Ranking Actinic Keratosis Treatments: What Works Best?

Actinic keratosis is scaly or rough patches or bumps on the skin. While it’s considered common, it requires treatment because the cells in the patches of skin have the potential to turn into a type of skin cancer known as squamous cell skin cancer.

This article discusses the types of treatment available, at-home management techniques, and treatment success rates for actinic keratosis.

Types of Actinic Keratosis Treatment

Since actinic keratosis is considered a pre-cancerous condition, treating it before the cells can become cancerous and spread to other areas of the body is crucial.

There are many treatments available, and a healthcare provider will choose the best one depending on several factors, including:

• How many actinic keratosis areas a person has
• Where on the body they are located
• What they look like
• Whether a person has had skin cancer in the past
• Other medical conditions

The therapies and treatments offered for actinic keratosis include:

Topical Treatments

Topical treatments, such as creams and gels, often treat people with several actinic keratosis patches on their bodies. The ingredients used in the creams and gels most often include:

• 5-fluorouracil
• Diclofenac
• Imiquimod
• Tirbanibulin ointment

They are applied by rubbing them on the area of the skin affected as directed by a healthcare provider.

Sometimes, the skin can burn or become inflamed during treatment with creams or gels, but this is typically an indication that the medication is working. Of all the skin cream or gel ingredients, 5-fluorouracil is the most effective.

Cryotherapy

Cryotherapy is the most common and effective treatment for actinic keratosis. It is most often recommended for people with single actinic keratosis lesions on the scalp or face. Some people may only need one treatment, but others require more to rid the skin of all the actinic keratosis.

The treatment works by freezing the areas of the skin with liquid nitrogen. The skin may crust or blister before falling off, leaving healthy skin underneath.

Laser Therapy

Laser therapy works by using a laser to shrink or destroy the affected cells in actinic keratosis.

While it’s not the primary therapy for the condition, it is becoming more popular because it is highly effective and can lead to less bleeding and other complications such as scarring or swelling. 

Curettage

Healthcare providers will likely recommend curettage to people who have thicker actinic keratosis lesions. Curettage works by scraping the affected area of skin with a tool until the actinic keratosis patches are completely removed.

This process is often followed by a second step known as electrodesiccation, which is a procedure that works by heating the treated area so that any actinic keratosis cells left over are destroyed.

Chemical Peels

A chemical peel for actinic keratosis is not the same as those you can get at a spa. It is not cosmetic. The medical-grade peel used for actinic keratosis is designed to destroy the entire top layer of skin, taking the actinic keratosis with it.

Once the peel is completed, people will experience after-effects such as:

• Swelling
• Redness
• Soreness

The chemical used in the peel is trichloroacetic acid. This type of treatment is recommended for people with less severe actinic keratosis or those who wish to spend less on their treatments as it is less costly than other therapies.

Photodynamic Therapy

For people who have recurring actinic keratosis, photodynamic therapy may be recommended. The procedure is done in two steps. The first part of the treatment involves applying a solution to the skin, causing it to become hypersensitive to light. The solution sits on the affected area for 60 to 90 minutes.

Then, a red or blue light will be applied to the area to activate the solution, essentially destroying the actinic keratosis cells in the process. While this type of treatment is viable and effective, it does require you to remain inside for 48 hours following the procedure. The solution and light use can cause a severe skin reaction if exposed to UV light before the 48 hours have passed.

Self-Care and Home Management

At-home treatments use creams and gels to target actinic keratosis. Each person may require a different type of medication and process for applying.

There are several take-home prescribed topicals that can be used, including:

Alongside at-home topical treatment, people can also manage the disorder and prevent it from returning by:

• Wearing broad-spectrum sunscreen of SPF 30 or higher every day to all areas of the body not covered by clothing
• Reapplying sunscreen every two hours
• Avoiding tanning
• Protecting the skin from the sun’s rays by covering it with clothing, sunglasses, and hats
• Stay in the shade when outdoors
• Examine the skin often for new actinic keratosis growths

How Successful is Actinic Keratosis Treatment?

Each type of actinic keratosis treatment offers different success rates. They are broken down in the following chart:

These rates are taken from various studies, and your personal experience may differ.

Actinic Keratosis Recurrence After Treatment

Everyone treated for actinic keratosis will likely need to return to their dermatologist to follow up once treatment is done and to assess whether the lesions have returned. While treatment is highly effective at curing actinic keratosis, recurrence rates may change depending on the type of treatment. It is reported that actinic keratosis has an average recurrence rate of 24% 12 months after treatment.

Summary

Actinic keratosis isn't a severe health disorder on its own, but it can turn into skin cancer if it is left untreated. That is why it's vital to have it taken care of if you develop any patches or lesions. The varying treatments available will be used in specific cases, so not all will apply to you.

For example, people with one lesion may be recommended cryotherapy, whereas those with many actinic keratosis lesions will be recommended other treatments, such as topical creams or ointments. Your personal case will determine the best therapy for you based on your healthcare provider's recommendations.