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Medical Author:

Alan Rockoff, MD

Alan Rockoff, MD

Dr. Rockoff received his undergraduate degree from Yeshiva College with the distinction of Summa Cum Laude. He received his medical degree from the Albert Einstein College of Medicine. His internship and two years of Pediatric residency were at the Bronx Municipal Hospital Center, followed by training in Dermatology at the combined residency program at Tufts and Boston Universities. Dr. Rockoff is certified by both the American Board of Dermatology and the American Board of Pediatrics.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is an actinic keratosis, and what does it look like?
• Who is at risk for an actinic keratosis?
• Where on the body do actinic keratoses typically occur?
• What is the significance of an actinic keratosis?
• How is an actinic keratosis diagnosed?
• How is an actinic keratosis treated?
• What happens after an actinic keratosis is treated?
• Actinic Keratosis At A Glance
• Patient Comments: Actinic Keratosis - Describe Your Experience
• Patient Comments: Actinic Keratosis - Treatments
• Find a local Dermatologist in your town
• Actinic Keratosis Index

Most of the time, doctors can diagnose an actinic keratosis just by examining it. If the AK is especially large or thick, a biopsy may be advisable to make sure that the spot in question is just a keratosis and has not become a skin cancer.

There are other spots, called seborrheic keratoses, that are not caused by sun exposure and have no relationship to skin cancers. These are raised brown lesions that may appear on any area of the skin. They also often run in families.

The best treatment for an AK is prevention. For light-skinned individuals, this means minimizing their sun exposure. By the time actinic keratoses develop, however, the relevant ultraviolet radiation is often so far in the past that prudent preventive measures play a relatively small role. Fortunately, treatment methods are usually simple and straightforward:

• Cryosurgery: Freezing AKs with liquid nitrogen often causes them to slough off and go away.



• Other forms of surgery: Doctors sometimes cut away or burn off AKs.



• 5-fluorouracil (5-FU): Creams containing this medication cause AKs to become red and inflamed before they fall off. Although effective, this method often produces unsightly and uncomfortable skin for a period of weeks, thus making it impractical for many patients. This method is best for patients who have a great deal of sun damage and many AKs. Once the skin heals, it often looks much smoother and even-toned, in addition to having fewer actinic keratoses.



• Imiquimod (Aldara): This immune stimulator is similar in its indications and effects to 5-FU.



• Photodynamic therapy (PDT): This therapy involves applying a dye (aminolevulinic acid [Levulan] or ALA) that sensitizes the skin to light, leaving it on for about one hour, and then exposing the skin to light that activates the dye. This light can come from a laser or other light source. Like 5-FU and imiquimod, photodynamic therapy works best for patients with many AKs. Patients need to avoid exposure to sun or intense fluorescent light for two days after treatment to prevent ongoing peeling.



• Diclofenac (Solaraze): This cream is an nonsteroidal antiinflammatory drug (NSAID), an agent related to ibuprofen [Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever], a popular medication for headaches). Diclofenac is gentler than 5-FU or imiquimod, causing less inflammation, but must be applied for a longer period of about two months to achieve benefits.