Actinic Keratosis on the Face
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What are actinic keratoses?
Actinic keratoses (AKs)
are small, red, rough, scaly, flat spots that feel like dry skin
patches...almost like sand paper. They occur on sun-exposed areas, such as the nose, ears, face, chest, forearms, and back of the hands.
Common terms include AK, AKs, solar keratosis, precancers, and pre-skin cancers.
What causes
Actinic Keratosis?
Actinic Keratosis
is a result of disruption of skin cell function. Where normal skin
cells turn over on a systematic basis, the cells of an AK lesion
develop in a haphazard fashion. This is primarily the result of UV
exposure from the sun over the years. DNA alterations cause these
cells to clump, enlarge and project from the normally smooth
epidermal tissue. Although not a cause for alarm, they should be
checked to rule out the possibility of early skin cancer. Most
patients choose to treat AKs as a preventive measure and also to
restore smooth skin. AKs tend to grow larger over time and become
more difficult to remove if left unattended.
What are the
chances of AKs becoming skin cancers?
Anywhere from 5%-10% of AKs can potentially go on to become skin cancers. It is not possible to tell which ones will do this. Some AKs will never develop into anything else. Some AKs go away without treatment.
Do actinic keratoses ever turn into melanoma (a deadly form of skin cancer)?
No. While AKs may give rise to skin cancers like squamous cell carcinomas, they do not turn into melanomas. Nevertheless, it is important to keep in mind that people with AKs may be more prone to melanomas simply by having more sun damage
How is
Actinic Keratosis treated?
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Liquid nitrogen, or "freezing off" the AKs -- usually requires
repeated treatments as liquid nitrogen only affects visible
lesions
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5-fluorouracil to activate chemical peeling
Efudex.
Requires continued application even when skin has been
sensitized. More difficult therapy for those with sensitive skin
or outdoor lifestyle.
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Photodynamic therapy (PDT): Light activated therapy involves applying
a solution which makes AKs more sensitive to any form of light.
1 to 3 treatments depending on number of actinic keratosis
lesions and their depth.
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Laser
resurfacing with Fraxel Re:pair Laser is a new treatment choice
for diffuse AKs. This treatment also improves skin color,
texture and offers various levels of tightening.Single
treatment.
- Burning
off AKs with electricity.
- Fraxel Re:store series based gentle laser FDA approved for AK removal
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Immunotherapy: topical treatment with imiquimod (Aldara),
an immune enhancing agent
*PDT and Fraxel Re:pair provide the most efficient and fastest
resolution of AKs but do involve a higher cost that topical
products or individual lesion removal
How do I prevent developing more precancers?
Helpful measures include sun protection with hats, clothing, sunscreen, and sun avoidance, particularly during the peak hours of 10 a.m. to 4 p.m. Additional long-term maintenance options include nightly applications of retinoid creams, such as tretinoin (Retin-A) or tazarotene (Tazorac). Some studies also have shown a benefit from using green tea creams to decrease the number of AKs.
How do I know that my AK is not cancerous?
Any non-healing or recurring AK in the same spot may need a small
skin biopsy to make sure it has not turned into skin cancer.
Sometimes, we will treat the AKs and recheck them in three to four weeks. Any non-healing spots may then be suspect for possible cancer.
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