of the iceberg. There is usually more underlying damage than can be seen. There are other treatments which are more effective at targeting all the sun damage.
One of these is topical creams such as fluorouracil (Efudex, Carac, Fluoroplex), diclofenac (Solaraze), imiquimod (Aldara, Zyclara), and ingenol mebutate (Picato). All these treatments involve applying a cream to the affected area for a period of time, which results in redness and destruction of the precancerous lesions. There can be pain, sensitivity, and scabbing of the lesions. The entire process can take several weeks to heal the spots completely, but these treatments are usually very effective when completed properly. If you are interested there is a blog documenting a woman’s experience with efudex cream with excellent pictures.
Another treatment option for actinic keratoses is Blu-U treatment. This is currently considered the most effective treatment for actinic keratoses of the face and scalp. Treatment consists of application of a light sensitizing medication which is preferentially absorbed by the AKs. There is a 1 hour waiting period then the face or scalp is exposed to a horseshoe shaped blue light. There is a stinging, tingling, or burning sensation in the areas which are reacting most strongly. We do recommend taking an anti-histamine such as claritin (loratadine) prior to the treatment to help minimize this. The treatment under the light lasts for 16 minutes and 40 seconds. The most uncomfortable part is the first 6 minutes. We do provide a fan to reduce the discomfort. The treatment should be repeated 6-8 weeks from the first one. Post treatment sunlight and strong lights should be avoided for 48 hours. After that time no special precautions are necessary.