Treatment options

If the patches are not troublesome, yourdoctor may simply recommend that you keep an eye on them and come back if they change in any way for example,if you developnew symptoms such as a patch growing quickly, bleeding or forming an ulcer.

However, actinic keratoses areoften removed because of concerns they may develop into skin cancer (see below) or, less commonly, for cosmetic reasons.

The patches can beremoved using a variety of treatments, depending on your individual circumstances. The main treatments used are summarised below.

Creams or gels

There are a number of creams and gels that can be applied to the skin if you have several patches. Commonly used treatments include 5-fluorouracilcream, imiquimod cream,diclofenac gel andingenol mebutategel.

These creams andgelsare usually applied daily (washing your hands carefully after), oftenfor several weeks,and they cause the abnormal skin cells to die.They may make the skin sore, and it may weep and blister after a few days of treatment.

The various creams and gels seem to be similarly effective in treating actinic keratoses, although the potential side effects and the length of time that treatment is needed differs between each of them. Not all are easily available.

Discuss the benefits and risks of the different creams and gelsavailable with your GP before starting treatment.

Freezing with liquid nitrogen (cryotherapy)

In some cases, freezing the patches (cryotherapy) may be recommended. This causes blistering and shedding of the sun-damaged areas of skin.

The time it takes the skin to heal varies, depending on the areas of the body treated. Some areas may heal in a week or two, whereas others may take a few months to fully heal.

A light freeze usually leaves no scar, but thicker lesions or early skin cancer may need longer freezes, which can leave a permanently pale or dark mark.

Scraping (curettage)

Curettage is wherethe abnormalpatches are scraped off with a sharp spoon-like instrument called a curette. This procedure is done under a local anaesthetic (where the treated area is numbed) and is generally used to treat thicker patches and early skin cancers, or to help confirm a diagnosis.

Cautery (heat treatment) is used to stop any bleeding after the cells have been removed. A scab forms after the procedure, which heals over a few weeks to leave a small scar .

The scrapingsthat are removed can be examined under the microscope to confirm the diagnosis.

Cutting it out (excision)

If your doctor suspects the patch may be cancerous or pre-cancerous, they may cut it out using a scalpel under local anaesthetic and close the wound with stitches. The piece of skin is then examined under the microscope to confirm the diagnosis.

Removing the patchwill leave a permanent scar.

Other treatments

There are also a number of other treatments that may be effective in treating actinic keratoses, including:

• photodynamic therapy (PDT) where light is shone onto the affected area of skin after a light-activated cream has been applied; the light activates this cream and causes it to form a chemical that kills the abnormal cells
• laserresurfacing where a laser beam is used to removethe abnormal patches of skin
• dermabrasion where specially-designed abrasive instruments are used to remove the abnormal patches
• chemical peels where a corrosive liquid is applied to the affected area of skin toremove the abnormal patches

However, these treatments are not in widespread use and there is no clear evidence that they offer any additional benefit.