How to Treat Sun Damaged Skin?

An actinic keratosis (AK), also known as a solar keratosis, is a crusty, scaly growth caused by damage from exposure to ultraviolet (UV) radiation.

AKs are pre cancers. 10-15% can become squamous cell carcinomas. AK appear on skin that has been frequently exposed to the sun or to artificial sources of UV light, such as tanning machines. In rare instances, extensive exposure to X-rays can cause them. Above all, they appear on sun-exposed areas such as the face, bald scalp, ears, shoulders, neck and the back of the hands and forearms. They can also appear on the shins and other parts of the legs. They are often elevated, rough in texture and resemble warts.  Most become red, but some are light or dark tan, white, pink and/or flesh-toned. They can also be a combination of these colours.

In the beginning, AKs are frequently so small that they are recognised by touch rather than sight. They feel as if you were running a finger over sandpaper. Patients may have many times more invisible (subclinical) lesions than those appearing on the surface.

Most often, actinic keratoses develop slowly and can grow larger. Early on, they may disappear only to reappear later. Occasionally they itch or produce a pricking or tender sensation. They can also become inflamed and surrounded by redness. In rare instances, AKs can even bleed.

 

Treatment of actinic keratoses

There are two main methods of treatment. You can treat Actinic Keratosis individually, or to treat an entire area as field treatment. Early treatment can eliminate almost all actinic keratoses before they become skin cancers. If an AK is suspected to be an early cancer, you will need a biopsy under local anaesthetic. This is sent for histopathology analysis. 

 

Treatment of individual lesions

Cryotherapy, curette and diathermy or Laser treatment can be used to spot treat lesions. However, these can leave large scars which are difficult to treat later. Sometimes the lesions can become larger or darker. Removal of these lesions with suture closure can also be done to eliminate the lesion.

 

Field Therapy

If you have numerous or widespread actinic keratoses, you can treat visible and invisible lesions with a minimal risk of scarring. These topical treatments can cover a wide field of skin as opposed to targeting isolated lesions. All these treatments have around 80% efficacy. So you need to be examined for resolution of the AK around 6-8 weeks post treatment. Any suspicious lesions that remain are then biopsied. At the Swan Clinic we offer:

  • Chemical peel: Best known for reversing the signs of photoaging, this technique is also used to remove some superficial actinic keratoses on the face. An acid is applied such and/or similar chemicals to the face, causing the top skin layers to slough off. New health skin then grows. You will need to prepare the skin for 4 weeks using special creams. This involves minimal down time but might need to be repeated a month later. Best day is Thursday as peeling usually occurs three days later. Cost is $250 for the preparation creams. Deep peels are $330. You may need 1-3 peels repeated monthly. This is the only treatment you can apply to the entire face at one time. Check out our Medical Grade Peels Page

 

  • Protein Kinase C activator. This topical medication is available on prescription. An immunologic mechanism of action has been proposed. Treatment targets an area 5 x 5 cm and includes specific strengths for the face and body. The area can become red and crusted. You will need to apply the product to the area on three consecutive days and wash the area off after 6 hours. Cost is around $120 from your pharmacy for a 5 x 5 cm area. You will need the area checked after 8 weeks.

 

  • Topical immunotherapy. This topical medication is available on prescription. A form of topical immunotherapy, it stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells. It is usually applied twice a week for 4 weeks. You may need another course if it doesn’t resolve. Apply the cream to the treatment area in a thin layer, and rub in the cream until it disappears. Use the medicine before going to bed and leave it on for 8 hours. In the morning, wash off the medicine with water and a mild soap. Cost is around $100 from your pharmacy. Again, only treat the affected areas. You will need the area checked after 8 weeks.

 

How to spot an actinic Keratosis

These typically occur on the face, lips, ears, bald scalp, shoulders, neck and back of the hands and forearms. Ranging in size from a tiny spot to as much as an inch in diameter, AKs usually appear as small crusty or scaly bumps or “horns.” The base can be dark or light skin-coloured and may have additional colours such as tan, pink and red. Symptoms of actinic cheilitis, a variant of AK that appears on the lower lip, may include chapping, cracks and whitish discoloration.

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple: Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly.

Chronic sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin is cumulative, so even a brief period in the sun adds to the lifetime total. Cloudy days aren’t safe either, because 70-80 percent of the sun’s ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

The more time you spend in the sun over the years, the greater your odds of developing one or more AKs, so older people and outdoor workers are at increased risk. The incidence is slightly higher in men, because they tend to spend more time in the sun and use less sun protection than women do. Though some individuals as young as in their 20s are affected, AKs are much more common in people over age 50. Some experts believe that almost everyone over 80 has AKs.

Location makes a difference: The closer to the equator you live, the more likely you are to have actinic keratoses.