Actinic Keratoses
Actinic keratoses are widely viewed as precancerous skin lesions that are due to previous excessive sun exposure. Characterized by scaling areas on the face, ears, neck, arms, and hands, these lesions are asymptomatic and are more easily felt rather than seen. Some may contain color and mimic a melanoma while others may thicken and become painful. Often, these lesions are rubbed off only to recur again.
While these are not cancers, many may behave similar to or transform into squamous cell carcinomas. The risk of transformation increases with time, thus it is recommended that these lesions be treated and affected persons routinely screened for the development of new lesions. There are a variety of treatment options including liquid nitrogen cryotherapy, topical 5-fluorouracil (Efudex®, Carac®), topical imiquimod (Aldara®), ALA-PDT therapy, medium-depth chemical peels, CO2 laser resurfacing, or a combination of these treatments. Sunscreen and avoidance of the sun should be rigorously practiced to prevent new actinic keratosis formation.
Sample treatment regimens include:
5-Fluorouracil (Efudex®) twice daily for 3 weeks, or twice daily on Saturday and Sunday for 12 weeks; Carac® may be used once daily for 3-6 weeks. Expect a BRISK reaction where you may turn red, irritated, and scabby, at all the actinic keratoses sites.
Imiquimod (Aldara®) once daily on Tuesday and Thursday for 12 weeks; may do for 4 weeks, then take 4 weeks off. Expect a BRISK reaction where you may turn red, irritated, and scabby, at all the actinic keratoses sites.
Diclofenac (Solaraze®) twice daily for 3 months
Irritation may be expected and a break from treatment should be done for 1-2 days. Alert your physician with any excess irritation of possible infection.
Discuss your treatment options thoroughly with your physician or physician's staff.
Don Mehrabi MD, FAAD
Dermatologist, Certified by the American Board of Dermatology
Los Angeles, California
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