Best prescription medications for Actinic Keratosis

Introduction

Actinic keratosis, also known as solar keratosis, is a common precancerous skin condition. These rough, scaly patches develop on sun-exposed areas of the skin because of prolonged exposure to ultraviolet (UV) radiation. 1,2 If left untreated, actinic keratoses may progress into a type of skin cancer called squamous cell carcinoma. 1,2 Early detection and treatment are important in managing actinic keratosis and reducing the risk of skin cancer.

How Actinic Keratosis Develops

UV radiation from the sun or tanning beds is the primary cause of actinic keratosis. This radiation damages the DNA in skin cells, causing abnormal cell growth and the formation of precancerous lesions. 4,5 The damage accumulates over time, weakening the skin's immune system and making it more susceptible to actinic keratosis and skin cancer. 4,5

Several factors can raise someone’s risk of developing actinic keratosis, including:

• Fair skin, light hair, and light-colored eyes
• Advanced age
• History of excessive sun exposure or sunburns
• Weakened immune system
• Use of certain medications, such as immunosuppressants 3,6

Common Prescription Treatments for Actinic Keratosis

There are several prescription treatments used to manage actinic keratosis, including topical medications, cryotherapy (freezing), and photodynamic therapy. The choice of treatment depends on factors such as the number, location, and severity of the lesions, as well as your overall health and preferences. 9,10

One of the most widely used topical treatments is 5-fluorouracil (5-FU) cream. This medication works by inhibiting cell division, killing off rapidly growing, abnormal cells. 11,12 You typically apply 5-FU cream once or twice daily for 2-4 weeks, during which time the treated area may become red, inflamed, and mildly uncomfortable.

While 5-FU cream can cause temporary side effects like redness, inflammation, and mild discomfort, it has been shown to successfully clear actinic keratosis lesions and reduce the risk of skin cancer development.

Another topical prescription medication is imiquimod cream, which causes the immune system to target and destroy the abnormal cells in actinic keratosis lesions. 11,12 You typically apply imiquimod cream once or twice daily for up to 16 weeks, and it can cause skin irritation, redness, and a burning sensation.

In addition to topical medications, cryotherapy (freezing the lesions with liquid nitrogen), curettage and electrodesiccation (scraping and burning the lesions), laser therapy, and photodynamic therapy (using light-activated medications) are also used to treat actinic keratosis. 9,14

Over-the-Counter Options for Managing Actinic Keratosis

While over-the-counter (OTC) treatments can provide temporary relief for actinic keratosis symptoms, they are not a substitute for professional medical treatment. OTC options like diclofenac gel and hydrocortisone ointment may help alleviate mild itching or discomfort, but they do not treat the underlying precancerous changes in the skin. 10

It is important to consult with a dermatologist if you suspect you have actinic keratosis, as early detection and treatment can help prevent the progression to skin cancer. Your dermatologist can provide a comprehensive evaluation of your skin and recommend the most appropriate treatment plan based on your personal needs and the severity of your condition.

Lifestyle Changes to Support Actinic Keratosis Treatment

In addition to medical treatments, certain lifestyle changes can help you manage actinic keratosis and promote overall skin health. One of the most important steps is to protect your skin from further UV damage by:

• Using broad-spectrum sunscreen with an SPF of at least 30 daily
• Wearing protective clothing, such as long-sleeved shirts, wide-brimmed hats, and sunglasses
• Seeking shade during peak sun hours (typically 10 a.m. to 2 p.m.) 15,16

Sun protective clothing is an important part of a comprehensive sun protection plan, especially for people with actinic keratosis or a history of precancerous lesions. Look for clothing with a high Ultraviolet Protection Factor (UPF) rating. This indicates the garment's ability to block UV radiation. Many brands now offer stylish and comfortable options for sun protective clothing, including long-sleeved shirts, pants, hats, and even swimwear. By wearing these clothes consistently, you can significantly reduce your skin's exposure to harmful UV rays and lower your risk of developing new actinic keratosis lesions or skin cancer.

Maintaining an overall healthy lifestyle, including regular exercise, stress management, adequate sleep, and proper hydration, can also contribute to better skin health and support you in managing actinic keratosis. 20,21

Preventing Future Actinic Keratosis Lesions

Preventing the development of new actinic keratosis lesions is important. In addition to the sun protection measures and lifestyle changes discussed earlier, regular skin self-exams and annual check-ups with a dermatologist can help you detect and treat lesions early. 2,24

Certain topical medications, such as 5-fluorouracil (5-FU) and imiquimod creams, can also be used to prevent new actinic keratoses in people who are high-risk. 25,1 These medications work by targeting and destroying precancerous cells before they have the chance to develop into visible lesions.

For people with a history of multiple actinic keratoses or a weakened immune system, close monitoring by a dermatologist and a strong emphasis on sun protection are necessary to minimize the risk of developing new lesions and skin cancer. 26,27

Conclusion

Actinic keratosis is a common precancerous skin condition that needs prompt attention and appropriate treatment to prevent it from progressing to skin cancer. A comprehensive approach that combines medical treatments, sun protection, lifestyle changes, and regular skin check-ups is important for effectively managing actinic keratosis and reducing the risk of developing skin cancer.

