Current Management of Actinic Keratoses

I. Shoimer, BSc; N. Rosen, MD; C. Muhn, MD


Skin Therapy Letter. 2010;15(5):5-7. 

In This Article

Abstract and Introduction


An actinic keratosis (AK) is a pre-malignant cutaneous lesion that frequently manifests in sun-exposed areas of the skin as a small, rough, scaly erythematous papule. They are one of the most common presenting complaints for dermatologists. AKs should be treated due to their potential to progress into a squamous cell carcinoma (SCC). There are numerous treatments available for managing AKs including those broadly categorized as destructive, topical field, and procedural field therapies. The topical field therapies include 5-fluorouracil, imiquimod, and diclofenac gel. Recently, imiquimod 3.75% (Zyclara™) has been approved for the treatment of AKs on the face and scalp. It is a reasonable alternative to imiquimod 5%, as the approved indication includes a larger surface area for treatment, shorter duration course, and the potential for less severe local skin reactions. There is no widely accepted algorithm for the treatment of AKs, as comparative data is unavailable between all approaches. Therapy choices are guided by efficacy, adverse effects, cosmetic results, and patient compliance.


Actinic keratoses (AKs), or solar keratoses, are pre-malignant cutaneous lesions that predominantly manifest in sun-exposed areas. They are one of the most common pathologies seen by dermatologists, preceded only by acne vulgaris and dermatitis as more frequent complaints.[1] AKs are clinically relevant lesions due to their potential to progress into a squamous cell carcinoma (SCC).[2] Additionally, they are considered a risk factor for the subsequent development of melanoma and non-melanoma skin cancer (NMSC).

In the northern hemisphere, 11–25% of adults are believed to have at least one AK.[3] These lesions are most commonly seen in the older fair-skinned population (Fitzpatrick skin phototypes I-III). Cumulative ultraviolet (UV) radiation exposure and older age are the most important risk factors for this condition. Individuals who are immunocompromised or have certain genetic syndromes, such as xeroderma pigmentosum and albinism, are at greater risk.


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