Cavallo & Horlick Dermatology

631-732-9090Suffolk - Pt Jefferson Station
1500 Route 112 Bldg 6
Pt. Jefferson Sta., NY 11776

516-921-2294Nassau - Woodbury
169 Froehlich Farm Blvd.
Woodbury, NY 11797

Actinic Keratosis Long Island

Actinic keratoses (AKs): AKs form on skin that soaks up lots of sun over the years. An actinic keratosis (ak-ti-nik ker-ah-TOE-sis), or AK, is a rough, dry, scaly patch or growth that forms on the skin.

An AK, also called a solar keratosis, forms when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor tanning. Most people who are prone to AKs get more than one. When you have more than one AK, you have actinic keratoses, or AKs.

Anyone who has many AKs should be under a dermatologist’s care. Most people who have many AKs continue to get new AKs for life. AKs are considered precancerous. Left untreated, AKs may turn into a type of skin cancer called squamous cell carcinoma.

By seeing us for checkups, the AKs can be treated before they become skin cancer. If skin cancer does develop, it can be caught early when treatment often cures skin cancer. Left untreated, AKs may turn into a type of skin cancer called squamous cell carcinoma. People who have AKs also have a higher risk of getting other types of skin cancer. When found early, most skin cancers can be cured.

Symptoms of actinic keratoses

Most people who get AKs do not have any symptoms. They only notice changes to their skin. Symptoms can occur. A few symptoms to watch for are:

  • Rough-feeling patch on skin that cannot be seen.
  • Rough patch or growth that feels painful when rubbed.
  • Itching or burning.
  • Lips feel constantly dry.

Actinic keratosis: Now you see it, now you don’t

An AK can come and go. An AK can appear on the skin, remain for months, and then flake off and disappear. The skin can suddenly feel smooth. Many AKs re-appear in a few days to a few weeks. They often re-appear when the person goes outdoors without sun protection.

Even if an AK does not re-appear, you should see us. AKs form when the top layer of skin is badly damaged. You can get more AKs. If the damage grows deeper, skin cancer can develop

People who are most likely to get AKs have one or more of the following traits:

  • Fair skin.
  • Hair color is naturally blond or red.
  • Eyes are naturally blue, green, or hazel.
  • Skin freckles or burns when in the sun.
  • 40 years of age or older.

Weak immune system, which has many causes including:

  • Organ transplant: The medicine that prevents rejection weakens the immune system.
  • HIV/AIDS.

Have a medical condition that makes the skin very sensitive to UV rays, such as:

  • Albinism (albino).
  • Xeroderma pigmentosum.
  • Work with substances that contain polycyclic aromatic hydrocarbons (PAHs), such as coal or tar. Roofers have a higher risk of getting AKs because they work with tar and spend their days outdoors.

AKs usually appear after age 40. People who live in places that get intense sunlight all year, such as Florida and Southern California, may get AKs earlier. AKs also often appear much earlier in people who use tanning beds and sun lamps.

What causes AKs?

Ultraviolet (UV) rays cause AKs. Most people get exposed to UV rays from being outside during the day or using tanning beds. When UV rays hit our skin, the rays damage our skin. When we are young, the body can repair some of the damage. Over time, the damage accumulates, and the body is less able to repair itself. We eventually see UV-damaged skin. If UV rays continue to hit the skin, people get AKs

How do we diagnose actinic keratosis?

Dermatologists diagnose an actinic keratosis (AK) by closely examining the skin.

If we find a growth that is thick or looks like skin cancer during the exam, we will likely perform a skin biopsy, which can be done during an office visit. When found early and treated, skin cancer is often cured.

How do we treat AKs?

There are many treatments for AKs. Some treatments your dermatologist can perform in the office. Other treatments you will use at home. The goal of treatment is to destroy the AKs. Some patients receive more than one type of treatment. Treatments for AKs include:

Prescription medicine:

We may prescribe a medicine that you can use at home to treat AKs. Medicines that dermatologists prescribe include:

  • 5-fluorouracil (5-FU) cream: This is chemotherapy that you apply to the skin. It causes temporary redness and crusting. Patients typically apply 5-FU twice daily for 2 to 4 weeks. A person who has lots of damaged skin may need to use 5-FU longer. 5-FU causes sun-damaged areas to become raw and irritated. As the skin heals, healthy skin appears. Another treatment such as cryotherapy may be necessary to treat thick AKs.
  • Diclofenac sodium gel: This is a non-greasy gel. You apply it to skin with lots of AKs. Patients apply the medicine twice a day for about 2 to 3 months. During this time, you must protect your skin from the sun. You will see the best results about 30 days after you stop applying the gel. Some AKs can remain. We will treat these, often with cryotherapy.
  • Imiquimod cream: This cream helps boost your body’s immune system so that your body can get rid of the diseased skin cells. You will apply this cream to your skin as we direct. Most patients apply imiquimod for several weeks. Imiquimod causes the skin to redden and swell. After you stop using the medicine, the skin heals.
  • Ingenol mebutate gel: This gel works in two ways. It boosts the body’s immune system. It also is a type of chemotherapy for the skin. One formula is used to treat AKs on the head and scalp and is applied for 3 days in a row. The other formula treats AKs on the legs, arms, and torso. Patients apply this formula for 2 days in a row. Both formulas can cause rapid redness and swelling. As the skin heals, the redness and swelling clear.