By working closely with a dermatologist, you can develop a personalized treatment plan that addresses your specific needs and risk factors. Sticking to the recommended treatment regimen, practicing sun-safe habits, and maintaining an overall healthy lifestyle can significantly improve the outcomes for those with actinic keratosis and help prevent the development of new lesions in the future.

Remember, early detection and intervention are key in the fight against actinic keratosis and skin cancer. By staying informed, proactive, and committed to your skin health, you can take control of your condition and minimize the potential for more serious complications down the road.

Citations:

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<2>Mayo Clinic. (n.d.). Do you know how to prevent rough, scaly skin patches?-Actinic keratosis - Symptoms & causes. https://www.mayoclinic.org/diseases-conditions/actinic-keratosis/symptoms-causes/syc-20354969</2>

<3>American Academy of Dermatology Association. (n.d.). Actinic keratosis: Who gets and causes. https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-causes</3>

<4>Shao, X., Yu, R., Zhao, H., Wu, J., Wu, Q., & Shu, P. (2023). Causal relationship between genetically determined plasma metabolites and skin cancer: a two-sample Mendelian randomization study. Archives of Dermatological Research. https://pubmed.ncbi.nlm.nih.gov/38787420/</4>

<5>Wang, Z., Wang, X., Shi, Y., Wu, S., Ding, Y., Yao, G., & Chen, J. (2023). Advancements in elucidating the pathogenesis of actinic keratosis: present state and future prospects. Frontiers in Medicine, 10, 1089524. https://pubmed.ncbi.nlm.nih.gov/38566927/</5>

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<11>Drugs.com. (n.d.). List of 11 Actinic Keratosis Medications Compared. https://www.drugs.com/condition/actinic-keratosis.html</11>

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<13>MedlinePlus. (n.d.). Diclofenac Topical (actinic keratosis). https://medlineplus.gov/druginfo/meds/a611041.html</13>

<14>American Academy of Family Physicians. (2007). Treatment Options for Actinic Keratoses. https://www.aafp.org/pubs/afp/issues/2007/0901/p667.html</14>

<15>The Skin Cancer Foundation. (n.d.). Actinic Keratosis Treatment - The Skin Cancer Foundation. https://www.skincancer.org/skin-cancer-information/actinic-keratosis/actinic-keratosis-treatment-options/</15>

<16>UpToDate. (n.d.). Treatment of actinic keratosis - UpToDate. https://www.uptodate.com/contents/treatment-of-actinic-keratosis</16>

<17>Gioppo, I. S., de Castro Martins, I. M., Santos, S. S., Preto, J. F. R., Miola, A. C., & Miot, H. A. (2023). Association between calcium channel blockers and the severity of actinic keratosis on face and scalp: a cross-sectional study. International journal of dermatology, 62(1), 1-6. https://pubmed.ncbi.nlm.nih.gov/37855160/</17>

<18>Navarro-Bielsa, A., Gracia-Cazaña, T., García Malinis, A. J., Quintana, C., Gavín, N., Martínez, R., Puertolas, P., Zazo, E., & Gilaberte, Y. (2023). Skin cancer prevalence in farm workers in Spain. European journal of dermatology: EJD, 33(1), 1-7. https://pubmed.ncbi.nlm.nih.gov/36856390/</18>

<19>Gioppo, I. S., de Castro Martins, I. M., Santos, S. S., Preto, J. F. R., Miola, A. C., & Miot, H. A. (2020). Cardiovascular Drug Use and Risk of Actinic Keratosis: A Case-Control Study. Dermatology and Therapy, 10(4), 805-815. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367976/</19>

<20>Memorial Sloan Kettering Cancer Center. (n.d.). Photodynamic Therapy | Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/patient-education/photodynamic-therapy</20>

<21>Rai, R., Shankar, V., Arora, P., & Arora, S. (2022). Advances in Photodynamic Therapy for the Treatment of Actinic Keratosis and Nonmelanoma Skin Cancer: A Narrative Review. Dermatology and Therapy, 12(12), 2789-2806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9984667/</21>

<22>Saleh, M. M., Awwad, O., Abdel Jalil, M. H., Al-Qerem, W., Saleh, M., Al Thaher, Y., & Abdelghany, S. (2022). Correlation of skin cancer and actinic keratosis-related knowledge and sun protection behaviors and sunscreen use among a sample of Jordanian population. Journal of cosmetic dermatology.</22>

<23>Sgouros, D., Milia-Argyti, A., Arvanitis, D. K., Polychronaki, E., Kousta, F., Panagiotopoulos, A., ... & Katoulis, A. (2022). Actinic Keratoses (AK): An Exploratory Questionnaire-Based Study of Patients' Illness Perceptions. Current oncology (Toronto, Ont.).</23>

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<25>American Academy of Dermatology. (n.d.). Actinic keratosis: Who gets and causes. https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-causes</25>

<26>National Institutes of Health. (2022). Actinic Keratosis - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557401/</26>

<27>The Skin Cancer Foundation. (n.d.). Actinic Keratosis. https://www.skincancer.org/skin-cancer-information/actinic-keratosis/</27>

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<29>National Institutes of Health. (2018). Successful Treatment of Actinic Keratosis with Kanuka Honey. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000848/</29>