Treatment for Actinic Keratosis

The most common treatment for actinic keratosis (AK) is cryosurgery. In this procedure, a very cold substance, liquid nitrogen, is applied locally to the lesion. A scab or blister forms, which eventually falls off, leaving the area smooth. In dark-skinned people, care must be taken as this procedure can result in a white scar.

Another common treatment is the application of topical 5-fluorouracil (5-FU). This cream is applied twice daily to affected areas until any precancerous lesion "lights up" and becomes red and crusted. At that point the treatment is stopped and healing is allowed to occur. After the redness resolves, the skin becomes very smooth. 5-FU is useful for treating large areas with diffuse damage and on the temples, forehead, and arms.

Topical retinoids (Retin A, Avita, others) have been somewhat effective at treating and preventing AK as well. Once an area has been effectively treated, tretinoin cream or gel is recommended for daily use to reduce the need for further treatment and to counteract the effects of sun damage. In August 2015, the U.S. Food and Drug Administration (FDA) warned about severe allergic reactions and shingles (herpes zoster)—including serious eye injuries and skin reactions—caused by ingenol mebutate (Picato gel), which is approved to treat actinic keratosis.

This medication should be used only as directed and should not be used in, near, or around the eyes, lips, or mouth. Symptoms of an allergic reaction include swelling of the lips or tongue, difficulty breathing, faintness, and tightening of the throat.

Curettage and electrodesiccation, a "scrape and burn" technique, is sometimes used, particularly for a single, thick, or horn-like lesion.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 Aug 2000

Last Modified: 24 Aug 2015