Actinic Keratoses (AKs) are pre-cancerous lesions of the skin that tend to develop on areas that are most often exposed to the UV rays of the sun (e.g. head, neck, hands, etc.). They usually appear as red and scaly patches ranging from isolated to extensive. For some patients they are a minor irritation, for others they can be painful and disfiguring. Experts disagree on the prevalence of AKs moving from pre-cancer into cancer, with a range of 3-20%, often depending on the number of outbreaks, their severity, and the genetic predisposition of the individual. Treatments vary and present a wide range of choices, side effects, and actual efficacy (Hepplewhite, 2012).
As the demographics of the population age, it is likely there will be more and more incidents of AK due to geography (people living in sunny areas), time in the sun, and recreational pursuits (swimming, tanning beds, etc.).
Initiating treatment is vital to ascertain potential risk factors, identification of AK presentation and current health issues and medications.
Emollients and lotions with stronger SPFs are appropriate for mild cases of AK, but it is extremely important that they be used in conjunction with adequate sunscreen and sun protection (hats, clothing, etc.). Most emollients have a 40-70% clearance rate within 60 days in mild cases.
A topical NSAID is also effective for 60-90 days in mild to moderate cases in which there a few lesions present.
Fluorouracil (Efudix), a topical cytotoxic agent, is appropriate for more serve cases. However, it has some initial cosmetic side-effects that may be problematical for some patients, dependent upon the location of the AK.
Recurring AKs may also require a treatment originally used for serious wart infections, Imiquimod (Aldera). This treatment often causes increased inflammation, and patients should be educated about reasonable expectations prior to the Rx.
Cryotherapy or cauterization may be used to treat isolated cases of AK. These therapies may be initial painful for a few days and may result in some scaring, but are a quicker treatment with fewer side effects appropriate for patients who do not wish to wait 2-3 months for relief.
Photodynamic therapy can be used with hyper-resistant AKs. This treatment works at a cellular level to create a cytotoxic effect on both cancerous and pre-cancerous cells.
Use in Practice:
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