Understanding Actinic Keratosis (cont.)

What are available field or blanket treatments for AKs?

Current options include photodynamic therapy (PDT),  Efudex 5% cream, fluorouracil (Carac 0.5% cream), imiquimod (Aldara cream), and medium-deep chemical peels. Overall, multiple treatments may be required, and it is difficult to get rid of every precancer in one treatment. Efudex and Aldara may cause three to six weeks of marked redness, skin irritation, and sun sensitivity. Photodynamic therapy requires 36 to 48 hours of absolute sun avoidance after treatment and a few days of a mild sunburn reaction.

Have any famous people used Efudex?

Former President George H. W. Bush used Efudex for his facial AKs and was photographed with a red, irritated face. Efudex has really been the gold-standard (top of the line) treatment for more than 20 years. Many people don't want treatment with creams like Efudex and Aldara because of the potential prolonged downtime and skin irritation.

What is a good AK treatment for sensitive skin? I break out with almost all kinds of creams. Which field treatment can I use for my AKs?

Photodynamic therapy may be a good option for sensitive skin because it is an in-office treatment with a simple liquid application and light exposure.

I have a very red face and some family members have asked if I have rosacea. Is it possible that my rosacea is causing AKs?

Patients with fair skin, Irish or Scottish ancestry, and light-colored eyes are overall more prone to rosacea (red, flushed cheeks with pink bumps) as well as to AKs. Rosacea does not cause AKs. Both conditions can be worsened by continuous sun exposure and sun damage. Photodynamic therapy with intense pulse light (IPL) may be a great "two for one" package in your case because the combination treatment can effectively treat actinic keratosis, rosacea, and broken blood vessels (telangiectasia).

What general skin care tips do you give patients?

The sun is not your friend! Our main prevention measures are aimed at sun avoidance and sun protection. These include:

  • Use zinc sunscreens with SPF 30.

  • Use wide-brimmed hats (6 inches).

  • Use physical sun barriers, such as clothing and sunglasses.

  • Avoid the peak sun hours of 10 a.m. to 4 p.m.

  • Seek shade and stay indoors.

Some of the doctor's favorite actinic keratosis treatments include:

  • Photodynamic therapy (PDT)

  • Efudex 5% cream twice a day for four weeks to the entire area

  • Aldara cream once a day or every other day for four to 12 weeks

  • Retin-A or Tazorac cream nightly or every other night

  • Chemical peel using trichloroacetic acid (TCA 20%-35%)

Last Editorial Review: 9/18/2008