Actinic or Solar Keratoses

An actinic keratosis also known as a solar keratosis is a scaly spot found on sun-damaged skin. It is considered precancerous as it may develop into a squamous cell carcinoma.

Actinic keratosis may be solitary but they often occur as multiple lesions in an area of sun damage. The clinical appearance varies and includes flat or thickened papules or plaques; white, yellow, scaly, warty or horny surface; skin coloured, red or pigmented and tender or asymptomatic.

Treatments available

Isolated solar keratosis in ‘non-cosmetic’ areas are often frozen with liquid nitrogen as this technique is quick and simple. However, when these keratosis cover a wider area, so-called ‘field treatments’ are recommended as they are able to cover a larger area. The advantage of field therapies is that they treat sub-clinical as well as obvious solar keratoses at the same time. They are generally much less likely to cause scarring or pigment disturbance than cryotherapy. No currently available field treatment is perfect but there are numerous.

Localised treatment options:

• Cryotherapy
• Surgical treatments including shave excisions, cautery & curettage

Field treatment options :

• 5 Fluorouracil Cream (Efudix)
• Imiquimod (Aldara)
• Ingenol (Picato)
• Photodynamic Therapy

Other options include:

• Diclofenac
• Various chemical peels
• CO2 laser resurfacing
• Topical Tretinoin
• Topical Keratolytics

None of the available treatment options are perfect. Some have better cosmetic results than others. The cost is also a consideration.