Treatment options for actinic keratosis, or age spots, include topical medication or in-office procedures. A doctor or skin care specialist can offer guidance on the best approach.
Actinic keratosis is a common skin condition that appears on sun-exposed skin. It creates scaly, discolored bumps or lesions that may appear on your face, arms, and hands. These marks also go by the name “age spots.”
Treatment for actinic keratosis isn’t just cosmetic. Getting treatment can also help prevent skin cancer, since between 5% and 10% of actinic keratosis lesions will become cancerous, according to the Skin Cancer Foundation.
Since you typically can’t tell which lesions will pose a risk to your health, your doctor or dermatologist may recommend taking a proactive approach and getting rid of any spots you have.
Your treatment program may include chemical procedures, surgery, medications, or a combination of the three. The best approach for you will typically depend on the number of lesions you have, the appearance of your actinic keratosis lesions, and your personal health history.
Read on to discover which actinic keratosis treatments may be an option for you.
Procedures include treatments performed by a trained professional who uses specialized equipment in a medical office.
Surgery and other procedures typically produce results sooner than at-home treatments, but they can also cause more pain. Some may involve additional side effects, including a risk of scarring.
Photodynamic therapy
In this procedure, your dermatologist “paints” your actinic keratosis spots with a chemical agent. Then, you’ll sit in the dark for 60 to 90 minutes to give the chemical time to soak into your skin. Next, your dermatologist will turn on a lamp that produces red or blue light. The light activates the chemical and destroys the lesions.
This procedure can work to treat a number of spots without damaging the skin in between. But the treated skin may feel a little burnt or swollen after the procedure.
You’ll also need to play vampire, so to speak, and avoid sunlight for at least 48 hours afterward. Some of the chemical agent may linger on the surface of your skin, and you don’t want to accidentally reactivate it and give yourself a sunburn.
In some cases, you may need a second round of photodynamic therapy. You can return 3 weeks after your first appointment.
Chemical peel
In this procedure, a dermatologist or other trained healthcare professional will cover your skin in trichloroacetic acid, a chemical agent that makes the top layers of your skin slide off.
Afterward, you may notice some inflammation, discoloration, and soreness, but new skin will regrow within a few weeks.
Like photodynamic therapy, chemical peels can treat a number of spots over a wide surface area.
According to a
Cryosurgery
The dermatologist may recommend cryosurgery if you only have a few lesions in a limited area.
This procedure uses liquid nitrogen. The dermatologist will either spray it onto each lesion or brush it on with a cotton swab. Liquid nitrogen is very cold and may sting a little when applied.
The actinic keratoses may fall off within just a few days after the treatment. They may get crusty or show blisters before falling off, but this is a natural part of the process.
Often, the lesions fall off after a single visit, but you may need multiple rounds of treatment before the spots go away.
Laser resurfacing
As its name suggests, laser resurfacing burns the surface layer of your skin with a laser. This procedure is typically used for actinic keratoses on your face and scalp. The doctor has a lot of control over how deep the laser goes, so laser resurfacing may be especially helpful for lesions on your sensitive lips.
Unsurprisingly, lasers can be painful, so if the doctor plans to treat deeper layers of your skin, they may give you local anesthetic beforehand. Depending on the type of laser used, you may have some risk of scarring or loss of pigment in your skin.
Your skin may feel raw or sore after treatment, but it will likely heal after 1or2 weeks.
Curettage and electrodessication
Sometimes, thick actinic keratosis spots can be
The doctor may follow up with electrodessication, a procedure that uses an electric device to heat the treated area. Electrodessication serves two functions: it destroys any remaining actinic keratosis cells and helps prevent excessive bleeding.
Due to the risk of scarring, curettage isn’t recommended for facial actinic keratosis unless the doctor believes you could have a cancerous spot.
Topical medications include creams, ointments, and gels you apply to the surface of your skin. Although this kind of treatment may take longer than in-office procedures, you can apply the medication in the convenience of your own home.
A dermatologist may prescribe topical medication if you have a number of spots across a wide area of your skin.
If you have a lot of actinic keratoses, you might not be able to remove every single spot. But many medications can clear
FDA-approved medications
The Food and Drug Administration (FDA) has approved the following medications for actinic keratosis treatment:
- 5-fluorouracil (5-FU)
- imiquimod (IMQ)
- diclofenac sodium (DFS)
- tirbanibulin
- ingenol mebutate (IM)
The dermatologist or another doctor can recommend and prescribe the right medication for your needs.
