Actinic Keratosis (AK) is a form of damage to skin from long standing exposure to UV rays. This is mostly seen in equatorial region of earth in white people; common in Australians. These are scaly freckles on reddish base, range from a few millimeters to a few centimeters in size, mostly over the exposed surfaces of body; bald scalp, forehead, face, ear and forearm etc.
Before treatmant
After treatment
It may regress completely, remains unchanged or progress to skin cancer. Cancer conversion rate ranges from 0.1% to 10%. Around 65% are squamous cell carcinoma and 36% are basal cell carcinoma. Furthermore, risk of progression of actinic keratosis to squamous cell carcinoma was 0.60% at 1 year and 2.57% at 4 years; whereas that of basal cell carcinoma was 0.48% at 1 year and 1.97 at 4 years; found in one study.
Other disfiguring lesions those may be found on body especially on face are wrinkles around eyes, acne scars, surgical scars; pigmented lesions e.g. age spots, sun spots and melasma.
Medical management begins with educating the patient to limit sun exposure. Patients should be cautioned to avoid sun exposure from 10:00 am to 3:00 pm as much as possible. They also must wear adequate sunscreens and protective clothing daily.
Medical therapy has the advantage of being able to treat large areas with many lesions. The disadvantages of medical therapies include lengthy courses of treatment with irritation and discomfort. The US Food and Drug Administration (FDA) has approved 4 medications for the treatment of actinic keratoses. These are topical 5-fluorouracil (5-FU), 5% and 3.75% imiquimod cream, topical diclofenac gel, and photodynamic therapy (PDT) with topical delta-aminolevulinic acid.
Recently, indications cleared by the FDA for the fractional laser system, a 1550-nm Erbium laser; include skin resurfacing procedures such as wrinkles, acne scars, surgical scars; and pigmented lesions, such as age spots, sun spots, actinic keratosis, and melasma.
FDA clearance for use of laser therapy was based on data from a 6-month multicenter study of 21 patients with actinic keratosis, each of whom underwent a series of 2 to 4 Thulium laser treatments, spaced 2 to 4 weeks apart. Results showed that the regimen yielded a mean 83.5% decrease in AK lesions on the face and other regions such as the arms, hands, and chest. Improvements in skin texture and pigmentation were also observed; no adverse events were reported.
Potential adverse events those may be noticed are prolonged redness, swelling, blistering, scarring, infection, hyper-pigmentation, herpes reactivation, and acne flare-up.
