Treatment Options for Actinic Keratosis

Actinic Keratosis or Solar Keratosis is seen as skin lesions or patchy areas of skin which may have wart like growths. This disease is directly linked to prolonged exposure to the ultraviolet radiation of the sun. Occurring as single or a localized patch, it may also occur as multiple lesions across the area of sun-exposed skin like the face, forearms or even the chest or back.

Though these warts or lesions are benign in nature, it is also a condition which is considered to be pre-cancerous. Approximately 10% of patients exhibiting symptoms of this disease progress to more serious conditions like skin cancer or squamous cell carcinoma.

It is also observed that this condition may remain unchanged in some patients, not adversely affecting the body in any way. They can also be painless and may not cause any skin irritation. In some cases they may also self-heal.

But the moot point is that it is not wise to take chances with a disease which can spell Cancer in later stages. Single warts may remain unchanged but multiple warts increase the chances of any one developing cancerous cells. Sometimes affected area assumes skin color and becomes difficult to spot. A seemingly healed wart may reappear and then assume complications.

Treatment is relatively simple and in most cases, well received. Thus it is best to adhere to medical advice.

Management of this disease begins with advising the patient of limiting sun exposure and often, avoiding exposure completely between 10 am and 3 pm. Skin care with the help of a good sunscreen with appropriate SPF (15 or more) is also advised.

Out of the many options available for treatment of this condition, the medical practitioner chooses the best that suits the profile of the patient. The following variables are taken into account:

• Frequency and number of lesions
• Most efficient method of treating the identified lesion/s
• Age of the patient
• Previous onset of skin cancer, if any
• Tolerance to the chosen method of treatment

Treatment can be broadly differentiated into two types:

• Medicinal therapy
• Surgical removal of affected area

Medicinal therapy is most opted when multiple lesions are formed over a large area of skin like on the face or the forearms. While it is of advantage in the condition stated above, its disadvantage is that it may take time to have its effects felt and can also cause discomfort during its course. 5-flourouracil, topical diclofenac gel, imiquimod cream and

PDT with topical aminolevulinic are some medication which is commonly used.

• 5-flourouracil follows a course of 60-90 days of treatment. It can be painful as the lesions tend to become red and inflamed. It can also be disfiguring as ulcerations are followed by the formation of a crust over the affected area. This is however a temporary phase and within 2 weeks of stopping treatment, a marked difference in the complexion is noticed and Keratosis is improved.
• Topical diclofenac sodium gel is a non steroid drug and is usually prescribed for a period of 3 months. It is quite preferred as a follow up treatment after a certain kind of surgical removal – called Cryotherapy or freezing the area and its removal. The best thing about this treatment is that it has shown to have the minimal inflammatory symptoms associated with topical treatment.
• Imiquimod cream is effective in a course of a week to 4 months, though an average of a month treatment is found to be effective. Side effects vary from patient to patient and doses regulated accordingly. It is also found to be safe for patients who have undergone organ transplant and are showing symptoms of Keratosis.
• PDT uses a chemical which when introduced into the bloodstream accumulates in the actinic cells and produces a strong photosensitizer. When these cells are further exposed to light of a particular wavelength, they are destroyed. Thus Keratosis is treated. But topical pain is reported in this type of therapy. The advantage, however, is counted high as cosmetically it is the best option available

Surgical removal and treatment of Keratosis has many options too and are usually preferred when lesions are bigger or harder.

• Freezing the affected area and thus killing skin cells is known as Cryosurgery. Liquid nitrogen is the most commonly used cryogen. It does not affect the other parts of skin such as collagen, nerves and blood vessels. This is the reason why this therapy may often leave white spots and require further follow-up therapy.
• Electric cauterization is also preferred in the case of bigger or harder warts. The area is burned which causes cell death
• Conventional surgery under local anesthesia can also be performed
• Laser or other light sources have also been used for therapy in recent times
• Cosmetic reconstruction, though very rarely performed solely for this condition may also be part of therapy

With a multitude of options available, one can make the right decision, in concurrence with the advice of the medical practitioner and lead a healthy life.