5-Fluorouracil (5-FU)
- Brand names: Carac, Efudex, and Fluoroplex are brand names for 5-FU.
- How to use it: You’ll apply the cream twice a day until the lesions peel off. This can take 2 to 4 weeks. Your lesions may not completely heal until a month after you stop using 5-FU.
- How it works: It
blocks DNA synthesis and disrupts cell division in the actinic keratoses. - Side effects: You may experience skin discoloration, swelling, or crusting, but your risk of scarring is low.
- Special considerations: 5-FU can harm developing fetuses, so avoid using it while pregnant.
Imiquimod (IMQ)
- Brand names: Aldara and Zyclara are brand names for IMQ.
- How to use it: The prescribing clinician may recommend applying the cream once or twice a week for 12 to 16 weeks.
- How it works: IMQ stimulates your immune system to produce a chemical called interferon that attacks precancerous cells.
- Side effects: You may notice itching, swelling, flaking, or skin discoloration.
- Special considerations: This medication may not be the best option if you have an immunodeficiency disorder.
Diclofenac sodium (DFS)
- Brand names: Solaraze is a brand name for DFS.
- How to use it: You’ll apply the gel to your skin twice a day for 2 to 3 months.
- How it works: DFS combines the nonsteroidal anti-inflammatory drug (NSAID) diclofenac with hyaluronic acid, a chemical that helps smooth your skin.
- Side effects: DFS can cause itching, rash, dryness, and scaling. If you have sensitive skin that reacts harshly to 5-FU, this medication may offer a gentler alternative.
- Special considerations: Since NSAIDs can affect your blood circulation, you’ll want to avoid using DFS if you’ve recently had a heart attack.
Tirbanibulin
- Brand names: Klisyri is a brand name for tirbanibulin.
- How to use it: Apply the ointment once daily for 5 days in a row. Avoid washing or touching the area for 8 hours after you put the ointment on.
- How it works: The ointment kills fast-growing cells, such as the ones in actinic keratoses, by preventing the growth of certain cellular building blocks.
- Side effects: You may notice some mild itching and stinging where you apply the ointment.
- Special considerations: Since tirbanibulin destroys cells, avoid spreading it to any entry points to your body, such as your eyes or lips. You’ll only want to apply this to your face and scalp.
Ingenol mebutate (IM)
- Brand names: Picato is a brand name for IM.
- How to use it: This medication comes in two strengths: 0.015% and 0.05%. To treat spots on your body, you’ll typically use 0.05% gel once a day for 2 days. To treat spots on your face, you’ll typically use 0.015% gel for 3 days. Avoid touching or washing the treated area for 6 hours after you apply the gel.
- How it works: Similar to tirbanibulin, IM kills fast-growing skin cells. Then it prompts your body’s immune system to clear out the rest of the abnormal cells.
- Side effects: You may have crusting, flaking, itching, or swelling in the treated area.
- Special considerations: As with tirbanibulin, you’ll want to avoid letting the gel enter your eyes or mouth.
One of the best ways to protect your skin from actinic keratosis is to prevent these spots from appearing in the first place. Even if you already have a few spots, you can take action to prevent more from developing.
A few helpful skin health strategies:
- Apply sunscreen before every outdoor adventure: Sun damage is cumulative, so even a few minutes of sunlight can ultimately harm your skin.
- Reapply sunscreen every 2 hours: Sunscreen doesn’t offer permanent protection. Most sunscreens wear off after a few hours, so carry some sunscreen with you to reapply on long trips.
- Higher sun protection factor (SPF) does a better job: Opt for sunscreen with at least 30 SPF — this means it blocks 30 times more ultraviolet (UV) rays than unprotected skin.
- Wear sun-protective outfits: All clothes block UV rays to some extent, but darker, tightly woven fabrics generally offer more protection.
- Find shade: If all else fails, you can use your environment to block out the sun. If you’re outdoors, try resting under an umbrella, tree, or gazebo during the brightest parts of the day.
Although actinic keratosis spots may seem harmless, some can become cancerous, so it’s important to treat all of your spots as soon as you notice them.
Treatment methods vary widely, from 1-day surgeries to medication regimens that last weeks. A dermatologist can offer more guidance on which treatments will work best for your specific needs.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.