Private sun damage & actinic keratosis clinic in London, same-day dermatology.

Recognising them

• Rough, dry, scaly patches, usually a few millimetres to a centimetre
• pink, red, brown or skin-coloured, sometimes with a white or yellowish crust
• Often felt before seen — run your fingers over the area
• on the face, scalp (especially if balding), ears, backs of the hands, forearms and lower legs
• typically multiple, on a background of general sun damage — freckling, thinning, broken capillaries
• they may come and go, becoming more prominent in summer

Who gets them

• fair skin that burns easily, particularly with red or blonde hair
• age over 50, and considerably more common with each decade after
• cumulative lifetime sun exposure — outdoor work, sport, sunbeds, living abroad
• immunosuppression — particularly after organ transplant, where lesions are more numerous and more likely to progress
• previous skin cancer

Treatment options

• Cryotherapy — freezing individual lesions with liquid nitrogen. Quick, done in clinic, causes a blister and sometimes a pale mark afterwards. Best for a few discrete patches.
• Topical field treatments — creams applied over a whole affected area for a defined period. They cause marked redness, crusting and soreness while working, which is expected and is the treatment doing its job. People often stop early; finishing the course is what determines the result.
• Photodynamic therapy — a light-activated cream, effective for larger areas with good cosmetic outcome.
• Curettage or excision for thickened lesions, or where cancer needs excluding with a specimen.
• Observation is reasonable for a small number of thin, asymptomatic lesions with regular review.

Preventing more