Actinic Keratosis Treatment
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.
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 available include diclofenac sodium gel, brand nameSolaraze 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.