Actinic Keratosis Treatment

Cryotherapy

Cryotherapy is the treatment of choice for most, isolated, superficial,

actinic keratoses. Actinic keratosis reside in the epithelium.

Cryotherapy with liquid nitrogen causes the separation of the epidermis

and dermis, resulting in a highly specific, nonscarring method of

therapy for superficial lesions. Patients with darker complexions may

develop hypopigmented areas after freezing, and treating multiple

lesions on the face in such patients may result in white spots on the

face.

Surgical removal

Individual thick lesions or those with thick crusts that are often

found on the scalp should be removed with minor surgical procedures

such as electrodesiccation and curettage or excision.

Topical chemotherapy with 5-fluorouracil (5-FU)

5-FU, brand names Carac and Efudex, is an effective topical treatment

for superficial actinic keratosis. Carac is applied once daily, Efudex

is applied twice daily for up to 21 days. The lesions tend to become

red, inflamed and tender after just 1 week of application. Eventually

they form a crust and fall off. Occasionally, the inflammation becomes

too intense and the treatment has to be discontinued before completion.

The agent is incorporated into rapidly dividing cells, resulting in

cell death. Normal cells are less affected and clinically appear to be

unaffected. Thick, indurated lesions become most inflamed and may best

be managed by surgically removing them before instituting topical

chemotherapy.

Patients should be cautioned about the various stages of inflammation

encountered during treatment. Considerable discomfort may be

experienced for 1 week or more during periods of intense inflammation.

Lesions on the back of the hands and arms require longer periods of

treatment than those on the face.

Other agents

Other agents available include diclofenac sodium gel, brand name

Solaraze and imiquimod 5% cream, brand name Aldara. All of the above

agents are used in combination with liquid nitrogen, and are effective

at eradicating actinic keratoses and preventing progression to squamous

cell carcinoma.

Photodynamic therapy is yet another mode of removal. This technique

uses visible light in combination with the application of 5-aminolevulinic acid, which causes a toxic reaction to cancer cells, including atypical keratinocytes associated with actinic keratoses.