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Actinic keratosis

Actinic keratosis treatments

What are the possible treatments for actinic keratosis?

Actinic keratosis

If you have noticed rough, scaly patches or lesions developing on your skin, you may be dealing with actinic keratosis. Fortunately, there are several effective treatment options available. The right approach depends on the nature and extent of the lesions, as well as your personal circumstances.  

Remove lesions

A common method of treating actinic keratosis involves physically removing the lesions from the skin. This approach is especially effective when there are only a few isolated spots. The goal is to destroy the abnormal cells before they can develop into something more serious. Several clinical techniques can be used to achieve this: 

Surgery

This is typically used when a lesion appears suspicious or is larger. Once the patient is under local anaesthesia, a dermatologist will perform a shave excision, curettage, or a more in-depth surgical procedure, depending on the severity.  This method offers high precision and allows for histological examination, but it may leave a scar.

Cryotherapy

This is one of the most commonly used treatments for actinic keratosis. It involves applying liquid nitrogen to the lesion to freeze and destroy the abnormal cells. The area may blister or peel over the following days, after which healthy skin typically regrows. Cryotherapy is quick and effective, though it may cause temporary discolouration or irritation at the treatment site.

Laser therapy

Laser treatments use focused light to remove the affected skin layers. This technique can be useful for removing severallesions at once and it also helps to improve skin texture. However, it usually requires specialized equipment and may involve a longer healing period. It is most often recommended for people with extensive sun damage or when other methods have not been effective.

Photodynamic therapy (PDT)

This is a newer option that uses a photosensitizing agent and a light source to destroy abnormal cells. It is particularly effective for treating multiple lesions in a defined area and offers good cosmetic results.

Topical medications

In cases where lesions are widespread or appear in multiple locations, topical medications may be the most suitable option. These treatments are applied directly to the affected areas of the skin and work over time to destroy precancerous cells. Topical medications have the added benefit of also treating invisible lesions.  

Some of the commonly prescribed topical treatments include: 

5-fluorouracil (5-FU)

This is a chemotherapy cream that targets and destroys abnormal skin cells. Treatment usually lasts several weeks, during which the skin may become red, sore, and flaky. Despite the discomfort, it is highly effective and often used for larger areas with multiple lesions.

Imiquimod

This cream stimulates the immune system to attack and remove abnormal cells. It can be used over several weeks, with local skin reactions such as redness and swelling being part of the expected process.

Diclofenac gel

A non-steroidal anti-inflammatory drug (NSAID), this gel is used over a longer period (typically 60–90 days) and tends to cause less irritation than other options. It is often recommended for patients with mild-to-moderate to moderate lesions.

Tirbanibulin

This treats AK by targeting abnormal skin cells through a dual mechanism: it disrupts tubulin polymerization, which stops the cells from dividing, and it triggers programmed cell death (apoptosis) in damaged keratinocytes. This selectively eliminates precancerous cells in sun-damaged skin while limiting effects on surrounding healthy tissue.

Topical medications offer the benefit of treating both visible and microscopic lesions. However, they require patient commitment, as results take time and side effects like skin inflammation are common during the treatment period. 

What factors influence the choice of treatment?

Determining the most appropriate treatment for actinic keratosis depends on several factors. A healthcare professional will assess your situation based on: 

The number and size of lesions

This is often the primary consideration. A single lesion may be best treated with cryotherapy or minor surgery, while multiple lesions across a large area may require topical therapy or laser treatment.

Location of the lesions

Lesions on sensitive areas such as the face, ears, or hands may influence the choice of treatment due to cosmetic outcomes and healing considerations.

Your age and general health

Older adults or those with other medical conditions may be more sensitive to certain treatments. A more conservative approach may be recommended depending on your overall health status.

Past reactions to treatments or medications

If you’ve had adverse effects to any treatment in the past, that option may be avoided in favour of something more suitable.

Personal preferences and lifestyle

Some patients may prefer a quicker treatment such as cryotherapy, while others may choose topical treatments they can apply at home. Downtime, healing time, and aesthetic outcomes are all part of the decision-making process.

 

Ultimately, your doctor will guide you towards a treatment plan that balances effectiveness with comfort and safety. 

The importance of treating actinic keratosis

Actinic keratosis is considered a precancerous condition. Although the individual lesions themselves are not cancerous, they have the potential to develop into squamous cell carcinoma — a form of skin cancer. Reported estimates of progression vary substantially across studies and depend on factors such as cumulative UV exposure, the number and thickness of lesions, and whether a person is immunosuppressed. 

Regular skin checks and daily sun protection are critical in managing this condition and reducing the risk of recurrence. 

Prompt diagnosis and treatment of actinic keratosis are essential, not  just to remove visible lesions, but to prevent more serious complications. Treating actinic keratosis early also helps improve the appearance and health of the skin, especially in sun-damaged areas. Left untreated, lesions may thicken, spread, or become harder to manage in future. 

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