If you have lived in Florida for a while, there is a good chance you have felt one: a small, rough patch on your face, scalp or hands that feels like sandpaper and never quite goes away. That is often an actinic keratosis, and it is worth treating.
What Is an Actinic Keratosis?
An actinic keratosis (AK), also called a solar keratosis, is a rough, scaly spot caused by years of ultraviolet (UV) exposure. AKs are considered precancerous: most never become cancer, but some can develop into squamous cell carcinoma, and there is no reliable way to tell in advance which ones will. Having AKs is also a sign of enough sun damage to raise your overall skin cancer risk.
AKs usually:
- Feel rough or gritty, sometimes more easily felt than seen
- Look pink, red, tan or skin-colored, often with a dry scale
- Appear on the face, ears, bald scalp, lips, backs of the hands and forearms
- Come and go, scaling and then seeming to fade before returning
On the lower lip, the same process is called actinic cheilitis and shows up as persistent dryness, scaling or a blurred lip border.
How Actinic Keratoses Are Treated
The right approach depends on how many spots you have, where they are, and how much surrounding sun damage there is. Dermatologists think of two strategies: treating individual spots, and treating the whole sun-damaged area (called field therapy) to catch spots that are not visible yet.
Treating individual spots
- Cryotherapy (freezing) — the most common treatment. Liquid nitrogen is applied to each spot for a few seconds. It stings briefly, then the area blisters or scabs and heals over one to three weeks. It can be done the same day as your exam.
- Curettage — for thicker spots, the lesion can be gently scraped away under local anesthetic, sometimes with a biopsy if the spot looks atypical.
Treating the whole sun-damaged area
- Prescription creams — 5-fluorouracil (Efudex), imiquimod (Aldara) and others are applied at home for a set number of weeks. Expect redness, peeling and crusting while they work. That reaction is part of the treatment, and the skin usually looks smoother afterward.
- Photodynamic therapy (PDT) — a light-sensitizing solution is applied to the skin and then activated with a special light, treating a wide area in one session.
- Chemical peels — medium-depth peels can treat widespread AKs on the face and scalp. See our chemical peels guide.
- Laser resurfacing — lasers such as LaseMD Ultra can improve the overall sun damage that produces AKs, along with tone and texture.
Many patients combine approaches: freezing the obvious spots, then a field treatment to reduce how many new ones appear.
When an AK Needs a Biopsy
A spot that is thick, tender, growing quickly, bleeding, or not responding to treatment may be a squamous cell carcinoma rather than an AK. In that case Dr. Sergay will usually take a quick biopsy to check. Read more about what skin cancer looks like.
Preventing New Actinic Keratoses
- Daily broad-spectrum sunscreen, SPF 30 or higher, on the face, ears, scalp and hands, every day of the year in Florida
- A wide-brimmed hat and UPF clothing, especially on a thinning or bald scalp
- Lip balm with SPF to protect the lower lip
- Nicotinamide (a form of vitamin B3) — in a large clinical trial, people with a history of skin cancer who took it daily developed fewer new skin cancers and AKs. Ask your dermatologist whether it makes sense for you.
- Regular skin checks — people with AKs are usually seen every 6 to 12 months, sometimes more often
Our Florida sun protection guide covers daily protection in more detail.
Actinic Keratosis Treatment in South Tampa
Dr. Amanda Sergay, a board-certified dermatologist, evaluates and treats actinic keratoses at our South Tampa office, with same-day cryotherapy and biopsy when needed. Treatment of spots by freezing (destruction) is included in our office visit. Learn more on our sun damage and actinic keratosis page, see our pricing, or book a skin cancer screening.
