Actinic Keratosis – Diagnosis and Treatment
Diagnosis
Diagnosis of actinic keratosis (AK), also known as solar keratosis, usually begins with a physical exam. Medical professionals often identify AKs by checking the skin for rough, scaly areas or red patches.
If the lesionโs appearance is unclear or if there are concerns about possible skin cancer, doctors may perform a skin biopsy. They take a small sample and examine it under a microscope (histologic evaluation).
People with facial AKs or multiple skin lesions often have regular check-ups. Subclinical lesions can exist, so ongoing monitoring is important.
Ways to Treat Actinic Keratosis
Prescription Creams and Gels
Doctors often recommend topical medications for people with several actinic keratoses. Some common options include:
| Medicine | Side Effects | Typical Use Time |
|---|---|---|
| Topical Chemotherapy Agents | Redness, peeling, stinging | 2โ4 weeks |
| Non-Steroidal Anti-Inflammatory Drug (NSAID) Gels | Rash, dryness, itching | Weeks to months |
| Immune Response Modifiers | Swelling, crusting | Weeks |
| Microtubule Inhibitors | Irritation, pain | 5 days |
- Topical Chemotherapy Agents: These creams help remove abnormal skin cells.
- Non-Steroidal Anti-Inflammatory Drug (NSAID) Gels: These gels can help clear rough, scaly patches.
- Immune Response Modifiers: These creams prompt the immune system to attack damaged cells.
- Microtubule Inhibitors: A newer type of medicine used for mild cases.
These medicines may cause side effects like redness, burning, peeling, or irritation. These reactions usually last a few weeks and show that the treatment is working.
Treatment periods vary, with some medicines used for two to four weeks. Field-directed therapies are helpful when large areas are affected.
In-Office and Procedural Methods
Healthcare providers use several techniques to physically remove actinic keratoses:
- Freezing (Cryotherapy): Providers apply liquid nitrogen to freeze the lesion, which then falls off. Side effects can include blisters, lighter or darker skin, and rare scarring.
- Scraping (Curettage) and Electrosurgery: Doctors scrape away damaged tissue and may use electrosurgery to destroy remaining cells. Numbing medicine makes the procedure more comfortable. Good aftercare reduces the risk of infection or skin color changes.
- Laser Removal: Special laser devices remove unwanted patches and allow healthy skin to surface. Laser procedures may cause redness or discoloration.
- Light Therapy (Photodynamic Therapy): For larger or sensitive areas, providers use a light-activated chemical and then shine a specific light on the skin. The damaged areas react and clear out after therapy. Patients may feel warmth, tingling, or burning for a short time.
- Chemical Peels and Dermabrasion: These methods remove the top layers of skin and help get rid of affected cells over a broad area. Chemical peels use special acids, while dermabrasion sands the skin.
Doctors may choose standard surgery to cut out the area if they suspect cancer. Each approach has different risks and benefits, so providers tailor treatment to each patient.
Getting Ready for Your Visit
Steps to Take Before the Appointment
To make the most of your visit, prepare ahead of time. Write down any spots or rough patches you have noticed, along with when you first saw them.
Prepare a list of questions to ask during your appointment. Good topics include:
- Whether you need any tests to confirm the problem
- What treatments are available and their possible side effects
- Expected costs and if health insurance will pay
- Signs of changes to watch for in your skin
- Advice on using sunscreen or avoiding more sun damage
- How often you need follow-up visits
A table can help you keep track:
| Concern | Notes |
|---|---|
| New or changed spots | |
| Sun exposure history | |
| Sunscreen use |
What the Provider May Ask or Do
The provider might ask for detailed answers about skin changes. They may ask when the patient first noticed the spots.
The provider may also ask if the number of spots has increased recently. They might ask if the areas are painful or irritating.
They may talk about time spent in the sun and ask about sun protection methods. The provider might also ask about any history of serious sunburns.
If they link the signs to frequent sun exposure, they may refer the patient to a dermatologist. This condition is very common, especially in people with sun-damaged skin.
The provider may share tips to reduce further sun damage. They may also explain when it is important to see a skin specialist.