In-office procedures:

  • Cryotherapy: Destroys visible AKs by freezing them. The treated skin often blisters and peels 0034 resizedoff within a few days to a few weeks. This is the most common treatment.
  • BLU-U Light or Photodynamic therapy (PDT):
  • Levulan® Kerastick® (aminolevulinic acid HCl) for Topical Solution, 20% (Levulan Kerastick) plus blue light illumination using the BLU-U® Blue Light Photodynamic Therapy Illuminator (Levulan PDT) is indicated for the treatment of minimally to moderately thick actinic keratoses. Levulan PDT, a 2-part treatment, is unique because it uses a light activated drug therapy to destroy AKs. How does it work? Levulan Kerastick Topical Solution is applied to the AK. The solution is then 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 Blue Light Illuminator, a reaction occurs which destroys the AK cells.

The 2-part treatment offers the following conveniences:

  • No prescription to fill
  • No daily medication to remember
  • Treatment is administered by a qualified healthcare professional

Levulan PDT can also fit your lifestyle:

  • The 2-part, 2 office visit treatment is completed in less than 24 hours
  • Low downtime
  • High ratings for cosmetic response
  • No scarring reported to date

Patients treated with Levulan PDT should avoid exposure of the photosensitized lesions to sunlight or prolonged or intense light for at least 40 hours.

Ask us if Levulan PDT is right for you!

What to expect before, during and after Levulan® PDT treatment

Before Treatment Starts

  • Be sure to tell us if you are taking any oral medications or using any topical prescription or non-prescription products on your face or scalp.
  • Bring adequate sun-protective items with you to your appointment such as a wide-brimmed hat or umbrella.

The Levulan PDT Treatment

Treatment Step 1: Application of Levulan Kerastick Topical Solutionsticks

  • Levulan will be uniformly applied to your AK lesions.
  • We will direct you to wait the recommended time in order to allow the solution to penetrate the targeted cells. Then you will return for the second part of your treatment which includes illuminating your treated lesions with the BLU-U® blue light.
  • You should not wash your face in between treatment steps.
  • Avoid exposing the treated lesions to sunlight and other forms of bright light for at least 40 hours. Examples include exam room examination lights, operating room lamps, tanning bed lights, and household lights at close range. Sunscreens will not protect against photosensitivity reactions caused by visible light during this time. Remember to wear light protective clothing, such as a wide-brimmed hat, during this time.

Treatment Step 2: BLU-U Treatmenttreatment

  • Before your BLU-U treatment, gently rinse and pat dry the treated area.
  • Your treatment with the BLU-U will take approximately 17 minutes.
  • Potective eyewear should be worn during your BLU-U treatment.
  • You may experience stinging or burning during your BLU-U treatment, but this should subside between 1 minute and 24 hours after the BLU-U is turned off.

After Treatment

You may apply moisturizers as needed.
The most common side effects are:
Burning/stinging, which could be severe, may last up to 24 hours after your BLU-U treatment
Redness and swelling which may last up to 4 weeks after your BLU-U treatment
Scaling/crusting which may last up to 4 weeks after your BLU-U treatment

General precaution for sun exposure

On a daily basis, always remember to use sunscreen and wear sun protective clothing to shield your skin from the sun’s damaging rays. .

Tips to prevent AKs (actinic keratoses)

Protect your skin from the sun. By protecting your skin from the sun, you can help prevent new AKs from forming. This also will help make your treatment more effective. Dermatologists offer these tips to their patients who have AKs:

  • Avoid the midday sun. You can do this by scheduling outdoor activities for earlier in the morning (before 10 a.m.) and later in the afternoon (after 2 p.m.).
  • Slather on sunscreen every day — even on cloudy days and in the winter. Apply sunscreen to all skin that clothing will not cover. 3 things your sunscreen must offer:
  1. SPF (sun protection factor) of 30 or higher.
  2. UVA/UVB protection (label may say “broad-spectrum”).
  3. Water resistance.
  • Protect your lips. Apply a lip balm that contains sunscreen. The lip balm also should offer an SPF of 30 or greater and UVA/UVB protection.
  • Protect your skin with clothing. Whenever possible wear:
  1. A wide-brimmed hat.
  2. Long sleeves.
  3. Pants.

To see how well your clothes will protect you, hold each garment in front of bright light. If you see light through the cloth, harmful light from the sun can penetrate the cloth. You should select another garment. You also could wear that garment but apply sunscreen first to the skin that the garment will cover.

Do not use tanning beds or other indoor tanning devices. Tanning beds and sun lamps emit UV rays that can be stronger than the rays from the sun. This can cause new AKs.

Check your skin as often as your dermatologist recommends. If you notice a growth on your skin that has any of the following traits, contact us right away:

  • Starts to itch or bleed.
  • Becomes noticeably thicker.
  • Remains after treatment.
  • Changes in size, shape, or color.

Keep all appointments with your dermatologist. Left untreated, AKs can turn into a type of skin cancer called squamous cell carcinoma. With early detection and treatment, skin cancer has a high cure rate.

Because AKs develop on skin that has been badly damaged by UV rays, you also have a higher risk for developing other types of skin cancer, including melanoma. Keeping your appointments helps to find skin cancer early when a cure is likely.

Realize that new AKs may form. AKs form on badly damaged skin. Some people will continue to develop new AKs for life, even when they protect their skin from the sun. This does not mean that sun protection and treatment are not working.

Ask us if Levulan PDT is right for you!


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