Actinic Keratosis

Dr Catherine Fernando

IYASU Healthcare

East Lothian's Private GP Service

Explains how medical therapy can treat actinic keratoses

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Actinic keratosis (AK) is a common skin condition caused by long-term exposure to ultraviolet (UV) light from the sun or tanning beds. It is considered a precancerous lesion because a small percentage can progress to squamous cell carcinoma (SCC), a type of skin cancer. Early diagnosis and treatment are important, and the good news is that AKs are very manageable.

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Who Does Actinic Keratosis Affect?

Anyone can develop AKs, but they are most common in:

• People over 40, especially those who have spent years outdoors

• Individuals with fair skin, light eyes, and light hair

• People who sunburn easily

• Outdoor workers (farmers, gardeners, construction workers)

• People who use tanning beds or have a history of high sun exposure

• Those with a weakened immune system

AKs usually appear on areas that get the most sun exposure: the face, scalp (especially in balding men), ears, neck, chest, forearms, and back of the hands.

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How Common Are Actinic Keratoses?

Actinic keratosis is very common, especially in countries with strong sunlight. In some regions, up to 1 in 4 adults over age 60 have at least one AK. Many people have multiple lesions at once.

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What Do Actinic Keratoses Look and Feel Like?

They can vary, but typical features include:

• Rough, dry, or scaly patches

• Skin-colored, pink, red, or brown spots

• A gritty or sandpaper-like texture

• Flat or slightly raised areas

• Sometimes tender when touched

AKs may come and go, but even if they temporarily improve, they still warrant monitoring and treatment.

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Lifestyle Measures to Reduce AKs and Protect Your Skin

Protecting your skin from further UV damage is an essential part of treatment:

1. Sun Protection

• Use a broad-spectrum SPF 30 or higher sunscreen daily

• Wear wide-brimmed hats, sunglasses, and protective clothing

• Seek shade between 10 a.m. and 4 p.m.

• Avoid tanning beds completely

2. Skin Self-Checks

• Examine your skin monthly for any changes

• Take note of new or changing patches, bumps, or sores

3. Regular Dermatology Checkups

• People with a history of AK should have periodic skin exams

These steps help prevent new AKs and reduce the risk of transformation to skin cancer.

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Treatment Options for Actinic Keratosis

Your doctor may recommend one or more treatments depending on how many lesions you have, their location, and how they look.

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1. Cryotherapy (Freezing)

Cryotherapy uses liquid nitrogen to freeze and destroy the abnormal cells.

• Usually used for single or small numbers of AKs

• The treated spot may sting, blister, or peel

• Healing occurs over 1–2 weeks

Cryotherapy is quick, effective, and commonly used in clinics.

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2. Topical Treatments (Creams and Gels)

Topical treatments are especially helpful when there are multiple AKs or large areas of sun-damaged skin (“field treatment”).

Common topical options include:

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• 5-Fluorouracil (5-FU)

A traditional treatment applied for several weeks. It works by removing abnormal precancerous cells but can cause redness and irritation during the course of therapy.

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• 5-Fluorouracil combined with Calcipotriol (5-FU-Cal)

This newer combination treatment has gained attention because it significantly shortens treatment time.

• Typically applied twice daily for 4 days, instead of 4 weeks with standard 5-FU

• Often produces a strong but short-lived reaction (redness, crusting)

• Shown to be highly effective in clearing AKs in the treated area

• It is one of the most efficient field treatments currently available.

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• Imiquimod

A cream that stimulates the immune system to clear abnormal cells. Used over several weeks.

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• Diclofenac gel

A milder option with fewer side effects but requires longer use.

Warning Signs: When AK Might Be Turning Into Squamous Cell Carcinoma

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While the majority of AKs do not turn into cancer, some may progress to squamous cell carcinoma (SCC). It is important to look for:

• Rapid growth

• A spot that becomes thick, hard, or wart-like

• Persistent tenderness or pain

• Ulceration, bleeding, or crusting that does not heal

• A lesion that becomes significantly more raised than before

 

If you notice any of these changes, you should seek medical attention promptly. SCC is very treatable when caught early.

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When to See a Doctor

You should consult a doctor or dermatologist if you:

• Think you may have actinic keratosis

• Notice any changes in an existing AK

• See a persistent sore, growth, or scaly patch

• Would like advice about the best treatment option

• Need guidance on how to protect your skin and monitor for skin cancer

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Everyone deserves access to accurate diagnosis, supportive care, and effective treatment. If you think you may have actinic keratosis, make an appointment to see Dr Catherine Fernando at IYASU Healthcare. She can confirm the diagnosis, provide safe and effective treatment and ensure that any suspiscious spots are evaluated properly. 

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