What is Actinic Keratosis?

Actinic keratosis (AK) is one of the most common issues we see in dermatology clinics. It’s evidence that the skin has had too much sun exposure. Because of this UV damage, the skin hasn’t been able to regulate growth and now produces white to flesh tone to pink, scaly lesions on the skin. If left untreated, these can develop into squamous cell carcinoma.

What Are the Symptoms of Actinic Keratoses?

Patients first notice actinic keratoses (plural of actinic keratosis) as scaly, gritty spots on the face or other chronically sun exposed skin areas. Sometimes, it takes on a red color. It feels thick and , almost like a scab that never quite heals. In some cases, it fades and reappears over a long period of time.

These spots can come and go as the body fights abnormal cells. For a time, our body can fight AK’s on its own, attacking and healing the abnormal cell areas. But later, the scale comes back, and the cells start to grow and turn over more quickly than the body can heal. As the cells turnover, they stack up and begin to create a thicker white to pink scale.

What Causes Actinic Keratoses?

Actinic keratoses don’t play favorites. Anyone can develop these spots, no matter their ethnicity, gender, or race. It’s UV exposure that affects your susceptibility to developing actinic keratoses. These lesions usually appear in patients over the age of 40 after years of sun damage, but can arise earlier in lighter complected individuals with substantial sun exposure and damage.

Patients with a history of skin cancer need to closely monitor their skin for signs of actinic keratoses or any other suspicious spots. Prior skin cancer has already indicated significant UV exposure and damage to the body. That inherently puts you at risk to develop actinic keratoses as well as future skin cancers.

Actinic Keratosis Treatment Options

Not all actinic keratoses will develop into skin cancer, however most dermatologists will want to remove them as a precaution. In-office actinic keratosis treatments include cryosurgery, topical field therapy, or photodynamic therapy. 


Cryosurgery is the longtime standard of treatment for actinic keratoses. When treating isolated lesions, we apply ultra cold liquid nitrogen to the spot. The liquid is so cold, it destroys the cells.

Topical Field Therapy

When you have large numbers, or fields, of actinic keratoses, it’s often too uncomfortable or painful to treat these spots by freezing. In these cases, we use field therapy — a topical approach to treating many actinic keratoses located in one area.

Dermatologists will prescribe one of the following topical medications based on the patient’s needs:

  • Fluorouracil (branded as Efudex, Fluoroplex or Carac): This chemotherapeutic topical medication has been used for decades to cause precancerous areas to slough off.
  • Imiquimod: This somewhat newer immune response modifying cream is used in a variety of different regimens. It stimulates the immune system to better recognize abnormal cells and attack them in the form of inflammation, clearing them away.
  • Ingenol mebutate (branded as Picato): This topical cream offers results with a shorter application cycle. With a maximum of three days application, patients experience inflammation and sloughing of precancerous lesions.

Photodynamic Treatment (PDT)

PDT (also used for cosmetic photo-rejuvenation) allows us to use light to treat actinic keratosis. We apply a photosensitizing agent (such as aminolevulinic acid) to the skin and allow it to incubate, or be absorbed into more metabolically active cells. We then expose this area to wavelengths of light that activate the applied agent. Because actinic keratoses cells are more metabolically active than normal cells, they take in more aminolevulinic acid. When exposed to the light, the cells are destroyed. Compared to other forms of treatment, this can be a quick way to treat fields of actinic keratosis.

What Should You Expect During Actinic Keratosis Treatment?


Application of liquid nitrogen can be painful. Your dermatologist will apply liquid nitrogen directly to the lesion. After this procedure, the area will continue to sting and burn for about 5-10 minutes. Damaged cells crust and slough off.

Most patients experience redness, inflammation, or blistering, but most spots heal within a week or two.

Topical Field Therapy

These medications are applied at home over a prescribed period of time determined by the type of medication used and how aggressively the patient/doctor want to treat the lesion(s). All topical field therapy treatments can result in redness, inflammation, and discomfort. A small percentage of patients also experience flu-like symptoms with imiquimod.

When dermatologists prescribe topical field therapy, follow their dosing directions carefully. When these medications are used according to the FDA-approved package instructions, skin often becomes extremely red, swollen, inflamed, and uncomfortable. To minimize patient discomfort, we modify these instructions and often recommend less frequent application over a longer period of time.

Photodynamic Treatment

PDT is typically a great option for patients who want the most immediate results. We first apply a photosensitizing agent to the skin for up to 3 hours. Then, we expose the skin to a specific wavelength of light for up to 20 minutes or longer.

This procedure stings and burns substantially, especially with longer incubation periods of the photosensitizing agents. To minimize this, we often shorten the incubation period to make it more tolerable for the patient while still effectively treating the cells. We also provide a strong fan to cool the skin during treatment and lessen discomfort. After treatment, the spots become red and inflamed before they crust off. Most patients heal completely within 7-10 days.

FAQs on Actinic Keratoses

What percentage of actinic keratoses will turn into cancer?

About 10-15% of actinic keratoses will turn into cancer given prior studies. If you have spots that persist and proliferate, there’s an increased likelihood these will develop into squamous cells. If left untreated, SCC can be fatal.

What’s the duration of actinic keratosis treatment?

Because these cells are precancerous, a dermatologist needs to regularly monitor the progression of actinic keratoses. Patients with fields of actinic keratoses need to be seen at least twice a year, perhaps more frequently.

Do I have to stay out of the sun?

Of course — that’s what got you here. Sun exposure suppresses your immune system as it is attempting to fight these abnormal cells. Plus, additional sun damage increases your likelihood of developing more spots. When you’re outdoors, wear a hat, long sleeves, and sunscreen. Reapply sunscreen if longer outdoor exposure.

Additional Resources


Click here to find an Epiphany provider near you.