Actinic Keratosis

Actinic keratosis (solar keratosis) are dry, scaly patches of skin usually appearing on sun damaged skin. They are a sign of DNA damage to the skin cells from UV damage.

Actinic Keratosis (A.K.) usually present as superficial, lightly scaly, roughening of the skin, which are often more easily felt than seen. They are usually small, (less than 10mm), discrete lesions and may be single or multiple (non – symmetrical). They are normally found on the light exposed areas such as the face, bald scalp, ears, back of the hands and lower legs in women. They are more common in people with fair skin, who have been exposed to a lot of ultra- violet radiation as a result of their age, occupation, hobbies or from living in a warm climate for a few years.

Do they need to be treated?

Some actinic keratoses may resolve spontaneously over time. However, a small percentage (0.5 to 2%) may go on to develop into a Squamous Cell Carcinoma, if left untreated. When left untreated, actinic keratoses can also be uncomfortable and unsightly. Most actinic keratoses should be treated, particularly in younger patients or fit elderly patients.

Are actinic keratoses pre-cancerous?

The vast majority of actinic keratosis lesions are and remain benign. However, the presence of these lesions indicates that you have sustained skin damage and that you are at risk of developing skin cancer.

This is why it is important to treat these changes not just because of their cosmetic appearance, but because of their potential to become cancer. Most AKs, when they do become cancerous, evolve into squamous cell carcinoma.

What are the treatment choices for actinic keratosis?

The mainstay of treatment is “Efudix cream” (Fluouroucil Cream). This cytotoxic agent seeks out and stimulates an inflammatory reaction in the dysplastic cells and will selectively destroy both the A.K. and any invisible adjacant dysplastic areas.

There are other medical options:

“Solaraze Gel” (Diclofenac) apply b.d. for up to 3 months.
Freezing (cryotherapy) with liquid nitrogen if only a spot or two, but a cream is better for widespread actinic damage
Excision/curretage
Laser surgery

What does treatment with Efudix cream involve?

We provide an Efudix treatment protocol to all patients receiving a presription.

Generally it requires applying the cream twice a day to the entire facial area that the doctor recommends. If the hands or the arms are involved, the cream may even have to be put on three or four times a day there.

After a few days, redness, ulceration, and crusting will be noted. We recommend you book in a follow up appointment with the doctor again two weeks after starting it to see how the treatment is progressing.

Usually the cream is still applied for another two weeks (four weeks total) and then it is stopped. Gradually the skin heals and will be red for four to six weeks afterward. All the scaly sores should go away. If there are any abnormal areas that remain when the doctor re-checks you at six to eight weeks after stopping the Efudix, they need to be biopsied because they could be a cancer that is resistant to this therapy. Dr. Hughes will then refer you to a surgical dermatology who performs biopsies if you have any remaining suspicious lesions. Even small cancers may go away with the cream, however.

During treatment, your skin will become very dry, crusty, and itchy. You will be miserable. Remember, this is chemotherapy. Keep your skin moisturised with Eucerin (ointment or cream), Bepantiseptic cream, Vaseline, baby oil, biooil, Aquaphor Cream, Silcock’s Base, vitamin E ointment, etc… If this does not work, the doctor can prescribe some steroid cream to help out.

How can I prevent getting more actinic keratoses?

The reason all these precancerous “sun changes” occurred is because of sun exposure.

After treatment, it is very important that you not be exposed to the sun while the skin is red, because it will be much more likely to sunburn. To prevent new lesions from occurring, it is best to avoid sun exposure. Do this by using a hat, wearing long sleeve clothes, applying sunscreens on your face, top of ears, neck, chest, backs of hands etc. and avoiding the sun during the middle of the day

We stock high factor suncreams and even one specifically designed for people suffering from actinic keratoses, please ask us about this when you visit.