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Identifying Actinic Keratosis

Discovering a suspicious spot or growth on your skin might signal an actinic keratosis (AK). It's essential to seek a comprehensive skin examination. An AK, if confirmed, can be managed to reduce the risk of skin cancer, improve skin appearance, and alleviate discomfort such as itching or pain.

The Dermatologist's Role

Dermatologists are at the forefront of diagnosing and treating AKs, a prevalent condition they encounter frequently. Their expertise ensures accurate identification and effective treatment strategies.

Diagnosis Process

A dermatologist will conduct a meticulous skin examination and inquire about your health history, medications, and symptoms. The presence of AKs can often be diagnosed through visual inspection, with the dermatologist also vigilant for signs of skin cancer. Individuals with extensive UV light damage are at a higher risk for both AKs and skin cancer.

Treatment Considerations

Dermatologists discuss treatment options for these precancerous growths, usually recommending treatment. However, for some patients, especially those who are frail or have difficulty tolerating treatment, frequent skin exams may be suggested instead. Treatment involves destroying the AKs, which can temporarily leave the skin raw, red, and swollen.

Therapies for AKs

The suitability of treatment depends on various factors, including the number of AKs, their location, appearance, personal medical history, and other health conditions.

In-Office Procedures

Several procedures can be performed during an office visit to treat AKs:

Cryosurgery: The dermatologist applies liquid nitrogen to freeze the AK, causing it to fall off after a few days.

Chemical Peel: A medical-grade peel that destroys the top skin layers, leading to red, swollen skin that heals with new skin.

Curettage: For thick AKs, the dermatologist scrapes away the lesion, potentially followed by electrodesiccation to eliminate remaining cells.

Photodynamic Therapy (PDT): A two-part process involving a light-sensitive solution and light exposure to destroy AKs.

Laser Resurfacing: Useful for treating actinic cheilitis, it removes the skin surface layer, resulting in raw skin that heals with new skin.

At-Home Treatments

For multiple or palpable AKs, dermatologists may recommend at-home treatments with prescribed medications, which can address unseen AKs and reduce the risk of new developments.

Medications for AKs

Several FDA-approved medications are available for at-home treatment:

5-Fluorouracil (5-FU) Cream: Applied once or twice daily for 2 to 4 weeks, except for pregnant women due to potential harm to the unborn baby.

Diclofenac Sodium Gel: Applied twice daily for 2 to 3 months, with sun protection advised.

Imiquimod Cream: Applied once or twice weekly for 12 to 16 weeks, or in a pulsed manner for better tolerance.

Tirbanibulin Ointment: Applied for five consecutive days, carefully spread over the specified treatment area.

Avoiding Corticosteroids

During AK treatment, avoid using hydrocortisone or corticosteroids, as they can interfere with the effectiveness of AK treatments.

Outcome and Prevention

While some individuals may only develop a few AKs that can be cleared with treatment, others with extensive AKs should remain under dermatological care due to the likelihood of recurrent lesions and potential skin cancer development. Regular check-ups and proactive self-care are crucial for prevention and early detection of skin cancer.

Dermatologists will guide you on the frequency of follow-up appointments, which may vary based on individual risk factors. Consistent self-care and diligent check-ups are vital for the best possible outcomes in managing AKs and preventing skin cancer.