An AK forms when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor tanning. Most people get more than one AK. When you have more than one AK, you have actinic keratoses, or AKs. AKs are very common and one of the most frequent reasons for seeing a dermatologist.
Anyone who has many AKs should be under a dermatologist’s care. Most people who have many AKs continue to get new AKs for life. AKs are considered precancerous. Left untreated, AKs may turn into a type of skin cancer called squamous cell carcinoma.
By seeing a dermatologist for checkups, the AKs can be treated before they become skin cancer. If skin cancer does develop, it can be caught early when treatment often cures skin cancer.
Signs of actinic keratosis
Scaly feeling on sun-damaged skin
You often feel an AK before you see it. This man felt a sandpaper-like patch on his sun-damaged neck before an AK appeared.
Rough, reddish, raised bumps
Most AKs look like raised, scaly, red bumps on the skin. This 57-year-old woman has several AKs on her face.
Brown patches
The AKs on this man’s face appear as brown patches. When AKs look like this, they can resemble melanoma, a type of skin cancer.
Horn
Some AKs grow quickly and look like an animal’s horn. Horns are more likely to progress to skin cancer.
Symptoms of actinic keratosis
Most people who get AKs do not have any symptoms. They only notice changes to their skin. Symptoms can occur. A few symptoms to watch for are:
- Rough-feeling patch on skin that cannot be seen
- Rough patch or growth that feels painful when rubbed
- Itching or burning
- Lips feel constantly dry
An AK can come and go. An AK can appear on the skin, remain for months, and then flake off and disappear. The skin can suddenly feel smooth. Many AKs re-appear in a few days to a few weeks. They often re-appear when the person goes outdoors without sun protection.
Even if an AK does not re-appear, you should see your dermatologist. AKs form when the top layer of skin is badly damaged. You can get more AKs. If the damage grows deeper, skin cancer can develop.
How do dermatologists diagnose actinic keratosis?
Dermatologists diagnose an actinic keratosis (AK) by closely examining the skin.
If your dermatologist finds a growth that is thick or looks like skin cancer during the exam, your dermatologist will likely perform a skin biopsy. Your dermatologist can safely perform a skin biopsy during an office visit.
When found early and treated, skin cancer is often cured.
How do dermatologists treat AKs?
There are many treatments for AKs. Some treatments your dermatologist can perform in the office. Other treatments you will use at home. The goal of treatment is to destroy the AKs. Some patients receive more than one type of treatment. Treatments for AKs include:
In-office procedures
- Cyrotherapy: Destroys visible AKs by freezing them. The treated skin often blisters and peels off within a few days to a few weeks. This is the most common treatment. When the skin heals, you may see a small white mark.
- Chemical peel: This is a medical chemical peel. You cannot get this peel at a salon or from a kit sold for at-home use. This strong peel destroys the top layers of skin. The treated area will be inflamed and sore, but healthy new skin will replace it.
- Curettage: Your dermatologist carefully removes a visible AK with an instrument called a curette. After curettage, your dermatologist may use electrosurgery to remove more damaged tissue. Electrosurgery cauterizes (burns) the skin. New healthier skin will appear.
- Photodynamic therapy (PDT): A solution is applied to make the skin more sensitive to light. After a few hours, the treated skin is exposed to a visible light, such as blue or laser light. The light activates the solution and destroys AKs. As the skin heals, new healthy skin appears.
- Laser resurfacing: Much like a chemical peel, a laser can remove the surface layer of the skin. This destroys AK cells. After treatment, the skin will be raw and sore. The skin heals within 1 or 2 weeks, revealing healthier new skin.
Prescription Medicines
Your dermatologist may prescribe a medicine that you can use at home to treat AKs. Medicines that dermatologists prescribe include:
- 5-fluorouracil (5-FU) cream: This is chemotherapy that you apply to the skin. It causes temporary redness and crusting. Patients typically apply 5-FU twice daily for 2 to 4 weeks. A person who has lots of damaged skin may need to use 5-FU longer. 5-FU causes sun-damaged areas to become raw and irritated. As the skin heals, healthy skin appears. Another treatment such as cryotherapy may be necessary to treat thick AKs.
- Diclofenac sodium gel: This is a non-greasy gel. You apply it to skin with lots of AKs. Patients apply the medicine twice a day for about 2 to 3 months. During this time, you must protect your skin from the sun. You will see the best results about 30 days after you stop applying the gel. Some AKs can remain. Your dermatologist will treat these, often with cryotherapy.
- Imiquimod cream: This cream helps boost your body’s immune system so that your body can get rid of the diseased skin cells. You will apply this cream to your skin as directed by your dermatologist. Most patients apply imiquimod for several weeks. Imiquimod causes the skin to redden and swell. After you stop using the medicine, the skin heals.
- Ingenol mebutate gel: This gel works in two ways. It boosts the body’s immune system. It also is a type of chemotherapy for the skin. One formula is used to treat AKs on the head and scalp and is applied for 3 days in a row. The other formula treats AKs on the legs, arms, and torso. Patients apply this formula for 2 days in a row. Both formulas can cause rapid redness and swelling. As the skin heals, the redness and swelling clear.
Researchers continue to look for new treatments for AKs. No one treatment works on all AKs.
Outcome
Some people get only a few AKs. These AKs often clear with treatment.
If you have many AKs, you need to be under a dermatologist’s care. AKs form in skin that has been badly damaged by the sun or indoor tanning. This damage often causes people to get new AKs for life. Left untreated, AKs may turn into squamous cell carcinoma, a type of skin cancer. With frequent checkups, this skin cancer can be found early and removed. When found early and treated, most skin cancers can be cured.
Your dermatologist will tell you how often you should return for checkups. Some patients need a checkup once every 8 to 12 weeks. Others return for a checkup 1 or 2 times per year.
You should keep every appointment. If skin cancer develops, the sooner it is detected and removed, the better the outcome.
