An actinic keratosis is a scaly or crusty bump that forms on the skin surface. They are also called solar keratosis, sun spots, or precancerous spots. Dermatologists call them "AK's" for short. They range in size from as small as a pinhead to over an inch across. They may be light or dark, tan, pink, red, a combination of these, or the same color as ones skin. The scale or crust is horn-like, dry, and rough, and is often recognized easier by touch rather than sight. Occasionally they itch or produce a pricking or tender sensation, especially after being in the sun. They may disappear only to reappear later. Half of the keratosis will go away on their own if one avoids all sun for a few years. One often sees several actinic keratoses show up at the same time. Keratoses are most likely to appear on sun exposed areas: face, ears, bald scalp, neck, backs of hands and forearms, and lips. They may be flat or raised on appearance.

Actinic keratosis can be the first step in the development of skin cancer, and, therefore, is a precursor of cancer or precancer. It is estimated that 10 to 15 percent of active lesions, which are redder and more tender than the rest will take the next step and progress to squamus cell carcinomas. These cancers are usually not life threatening, provided they are detected and treated in the early stages. However, if this is not done, they can bleed, ulcerate, become infected, or grow large and invade the surrounding tissues and, 3% of the time, will mestastasize or spread to the internal organs.

The most aggressive form of keratosis, actinic cheilitis, appears on the lips and can evolve into squamous cell carcinoma. When this happens, roughly one-fifth of these carcinomas metastasize. The presence of actinic keratoses indicates that sun damage has occurred and that any kind of skin cancer -- not just squamous cell carcinoma can develop. People with actinic keratosis are more likely to develop melanoma also. Sun exposure is the cause of almost all actinic keratoses.

There are a number of effective treatments for eradicating actinic keratoses. Not all keratoses need to be removed. The decision on whether and how to treat is based on the nature of the lesion, age, and health.

Cryosurgery, one of the most common treatments done, freezes off lesions through application of liquid nitrogen. This is done with a special spray device or cotton-tipped applicator. It does not require anesthesia and produces no bleeding. The longer the spot is frozen the better the chance it will never come back. Longer freezes can result in hypopigmented areas.
 
Curettage is another treatment. The physician scrapes the lesion and may take a biopsy specimen to be tested for malignancy. Bleeding is controlled by cautery --application of an acid or heat produced by an electric needle.

Shave Removal utilizes a scalpel to shave the keratosis and obtain a specimen for testing. The base of the lesion is destroyed, and the bleeding is stopped by cauterization.

Topical cream can be effective in treating keratoses, particularly when lesions are numerous

Treatment with topical cream leaves the affected area temporarily reddened and raw and will cause some discomfort resulting from skin breakdown. The more raw and inflamed the skin becomes, the better the end result

Levulan Photodynamic Therapy using the BLU-U® Blue Light Photodynamic Therapy Illuminator is an advanced 2-step treatment for minimally to moderately thick Grade 1 or 2 AKs (AKs that have not yet become enlarged and thick) of the face or scalp. This therapy is unique because it uses a light activated drug therapy to destroy AKs. The 2-step process consists of treatment with Levulan Kerastick Topical Solution, 20% and the BLU-U Blue Light Photodynamic Therapy Illuminator (BLU-U).

Many of the patients participating in the clinical trial studies experienced 75-100% clearance of Grade 1 or 2 AKs eight weeks after treatment with Levulan Kerastick Topical Solution and BLU-U.   Based on the combined results of two medical studies, 94% of patients treated with Levulan PDT and BLU-U rated the cosmetic response as good to excellent.  Additionally, no scarring was reported during the medical studies. The most common side effects experienced by patients in these medical studies included scaling/crusting, hypo/hyper-pigmentation, itching, stinging, and/or burning, redness and swelling. Severe stinging and/or burning at one or more lesions being treated was reported by at least 50% of patients at some time during treatment.

How does Levulan PDT work?

When Levulan Kerastick Topical Solution is applied to Grade 1 or 2 AKs, the solution is absorbed by the AK cells where it is converted to a chemical that makes the cells extremely sensitive to light. When the AK cells are exposed to the BLU-U, this light causes reactions which destroy the AK cells.