Actinic keratosis

Actinic keratosis is often diagnosed based on clinical features. Your primary care provider or dermatologist can establish diagnosis based on the following:

Review of your past medical history. Your doctor will assess whether you are at risk of developing actinic keratosis, for example, by working or playing sports outdoors without adequate sun protection.

Physical exam.  Your doctor will assess your skin condition and any presenting lesions. To do this, your doctor may use a dermatoscope—an optical instrument similar to a magnifying glass with light—to examine the lesions in more detail. This technique, known as dermoscopy, will allow your doctor to observe the lesions below the skin’s surface and obtain a magnified image.

An actinic keratosis sometimes disappears on its own but might return after more sun exposure. It's hard to tell which actinic keratoses will develop into skin cancer, so they're usually removed as a precaution.

Medications

If you have several actinic keratoses, your doctor might prescribe a medicated cream or gel to remove them, such as fluorouracil (Carac, Fluoroplex, others), imiquimod (Aldara, Zyclara), ingenol mebutate or diclofenac (Solaraze). These products might cause redness, scaling or a burning sensation for a few weeks.

Surgical and other procedures

Many methods are used to remove actinic keratosis, including:

Freezing (cryotherapy). Actinic keratoses can be removed by freezing them with liquid nitrogen. Your doctor applies the substance to the affected skin, which causes blistering or peeling. As your skin heals, the damaged cells slough off, allowing new skin to appear. Cryotherapy is the most common treatment. It takes only a few minutes and can be done in your doctor's office. Side effects may include blisters, scarring, changes to skin texture, infection and changes in skin color of the affected area.

Scraping (curettage). In this procedure, your doctor uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which the doctor uses a pencil-shaped instrument to cut and destroy the affected tissue with an electric current. This procedure requires local anesthesia. Side effects may include infection, scarring and changes in skin color of the affected area.

Laser therapy. This technique is increasingly used to treat actinic keratosis. Your doctor uses an ablative laser device to destroy the patch, allowing new skin to appear. Side effects may include scarring and discoloration of the affected skin.

Photodynamic therapy. Your doctor might apply a light-sensitive chemical solution to the affected skin and then expose it to a special light that will destroy the actinic keratosis. Side effects may include redness, swelling and a burning sensation during therapy.