Actinic Keratosis (AK)
What is Actinic Keratosis (AK)?
Actinic keratosis (AK’s) are scaly, crusty growths that typically appear sun-exposed areas such as the face, scalp, lips, neck, top of hands and forearms. This is a skin condition resulting from YEARS of damage from the sun’s ultraviolet (UV) rays. The majority of the damage is from accumulated, small amounts of sun exposure, rather than large amounts during occasional sunny vacations. When these cells become damaged, they begin to multiple abnormally and in an uncontrollable fashion so your body does not have the ability to slough them off before they become thick and crusty. However, at times they can “come and go”. Most have a red or pink base with some white scaling or crusting on the surface. As they continue to progress, they can even develop a hard, crusty “horn” that protrudes from the surface of the skin. AK’s can usually be felt easier than seen, and many patients describe a “sliver” like sensation when rubbed. These are the earliest sign of sun damage and therefore are classified as “PRECANCEROUS” lesions. If left untreated, 6-10% of AKs can develop into squamous cell carcinoma (SCC), the second most common form of skin cancer. Although SCC are not usually life-threatening skin cancers, they often require surgery for completely removal. Our goal is to effectively treat these lesions BEFORE they develop into skin cancer that would require more invasive surgery. Although some people have isolated lesions that can effectively be cured, the majority of people have multiple, scattered lesions that may require on-going maintenance treatments.
Below is a list of the treatment options that we offer in our clinic. Together we will decide what the most effective and appropriate choice for you.
Actinic Keratosis Treatment Options
Cryotherapy – Liquid Nitrogen
This is the most common treatment for AK’s, especially when treating localized areas. The liquid nitrogen is a cold, liquefied gas with a temperature of -196C (-321F) that is applied with a spray device to individual lesions. This cold temperature freezes the water within the damaged cells, thereby destroying it. The lesions subsequently swell and/or blister, become crusted and fall off within one to three weeks, leaving the healthy skin below. Aggressive freezing has the potential to cause some permanent whitening of the skin, so with stubborn or extensive areas, other treatment options may be recommended. Even with other therapies, liquid nitrogen is almost always used as an adjunctive and ongoing treatment.
One of the most commonly used topical medications for AK’s is 5-fluorouracil (Efudex) cream. This cream selectively targets these rapidly growing precancerous cells and blocks the DNA that tells the cell how to copy itself. Therefore, it stops these cells from multiplying and reduces the chance of them developing into skin cancer. This treatment is especially effective on the hands, forearms, scalp or lower legs where other treatment methods are not appropriate. However, you may want to treat one area at a time (eg. right arm first, then left arm).
Aldara (5%) /Zyclara (3.75%) (Imiquimod)
Imiquimod cream is another topical cream that works in a different way. It stimulates the immune system to produce interferon, a chemical that destroys cancerous and precancerous cells. Once the immune system has been activated, the precancerous lesions become red and irritated, indicating the appropriate and desired response. Frequently underlying lesions that are not visible to the eye, become activated, indicating effective treatment for damage that has not reached the surface of the skin yet.
Photodynamic Therapy (PDT)
PDT is useful for widespread lesions on the face and scalp. A light-sensitizing agent, Levulan (5-ALA) or Metvix is applied to the affected area on the face or scalp in the physician’s office. The patient can leave while the medication “incubates” on the skin for three hours. The patient then returns to the office and the medicated areas are activated by a red light, which selectively destroys AKs. After the procedure, patients must strictly avoid sunlight for at least 48 hours, as UV exposure will increase activation of the medication, and may cause severe sunburns. Some pain, redness and swelling will occur as it peels over the course of the next 7-10 days.
TCA Chemical Peel
Tricholoacetic acid (a medium depth peeling agent) that is applied to the surface of the damaged skin. As it penetrates through the superficial and deeper layers of the skin, it effectively targets both visible and underlying lesions that have not reached the surface of the skin. Rather than focusing on specific lesions, it uses a “zone” approach, treating the entire damaged areas. Although it is somewhat painful, the application only takes a few minutes and the pain quickly subsides. The skin will remain red and swollen for 2-3 days, and then the damaged skin will peel over the course of the next 7-10 days. In addition to removing the precancerous cells, it also removes superficial dead and damaged skin, resulting in healthier skin and an overall improvement to the appearance of the skin.
TCA Peel with SP Dynamis Fotona Laser Spot Resurfacing
This new Erbium Yag 2940nm Laser has the ability to effectively remove thickened lesions that cannot be sloughed off with the peel alone. The entire face and/or scalp is first treated with the TCA peel procedure listed above, treating the superficial and underlying lesions. Immediately following, hypertrophic (thickened or enlarged) cells are flattened out in a systematic process with the laser. Multiple passes may be required until all the thickened areas are removed. The advantage is the skin is smooth when you leave the office, before the peeling has even started. Treatment can usually be completed without the use of any anesthetic and healing time is about 7-10 days.
SP Dynamis Fotona Full Face Laser Resurfacing
Rather than using a chemical peeling agent to remove the damaged layers, the laser can effectively remove layers of skin cells in a very systematic and controlled fashion. With this new laser technology, we have the ability to control the depth and layers of skin that we remove. Following the full face laser treatment, thicker, stubborn areas will be “spot treated” with the procedure method listed above. Removing multiple layers of damaged skin results in healthier skin, with the added benefit of a cosmetic improvement. Topical numbing cream and/or oral sedation will be required for this treatment. Healing time is usually about 10-14 days
As the major precipating factor is sun exposure, it is imperative that you get in the habit of wearing DAILY SUNSCREEN with a minimum SPF or 30-60. Oftentimes, it is the daily UVA exposure that comes through car windows and penetrates deep into the dermis that caused damage that is not visible until much later. Often people are frustrated as they are doing all the right things; like avoiding extended sun exposure and using regular sunscreen, and yet they are still developing more. Remember that most of the damage is from 30, 40 or even 50 years ago! Although you can’t change the past, you can prevent further damage now.