Treatment Overview
Discovering a rough, scaly patch on your skin can be unsettling. For many people, actinic keratosis (AK) serves as a physical reminder of past sun exposure. These patches, often found on the face, ears, scalp, or hands, can feel like sandpaper and may itch or burn. While they are not skin cancer, they are considered precancerous. Living with AK often involves a mix of cosmetic concern and health anxiety, as leaving them untreated increases the risk of them developing into squamous cell carcinoma.
Treatment is proactive and preventative. The goal is to remove these damaged cells before they have the chance to become malignant. Because AKs often appear in clusters or areas of widespread sun damage, treatment approaches vary. A dermatologist will recommend a plan based on the number of lesions, their location, and the patient’s ability to manage recovery time (Skin Cancer Foundation, 2022).
Overview of treatment options for Actinic Keratosis
Treatment strategies for actinic keratosis are generally divided into two categories: lesion-directed therapies and field-directed therapies. Lesion-directed treatments, such as cryotherapy (freezing), target individual, visible spots. However, because UV damage affects the entire area of skin, medications are often used for “field therapy.”
Field therapy aims to treat a larger area of skin, such as the entire forehead or scalp. This approach destroys not only the visible lesions but also the microscopic, invisible damage beneath the surface that hasn’t appeared yet. Medications are typically applied topically at home. In some cases, medication is combined with light therapy (photodynamic therapy) in a clinical setting to activate the drug.
Medications used for Actinic Keratosis
Topical chemotherapy is a standard first-line defense. The most common medication in this class is 5-fluorouracil (5-FU). It is applied as a cream or solution once or twice daily for several weeks. Clinical experience suggests that while this treatment causes significant skin irritation, it is highly effective at clearing widespread damage.
Another major class is immune response modifiers, specifically imiquimod. Rather than attacking the cells directly, this cream stimulates the patient’s immune system to identify and reject the precancerous cells. It is often applied a few times a week for a specific cycle.
For patients who need a gentler option or have fewer lesions, non-steroidal anti-inflammatory drug (NSAID) gels, such as diclofenac sodium, may be prescribed. These are typically used for a longer duration, often two to three months, but tend to cause less severe skin reactions than chemotherapy creams.
A newer option is tirbanibulin, a microtubule inhibitor. This ointment is applied for a much shorter course typically only five consecutive days making it an attractive option for patients who struggle with the longer recovery times of older medications (Food and Drug Administration, 2021).
How these medications work
5-fluorouracil works by mimicking the building blocks of genetic material (DNA and RNA). When the rapidly dividing dysplastic skin cells try to use it to grow, the medication interferes with their ability to replicate, causing the cells to die. It specifically targets the faster-growing abnormal cells while largely sparing healthy skin.
Imiquimod works by triggering the release of cytokines, which are chemical messengers that tell the immune system to attack. This recruits the body’s own natural defenses to destroy the lesion.
Diclofenac works by blocking an enzyme (COX-2) that is often overproduced in sun-damaged cells and is involved in the development of tumors. By inhibiting this enzyme, it suppresses the growth of the actinic keratosis. Tirbanibulin works by disrupting the internal “skeleton” of the cell, making it impossible for the cell to divide and multiply (National Institutes of Health, 2023).
Side effects and safety considerations
Topical treatments for actinic keratosis (AK) commonly cause predictable skin reactions, redness, swelling, scaling, and crusting (the “ugly duckling” phase) which signal the medication is destroying damaged cells. 5-FU and imiquimod often cause more intense reactions than diclofenac.
Imiquimod can also cause occasional flu-like symptoms (fatigue, fever, muscle aches) as the immune system activates. Strict sun protection is essential due to extreme UV sensitivity. Patients must seek medical care for signs of bacterial infection (pus, excessive oozing, unmanageable intense pain) (American Academy of Dermatology, 2023).
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- American Academy of Dermatology. https://www.aad.org
- Food and Drug Administration. https://www.fda.gov
- National Institutes of Health. https://www.nih.gov
- Skin Cancer Foundation. https://www.skincancer.org
Medications for Actinic Keratosis
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Actinic Keratosis.