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Actinic Keratosis

Dr. Caroline Mann treats patients at

969 Mason Road, Suite 220
St. Louis, MO 63141

Phone: 314-996-8010 Fax: 314-275-8892
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Question: I have rough dry scaly patches on my arms. My doctor says it’s actinic karatoses. What are my options for treatment?

Answer: Actinic keratoses are rough, scaly, or warty premalignant growths on sun-exposed skin that are very common in people with fair complexions, with a prevalence of >80% in fair skinned people over the age of 60. Sometimes actinic keratosis may progress to squamous cell carcinoma, which is why these lesions are commonly called precancers.

Options include:

Photodynamic therapy (PDT) - a treatment that combines a concentrated light source and a topical medicine activated by light that destroys precancerous cells. PDT works because the topical medicine collects more readily in atypical or precancerous cells than in normal cells. When the medicine is exposed to directed light, it reacts with oxygen to create chemicals that can eliminate the atypical cell.

PDT can be effective for patients with a large number of lesions such as full face therapy. It is less likely to cause blistering and pigmentary changes than other treatments. It is performed in an office setting. A nurse or doctor will apply the topical medicine called LevulanTM to sun damaged skin. The medicine stays on the skin for two hours, then the patient is exposed to the light source for sixteen minutes. PDT can cause erythema or redness, burning and pain during the light exposure. Patients must avoid direct sunlight and fluorescent light for 48 hours. Healing occurs within 7-14 days, with acceptable cosmetic results.

Cryotherapy - a freezing technique, is also effective in treating actinic keratosis, but can cause large blisters and a subsequent delay in healing time. In addition, pigmentary changes and scarring may occur. Lastly, it can be directed only at individual lesions that are identified on the day of the visit with the dermatologist.

Topical creams - such as 5-FU and topical AldaraTM are still other options for treatment of actinic keratoses; however, they require application times from two weeks and up to six weeks, respectively. They can require up to two weeks for healing time, and both may cause severe erythema and crusting of the skin, requiring topical wound care.

To be sure, it is never too late to start sun protection. Your skin never forgets the previous damage, so it all adds up over ones’s lifetime.

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