What are Actinic Keratoses, and How are They Treated?

If you’ve spent years enjoying the sun, your skin may carry some evidence of that exposure. Actinic keratoses (AKs) rank among the most common skin conditions dermatologists treat, and while they’re often easy to dismiss as rough patches or “just dry skin,” they deserve attention. 

What Are Actinic Keratoses?

Actinic keratoses develop from years of accumulated ultraviolet (UV) exposure. They appear as rough, scaly patches on sun-exposed areas like the face, scalp, ears, neck, forearms, and hands. They can feel sandpaper-like to the touch, and they range in color from skin-toned to pink, red, or brown.

Dermatologists classify AKs as precancerous lesions. While not all AKs progress to squamous cell carcinoma (SCC), some do, and there’s no reliable way to predict which ones will. Treating them proactively removes the risk and gives your skin a cleaner foundation going forward.

AKs tend to show up in people over 40 with lighter skin tones and significant sun exposure histories, though anyone can develop them. If you notice a rough patch that won’t go away, a board-certified dermatologist can evaluate it and recommend the right course of action.

Topical Treatments

For patients with multiple AKs or widespread sun damage, topical treatments offer an effective field therapy approach, meaning they treat a broader area rather than targeting individual lesions.

Commonly used topical options include:

• 5-fluorouracil (5-FU): A chemotherapy cream that selectively destroys abnormal cells. It typically requires several weeks of application and causes redness and peeling as it works.
• Imiquimod: Stimulates the immune system to recognize and attack abnormal cells. It works more gradually but suits patients who can’t tolerate the intensity of 5-FU.
• Diclofenac gel: A milder anti-inflammatory option often used for thinner or less pronounced AKs.
• Tirbanibulin: A newer dual-action topical that blocks cell growth and migration, typically used over a shorter treatment course.

Your dermatologist will recommend the right topical based on the number of lesions, their location, and your skin’s tolerance.

Cryosurgery

Cryosurgery remains one of the most widely used treatments for individual actinic keratoses. Your dermatologist applies liquid nitrogen directly to the lesion, freezing and destroying the abnormal cells. The treated area blisters, crusts, and sloughs off over one to two weeks, leaving clearer skin behind.

Cryosurgery works quickly, requires no downtime, and effectively targets discrete lesions. It works best when AKs appear in limited numbers and locations.

Photodynamic Therapy (PDT)

Photodynamic therapy combines a light-sensitizing agent with a specific wavelength of light to destroy precancerous cells. 

Your provider applies a chemical to the skin, allows it to absorb into abnormal cells, and then activates it with the right wavelength of light. The reaction selectively damages AK cells while leaving the surrounding tissue largely intact.

PDT works especially well for patients with diffuse AKs across larger areas like the full face or scalp. It also stimulates collagen production, so many patients notice smoother, more even-toned skin after treatment.

Laser Treatments: Fraxel and Beyond

Lasers offer a powerful option for patients dealing with both actinic keratoses and broader sun damage. The Fraxel laser, in particular, resurfaces the skin at a fractional level, targeting damaged tissue while triggering the skin’s natural healing response.

Fraxel treats AKs while simultaneously addressing texture irregularities, sunspots, and fine lines. It delivers meaningful cosmetic improvements, making it a strong choice for patients who want to comprehensively address years of UV exposure in a single treatment approach.

The Right Treatment Starts with the Right Evaluation

Actinic keratoses don’t all look or behave the same way, and no single treatment fits every patient. The dermatologists at Krauss Dermatology evaluate your full picture, from the number and distribution of lesions to your skin type and lifestyle, and build a treatment plan that addresses both your medical and cosmetic goals. 

If you’ve noticed rough patches or have concerns about sun damage, schedule a consultation to get a clear answer and a clear path forward.

Take the Next Step

If you have further questions about treating actinic keratoses, we encourage you to schedule a consultation at Krauss Dermatology. Call us at (781) 247-5593 or fill out our online contact form. We look forward to taking care of you.