- Actinic keratosis should be treated to avoid the risk of cancerous development and the aesthetic harm.
- Cryotherapy with liquid nitrogen and photodynamic therapy can be used at dermatological outpatient clinics.
- Imiquimod and diclofenac gel can be used also by a primary care physician. However, the use of imiquimod requires good acquaintance with the drug because it causes a strong local reaction.
- Also known by the name solar keratosis
- A degenerative disorder of epidermal cell growth; a precancerous lesion that can develop into an epidermoid carcinoma that does not (yet) infiltrate through the basal membrane.
- Actinic keratosis can be treated without affecting the dermis (i.e. without causing a scar).
- Common among those with fair skin. Occurs in old age on sun-exposed areas of the skin.
- The face, bald scalp, upper corners of the ear lobes, and dorsum of the hand are sites of predilection.
- An erythematous, asymptomatic, well-demarcated small plaque is the first manifestation .
- The plaque grows up to a diameter of a few centimetres, scales, and may develop thick hyperkeratosis, even a cornu cutaneum.
- In most cases there are multiple lesions.
- Take a biopsy or refer the patient to a dermatologist.
Treatment and prophylaxis
- Before treatment exclude an epidermoid carcinoma (1).
- Cryotherapy with liquid nitrogen is effective, cheap, and the aesthetic outcome is good . Best suited for solitary localized keratoses.
- Excision is seldom needed; the cosmetic result is better with cryotherapy.
- Topical treatments are suitable particularly for actinic keratosis occurring in large areas (so-called field cancerization).
- Topical treatments induce a skin irritation reaction, the strength of which is individual. It is important to inform the patient about this.
- Primary topical treatments
- Imiquimod 5% and 3.75% cream
- Ingenol mebutate gel
- Secondary topical treatments
- Diclofenac 3% gel. Diclofenac can well be used for thin lesions, but the gel should be applied twice daily for 3 months before more permanent treatment results can be expected.
- Tretinoin cream (0.05%) can be used for the treatment and prophylaxis of very thin lesions [Evidence Level: C]. The cream can be used for long periods, even continuously.
- Photodynamic therapy [Evidence Level: B] (PDT) or the so-called daylight PDT are used in many dermatological outpatient clinics.
- Topical treatments can also be combined with cryotherapy or photodynamic therapy.
- Sunscreen preparations slow the development of new lesions [Evidence Level: B].
- Assess healing after 2–3 months.
- In following years new lesions will probably appear.
- If left untreated for years, actinic keratosis may develop into an epidermoid carcinoma.
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