Actinic Keratosis Treatment

Therapeutic measure: Ablative procedure

Ablative procedures refer to all methods used to remove skin from affected areas.

Cryotherapy, Cryosurgery

A commonly used procedure is cryosurgery (from the Greek for “ice” or “frost”). To do this, the tissue is destroyed locally through the targeted application of cold at temperatures below minus 25 degrees. Technically, this is done using a spray, a probe, or a stamp. Local anesthesia is not necessary for this. Side effects may include pain, and blisters or scars may form.

Removing layers of skin with laser therapy

Another method is laser therapy; the CO2 or erbium-YAG laser used specifically removes only the upper layers of the skin, making it a good complement to surgical treatment. Laser ablation is best suited for small, localized lesions (damage) that are not too thick; the side effects may be similar to those of cryotherapy.

Dermabrasion – Removing Layers of Skin

In dermabrasion, the outermost layers of the skin are removed using drill-like instruments. It is a relatively old procedure, and the success of the treatment depends heavily on the skill of the healthcare professional. Since the procedure is quite painful, a local anesthetic is required. This can subsequently lead to impaired wound healing and scarring.

Actinic Keratosis: Chemical Peel

Chemical peels refer to a trichloroacetic acid treatment in which the outermost layer of skin, along with the cells damaged by sun exposure, is exfoliated. However, the treated areas of skin are very sensitive after treatment and must be well protected from the sun.

Treatment: Surgical procedure

Surgical removal of actinic keratosis is a commonly chosen procedure, especially when skin cancer is suspected. Either the affected area is cut out with a scalpel or scraped out with a curette, a surgical spoon. Surgery is recommended when the actinic keratosis has already spread into deeper layers of tissue and the entire affected area needs to be removed. A sample can then be tested in the laboratory to determine whether it is malignant. Side effects are minimal with superficial ablation, and the wounds generally heal well. Potential disadvantages include local anesthesia, general surgical risks, scarring, and wound healing complications.

Therapeutic measure: Medication

For mild to moderate skin damage caused by actinic keratosis, topical treatments containing diclofenac and hyaluronic acid have proven effective. Under a doctor’s supervision, apply this cream morning and night for 60 to 90 days. During treatment, you must avoid exposure to sunlight and UV radiation. This anti-rheumatic drug inhibits the growth of tumor cells and has been shown to be effective in treating actinic keratoses that are not yet very advanced.

A similar cell-inhibiting effect can be achieved with the active ingredient 5-fluorouracil, which is also applied topically as a cream or solution. The drug inhibits cell division, which initially triggers an inflammatory reaction in the skin. The diseased cells die off, and new tissue forms. The 5-FU cream is approved only for use on small areas of skin and is not well tolerated by all patients. Another medication, imiquimod cream, is particularly recommended for actinic keratoses on the face or scalp. The cream is applied three times a week over a four-week period, after which a second treatment cycle may follow. The cream is well tolerated and has few side effects. It stimulates the immune system and helps the body fight off the abnormal cells on its own.

Ingenol mebutate (Picato) was also approved until 2020, but it has since lost its approval and is no longer used.

Actinic Keratosis – Photodynamic Therapy (PDT)

Photodynamic therapy (PDT) uses light-sensitizing substances to induce cell death in the affected areas of the skin. The affected areas of skin are first treated with a special cream and, after a specified period of time, exposed to a light source (red light). The metabolic processes triggered by this cause the altered skin cells to die. Studies often describe light therapy as painful; very often, the skin reacts with redness, a burning sensation, and itching. Overall, however, this therapy yields good results and allows for the treatment of larger areas while sparing healthy tissue. Those affected are also very satisfied with the cosmetic results.

For mild lesions (damage), daily PDT—approved in 2015—is also an option. With this form of therapy, you apply the active ingredient MAL (methyl 5-amino-4-oxopentanoate) to the affected areas of skin and then expose yourself to sunlight. The daylight version is described as significantly less painful; it is suitable for thin actinic keratoses on the face or scalp.