Several treatment options are available for actinic keratosis, including topical medications, cryotherapy, photodynamic therapy, and surgical procedures. The choice of treatment depends on various factors such as the number, size, and location of the lesions, as well as patient preferences and overall health status.

Topical Medications

Topical treatments are often the first-line approach for non-hyperkeratotic, non-hypertrophic, visible or palpable actinic keratoses (grade I, II). These medications are applied directly to the affected sun-exposed areas and work by selectively destroying the abnormal cells while minimising damage to the surrounding healthy skin.

Commonly used topical agents include imiquimod, 5-fluorouracil (5-FU), diclofenac, and tirbanibulin. Imiquimod is an immune response modifier that stimulates the body’s immune system to fight the precancerous cells. It is available in different concentrations (5%, 3.75%, and 2.5%) and is typically applied two to three times per week for several weeks. 5-FU is an antimetabolite that interferes with DNA synthesis, leading to cell death. It is applied once or twice daily for two to four weeks. Diclofenac, a nonsteroidal anti-inflammatory drug, is believed to inhibit the enzyme cyclooxygenase-2 (COX-2), which is involved in the development of actinic keratosis. It is applied twice daily for 60 to 90 days. Tirbanibulin, a recently approved topical treatment, inhibits tubulin polymerization and protein kinase signalling, leading to the death of rapidly dividing cells. It is applied once daily for five consecutive days.

These topical treatments can cause local skin reactions such as redness, swelling, itching, and crusting, which usually resolve within a few weeks after completing the treatment course. Patients should be educated about the expected side effects and the importance of adhering to the prescribed treatment regimen to achieve optimal results.

Cryotherapy

Cryotherapy, also known as cryosurgery, is a commonly used procedure for treating individual actinic keratosis lesions. It involves the application of liquid nitrogen to the affected area, causing the formation of ice crystals within the cells, leading to their destruction. The procedure is performed in the office setting and does not require anaesthesia.

The effectiveness of cryotherapy depends on factors such as the duration of freezing, the number of freeze-thaw cycles, and the size and thickness of the lesion. Typically, one to three freeze-thaw cycles are performed, with each cycle lasting 5 to 20 seconds. Thicker, hypertrophic lesions may require longer freezing times or multiple treatment sessions.

Common side effects of cryotherapy include pain, redness, swelling, and blistering at the treatment site. These usually resolve within a few days to weeks. Rarely, cryotherapy may cause scarring or permanent changes in skin pigmentation, especially in individuals with darker skin tones.

Cryotherapy is an effective treatment option for isolated actinic keratosis lesions, with reported clearance rates ranging from 39% to 83%, depending on the treatment protocol. However, it may not be suitable for treating large areas with multiple lesions or field cancerization, as it can be time-consuming and may result in a less favourable cosmetic outcome compared to field-directed treatments.

Photodynamic Therapy

Photodynamic therapy (PDT) is a minimally invasive procedure that combines the use of a photosensitizing agent with light exposure to selectively destroy precancerous cells.

It’s a clever combination of a special cream and a targeted light source that work together to wipe out precancerous cells while leaving healthy skin unharmed.

Here’s how it works:

1. Apply the “tracker”: First, a cream containing a photosensitizing agent (think of it as a tracker that sticks to the bad cells) is applied to the affected area.
2. Let it soak in: The cream is left on for a while to allow the “tracker” to be absorbed by those abnormal cells.
3. Activate with light: Next, the area is exposed to a specific type of light, which activates the “tracker” and triggers a reaction that destroys the targeted cells.

PDT can tackle individual spots or larger areas of sun damage. It’s a real game-changer, boasting impressive success rates in clearing AK lesions, and the results are often long-lasting.

Daylight PDT: A Brighter Approach

There’s even a newer version called daylight PDT that uses natural sunlight instead of artificial light. This means a shorter waiting time and less discomfort during the treatment.

While PDT is generally safe, you might experience some temporary redness, swelling, or a burning sensation afterward. But these side effects usually fade quickly.

PDT offers a minimally invasive and highly effective way to combat actinic keratosis, giving you a brighter outlook on your skin’s health.

Surgical Options for Actinic Keratosis

When dealing with stubborn or suspicious actinic keratosis (AK) spots, sometimes you need a more direct approach. That’s where surgical procedures come in. These techniques involve removing the troublesome lesions with precision, giving you immediate results and peace of mind.

Think of it like this:

• Curettage: This is like carefully scraping away the unwanted spot with a specialised tool, often combined with a little electrical zap to stop any bleeding and ensure no abnormal cells are left behind.
• Shave Excision: Imagine a dermatologist skillfully shaving off the lesion with a scalpel, leaving a smooth surface.
• Surgical Excision: This is a bit more involved, where the entire lesion and a small safety margin of healthy skin are removed. It’s usually reserved for spots that look suspicious or haven’t responded to other treatments.

The upside? These procedures get rid of the lesion right away, and your doctor can even examine the removed tissue to make sure everything is okay. The downside? There’s a chance of scarring, and it might not be the best option for lots of spots or larger areas.

Stopping AK Before it Starts: Prevention is Key

The best way to deal with actinic keratosis? Prevent it in the first place! Since the sun’s harmful UV rays are the main culprit, sun protection is your superpower:

• Dress for the occasion: Cover up with protective clothing, a wide-brimmed hat, and sunglasses.
• Slather on the sunscreen: Make sunscreen your daily BFF. Choose a broad-spectrum sunscreen with an SPF of 30 or higher and reapply it regularly, especially after swimming or sweating.
• Seek the shade: When the sun’s at its strongest (usually between 10 am and 4 pm), find some shade to hang out in.

Regular skin checks are like your early warning system. Your dermatologist can spot suspicious spots early on, and you can also do self-exams at home to keep an eye on your skin. Remember, catching AK early can prevent it from turning into something more serious, like skin cancer.