Actinic Keratosis: Red, scaly patches on your skin

This is a photo of a patient who had actinic keratoses on his skin, also know as pre-cancers of the skin. He was previously treated with liquid nitrogen. However, he had recurrent lesions and we decided we needed to treat him with a chemotherapy cream called 5-fluorouracil (5-FU) cream to obtain better response and clearance rate. This photo is 2 weeks into his treatment.

An AK forms when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor tanning. Most people get more than one AK. When you have more than one AK, you have actinic keratoses, or AKs. Anyone who has many AKs should be under a dermatologist’s care. Most people who have many AKs continue to get new AKs for life. AKs are considered precancerous. Left untreated, AKs may turn into a type of skin cancer called squamous cell carcinoma.

By seeing a dermatologist for checkups, the AKs can be treated before they become skin cancer. If skin cancer does develop, it can be caught early when treatment often cures skin cancer.

In-office procedures
--Cryotherapy: Destroys visible AKs by freezing them. The treated skin often blisters and peels off within a few days to a few weeks. This is the most common treatment. When the skin heals, you may see a small white mark.

--Chemical peel: This is a medical chemical peel. You cannot get this peel at a salon or from a kit sold for at-home use. This strong peel destroys the top layers of skin. The treated area will be inflamed and sore, but healthy new skin will replace it.

--Curettage: Your dermatologist carefully removes a visible AK with an instrument called a curette. After curettage, your dermatologist may use electrosurgery to remove more damaged tissue. Electrosurgery cauterizes (burns) the skin. New healthier skin will appear.

--Photodynamic therapy (PDT): A solution is applied to make the skin more sensitive to light. After a few hours, the treated skin is exposed to a visible light, such as blue or laser light. The light activates the solution and destroys AKs. As the skin heals, new healthy skin appears.

--Laser resurfacing: Much like a chemical peel, a laser can remove the surface layer of the skin. This destroys AK cells. After treatment, the skin will be raw and sore. The skin heals within 1 or 2 weeks, revealing healthier new skin.

Prescription medicine
Your dermatologist may prescribe a medicine that you can use at home to treat AKs. Medicines that dermatologists prescribe include:

--5-fluorouracil (5-FU) cream: This is chemotherapy that you apply to the skin. It causes temporary redness and crusting. Patients typically apply 5-FU twice daily for 2 to 4 weeks. A person who has lots of damaged skin may need to use 5-FU longer. 5-FU causes sun-damaged areas to become raw and irritated. As the skin heals, healthy skin appears. Another treatment such as cryotherapy may be necessary to treat thick AKs.

--Diclofenac sodium gel: This is a non-greasy gel. You apply it to skin with lots of AKs. Patients apply the medicine twice a day for about 2 to 3 months. During this time, you must protect your skin from the sun. You will see the best results about 30 days after you stop applying the gel. Some AKs can remain. Your dermatologist will treat these, often with cryotherapy.

--Imiquimod cream: This cream helps boost your body’s immune system so that your body can get rid of the diseased skin cells. You will apply this cream to your skin as directed by your dermatologist. Most patients apply imiquimod for several weeks. Imiquimod causes the skin to redden and swell. After you stop using the medicine, the skin heals.

--Ingenol mebutate gel: This gel works in two ways. It boosts the body’s immune system. It also is a type of chemotherapy for the skin. One formula is used to treat AKs on the head and scalp and is applied for 3 days in a row. The other formula treats AKs on the legs, arms, and torso. Patients apply this formula for 2 days in a row. Both formulas can cause rapid redness and swelling. As the skin heals, the redness and swelling clear.

Dr. Cindy N. Berthelot, M.D. is a board certified dermatologist treating patients in the greater Houston community, including Clear Lake, League City, Friendswood, Pasadena, Deer Park, Dickinson, Pearland, Alvin, Seabrook, Kemah, Webster, Galveston, Texas City, La Marque, and Santa Fe, Texas. To make an appointment with Dr. Berthelot, please contact us at 281.480.7272.