Actinic keratosis

This page was reviewed under our medical and editorial policy by

Frederick L. Durden, Jr, MD, Plastic and Reconstructive Surgeon & Microsurgical Reconstructive Surgeon.

This page was updated on October 20, 2022.

Actinic keratosis (AK) is a precancerous skin lesion, and more than 40 million Americans a year develop one, according to the American Academy of Dermatology Association.

Consider this a warning that you’re spending or have spent too much time in the sun. Exposure to the sun’s rays or the use of tanning beds may damage skin cells called keratinocytes, resulting in AKs. For these reasons, AKs tend to occur on parts of the body that get the most sun, namely the:

  • Face
  • Ears
  • Scalp (if you’re losing hair)
  • Hands
  • Neck
  • Lips (on lips, it’s called actinic cheilitis)

You may notice one or more AKs, as they often travel in packs.

  • AKs may develop into squamous cell skin cancers if they aren’t caught and treated. These cancers may spread to nearby tissues and organs.
  • Other complications may develop, too, such as bleeding or infection.

Knowing more may help you catch AKs early and have them treated.

What to look for

Not all AKs look the same. They may:

  • Resemble pimples, age spots or chapped lips
  • Look like a rough patch of irritated skin or a rash
  • Be characterized by a loss of color on your lips or a horn-like growth on your skin
  • Vary in color (red, pink, skin-colored, gray, yellow, brown, tan or white)

AKs don’t necessarily cause symptoms, but you may feel itching, stinging or pain in the area. In addition, AKs may bleed, and they may stick to your clothing, which may hurt.

Are you at risk?

Unprotected exposure to the sun’s damaging rays confers the greatest risk for developing AKs, but some factors add to that risk, including:

  • Naturally red or blond hair and/or light eyes
  • Age older than 50
  • Weakened immune system
  • History of organ transplant (medication taken to prevent the body from rejecting a transplanted organ may hamper the immune system’s ability to heal from ultraviolet or UV light damage)

Diagnosing and treating AKs

Your dermatologist may be able to tell if the growth is an AK by examining it. If skin cancer is suspected, a biopsy may be necessary.

There are many ways to treat AKs, and the decision should be based on how many AKs you have, where they’re located, what they look like, and your personal history of skin cancer.

Some are in-office treatments and others may be done at home. Each AK treatment has its own set of pros and cons.

In-office treatments

  • Cryosurgery: This procedure involves freezing the AK using a cold substance such as liquid nitrogen. The AK falls off after several days. You may crust or blister at the treatment site. Sometimes more than one treatment is needed.
  • Chemical peels: Yes, the same chemical peels used to remove dead skin and reveal a brighter facial complexion may also get rid of AKs. These are strong peels that may only be done under a doctor’s supervision. They remove the layers of skin where the AKs reside. Keep in mind, your skin may be red and swollen until it heals.
  • Curettage: If your AKs are thick, your dermatologist may opt to scrape them off. This is called curettage. It may be paired with another procedure called electrodesiccation, which targets any remaining AK cells with heat.
  • Photodynamic therapy: If you keep getting new AKs or they keep coming back, photodynamic therapy may be an option. First, your doctor applies a solution to your skin that makes it more sensitive to light. After about 60 to 90 minutes, you’ll be exposed to a blue or red laser light, which activates the solution and destroys the AK. There are some after-care instructions that you must follow, which include avoiding the outdoors during daylight hours. Exposure to any UV light may harm the treated area. More than one photodynamic therapy treatment is typically required for optimal results.
  • Laser resurfacing: In addition to removing damaged layers of skin to reveal a more youthful complexion, laser resurfacing may also help with lip AKs or actinic cheilitis. The laser energy removes the layers of skin where AKs reside. It may take up to two weeks to heal.

At-home treatments

Many topical therapies may be used at home to destroy the outermost layer of the skin and any AKs. This list includes:

  • Fluorouracil (5-FU): This drug destroys AK cells on or near the skin’s surface and may be recommended to treat AKs on the chest, arms or back. It’s not typically recommended for AKs on the face because it may make your skin red and sensitive. You use the medication once or twice a day for up to four weeks. Sun sensitivity may occur. 5-FU cream can’t be used if you’re pregnant.
  • Imiquimod: Part of a class of drugs known as immune response modifiers, imiquimod is applied once a day for up to two days a week. Treatment typically lasts 16 weeks even if your AKs are all gone before that time. Unlike Fluorouracil (5-FU), it may be used on your face, as it doesn’t cause as much redness. Potential side effects include redness, itching, burning, bleeding, flaking or dryness.
  • Diclofenac sodium: A topical nonsteroidal anti-inflammatory gel, diclofenac sodium is sometimes used to treat AKs. Exactly how it works isn’t fully understood. The gel is applied twice a day for two to three months. You may experience redness, itching, peeling or dry skin and/or muscle, joint or back pain.

All three of these drugs are U.S. Food and Drug Administration (FDA)-approved to treat AKs. Sometimes medications are paired with in-office procedures.

How to protect yourself from AKs

The best way to reduce the risk of AKs is to use a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher every day—and to reapply it frequently. It’s also important to practice other sun-safe behaviors, such as:

  • Avoiding the sun when it’s strongest
  • Seeking shade whenever possible
  • Wearing sun-protective clothing, including a wide-brimmed hat, sunglasses, long sleeves and long pants

When to see your doctor

Check your skin regularly, and if you notice anything suspicious or changing, check in with your dermatologist. It’s also important to schedule a yearly skin cancer exam. Catching and treating AKs early is an important step in helping to prevent skin cancer.

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