Actinic keratosis therapy

Therapeutic measure: Ablative procedure

Ablative procedures are all methods that are used to remove the skin from the diseased areas.

Cryosurgery

A frequently used procedure is cryosurgery (Greek, ice, frost). To do this, the tissue is destroyed locally by applying targeted cold of more than minus 25 degrees. Technically, this is done using a spray, a probe or a stamp. Local anesthesia is not necessary. Side effects may include pain and the formation of blisters or scars.

Removing skin layers with laser therapy

Another procedure is laser therapy; the CO2 or Erbium-YAG laser used only removes the upper layers of the skin and is therefore a good complement to surgical treatment. Laser ablation is best suited for small, limited and not too thick lesions (damage), the side effects can be similar to those of cold therapy.

Dermabrasion – milling off layers of skin

In dermabrasion, the top layers of skin are removed with milling-like instruments. It is a rather old procedure and the success of the therapy depends very much on the skill of the medical professional. Since the procedure is quite painful, local anesthesia is required. Subsequently, wound healing disorders and scars may occur.

Actinic keratosis: Chemical peeling

Chemical peels are a trichloroacetic acid treatment in which the top layer of skin with the actinically damaged cells is peeled off. However, the skin areas are very sensitive after the therapy and must be well protected from the sun.

Therapeutic measure: Surgical procedure

Surgically removing an actinic keratosis is a frequently chosen procedure, especially if there is already a suspicion of skin cancer. The damaged area is either cut out with a scalpel or scraped out with a curette, a surgical spoon. Surgical intervention is recommended if the actinic keratosis has already spread into deeper tissue layers and the entire altered tissue needs to be removed. A sample can then be examined for malignancy in the laboratory. The side effects of superficial ablation are minimal and the wounds usually heal well. Disadvantages can include local anesthesia, general surgical risks, scars and wound healing disorders.

Therapeutic measure: Drug treatment

For mild to moderate skin damage caused by actinic keratosis, ointment treatments with diclofenac and hyaluronic acid have proven to be effective. Under medical supervision, apply this cream morning and evening for 60 to 90 days. You must avoid exposure to sunlight and UV radiation during treatment. The antirheumatic drug inhibits the growth of tumor cells and has been shown to help with actinic keratoses that are not yet very pronounced.

A similar cell-inhibiting effect is achieved with the active ingredient 5-fluorouracil, which is also rubbed in locally as a cream or solution. The product inhibits cell division, which initially leads to an inflammatory reaction of the skin. The diseased cells die and new tissue is formed. The 5-FU cream is only approved for smaller areas of skin and is not well tolerated by all patients. Another preparation, Imiquimod cream, is particularly recommended for actinic keratoses on the face or scalp. The cream is applied three times a week over a period of four weeks, followed by a second treatment cycle if necessary. The cream is well tolerated and has few side effects. It stimulates the immune system and helps the body to deal with the degenerated cells itself.

Ingenol mebutate, an extract obtained from the spurge plant, has been approved for the treatment of actinic keratosis since 2013. However, the approval was withdrawn at the beginning of 2020. The gel under the trade name Picato® is suspected of provoking malignant forms of cancer in the treated areas. Four studies have confirmed this assumption: Malignant skin changes occurred more frequently in the treated areas weeks to months after application. Therefore, if you have treated actinic keratosis with the active ingredient ingenol mebutate in the past, you should carefully observe this/these area(s) and seek medical advice immediately.

Actinic keratosis - photodynamic therapy (PDT)

In photodynamic therapy (PDT), light-sensitizing substances are used to achieve cell death in the diseased skin areas. The affected areas of skin are first treated with a special cream and then exposed to a light source (red light) after a certain exposure time. The metabolic processes triggered by this cause the altered skin cells to die. In studies, the application of light is often described as painful, and the skin very often reacts with redness, burning and itching. Overall, however, this therapy achieves good results and can also treat larger areas while sparing the healthy tissue. Those affected are also very satisfied with the cosmetic result.

For mild lesions (damage), the daily PDT approved in 2015 is also an option. With this form of therapy, you apply the active ingredient MAL (methyl-5-amino-4-oxopentanoate) to the affected areas of skin and then expose yourself to daylight. The daylight variant is described as significantly less painful and is suitable for thin actinic keratoses on the face or scalp.