How can actinic keratoses be treated?

It is advisable to protect the skin from further sun damage (for example, by wearing a hat, long sleeves and a sunscreen with a high sun protection factor). Occasionally, small actinic keratoses may go away spontaneously, but generally it is advisable to treat them as there is a small risk that some might transform into a skin cancer.

Treatments used for actinic keratoses:   

Freezing with liquid nitrogen (Cryotherapy). This is an effective treatment which does not normally leave a scar, but it can be painful. (see Patient Information Leaflet on Cryotherapy)

Surgical removal. This requires local anaesthetic, after which the actinic keratosis can be scraped off with a sharp spoon-like instrument (a curette), or it can be cut out and the wound closed with stitches. Surgical removal leaves a scar but provides a specimen that can be analysed in the laboratory to confirm the diagnosis.

Creams. Courses of creams containing drugs called 5-fluorouracil or imiquimod are useful treatments for actinic keratoses, especially if there are a lot of them. These preparations appear to selectively destroy the abnormal cells in sun-damaged skin. However, they often cause a good deal of temporary inflammation of the treated areas. Diclofenac and retinoic acid are other drugs in cream or ointment form that are helpful when applied to actinic keratoses.

Photodynamic therapy. A chemical is applied to the affected area, which is then treated with the correct wavelength of visible light. This treatment is only available in certain hospitals (see Patient Information Leaflet on Photodynamic Therapy).

What can I do?

Protecting your skin from the sun will reduce the number of new actinic keratoses you get, and also reduce the risk of getting a sun-induced skin cancer. You should be extra cautious in the sun by following these recommendations:

Protect yourself from the sun, from 11 a.m. to 3 p.m., especially in sunny weather.

Wear protective clothing – hats, long sleeves, long skirts or trousers.

Apply a sunscreen regularly, of sun protection factor 30 or above (and able to block both UVA and UVB light), to exposed skin before going into the sun, and re-apply according to the manufacturer’s recommendations, especially after swimming, when you are out in the sun.

Protecting your children from the sun in the same way may reduce their risk of developing actinic keratoses.

Avoid sunbeds.

Examine your own skin every few months and see your doctor if an actinic keratosis starts to itch, bleed, or thicken, in case it has changed into a skin cancer (a squamous cell carcinoma)