What is actinic keratosis, and what treatment options are available
At DRS Skincare Hamilton, ON

Actinic keratoses often feel rough before they become clearly visible. Signs to watch for include:

• A persistent rough, dry, or sandpaper-like patch.
• A pink, red, tan, brown, or skin-coloured spot.
• Scaling, crusting, itching, burning, or tenderness.
• A firm or thickened area on sun-damaged skin.
• A lesion that repeatedly flakes off and returns.
• A spot that grows, bleeds, becomes painful, changes appearance, or does not heal.

Because actinic keratosis can resemble benign growths and certain skin cancers, an examination is recommended rather than attempting to diagnose or remove the lesion at home.

Treating actinic keratosis early may reduce the likelihood of progression to squamous cell carcinoma. Early treatment can also address irritation, tenderness, recurrent crusting, and cosmetic concerns before lesions become thicker or more extensive.

An assessment can also determine whether a suspicious lesion requires a biopsy to rule out skin cancer. Patients with multiple actinic keratoses may have broader areas of sun-damaged skin that benefit from field-directed treatment rather than treating only the most visible spots.

DRS Skincare offers individualized treatment plans for actinic keratosis and sun-damaged skin in Hamilton, Ontario. Depending on the number, thickness, location, and appearance of the lesions, treatment may include:

• Cryotherapy with liquid nitrogen.
• Prescription topical medications, such as fluorouracil cream (Efudex).
• Photodynamic therapy.
• Fraxel fractional laser treatment.
• Fractional CO₂ laser resurfacing.
• Curettage or other lesion-directed procedures.
• Combination treatment for persistent or extensive sun damage.
• Biopsy when a lesion has suspicious features.

Fluorouracil cream, commonly known by the brand name Efudex, may be used as a field treatment for areas containing multiple visible or microscopic actinic keratoses. During treatment, patients commonly experience temporary redness, inflammation, crusting, tenderness, and peeling as abnormal sun-damaged cells respond.

Some treatments target individual actinic keratoses, while others treat a wider area of sun-damaged skin where visible and microscopic precancerous changes may be present.

Efudex contains fluorouracil, a prescription medication that targets rapidly dividing abnormal cells in sun-damaged skin. It is often applied to the entire treatment area rather than only to individual visible spots, allowing it to address both visible actinic keratoses and microscopic changes that may not yet be apparent.

Treatment commonly causes a predictable inflammatory response that may include redness, burning, tenderness, crusting, and peeling. The intensity and duration of treatment depend on the location being treated, the degree of sun damage, and the instructions provided by the prescribing clinician.

Patients should use Efudex only as prescribed and should follow all aftercare and sun-protection recommendations.

Photodynamic therapy, also known as PDT, is a field-directed treatment that can be used to treat multiple actinic keratoses in an area such as the face or scalp.

A photosensitizing medication is applied to the treatment area and allowed to absorb. The area is then exposed to a specific light source, activating the medication and selectively damaging abnormal sun-damaged cells.

Photodynamic therapy may be recommended for patients with multiple lesions, recurrent actinic keratoses, or more widespread sun damage. Redness, sensitivity, crusting, and peeling can occur after treatment. Strict light avoidance and post-treatment instructions are important during recovery.

Fraxel is a non-ablative fractional laser that creates microscopic treatment zones within the skin while leaving surrounding tissue intact. It is commonly used to improve sun damage, uneven pigmentation, texture, and signs of photoaging.

In selected patients, Fraxel may be incorporated into a broader treatment strategy for actinic keratoses and chronically sun-damaged skin. It may also be combined with other approaches when visible lesions and wider areas of field damage need to be addressed.

Fraxel is not the appropriate treatment for every suspicious lesion. Any lesion that is thick, rapidly changing, bleeding, painful, or concerning for skin cancer should be medically assessed before cosmetic laser treatment.

Fractional CO₂ laser resurfacing removes microscopic columns of damaged skin and stimulates renewal of the surrounding tissue. It can provide a more intensive resurfacing treatment for significant sun damage, rough texture, pigmentation, and selected actinic keratoses.

Fractional CO₂ laser treatment may be considered for patients with more advanced photodamage or multiple areas of concern. It generally involves more downtime than non-ablative Fraxel treatment but may provide a more significant resurfacing effect.

Treatment intensity, recovery time, and suitability depend on the patient’s skin type, medical history, degree of sun damage, and treatment goals.

There is no single treatment that is best for every patient.

Efudex is a prescription field treatment that can address multiple visible and microscopic actinic keratoses. Photodynamic therapy is also commonly used as a field treatment for multiple lesions. Fraxel may be considered when sun damage, pigmentation, and skin texture are also important concerns. Fractional CO₂ laser provides more intensive resurfacing and may be selected for more significant photodamage in appropriately chosen patients.

Some patients benefit from combination therapy. During a consultation at DRS Skincare, the treatment plan may consider:

• The number and thickness of the actinic keratoses.
• Whether the damage is localized or widespread.
• The location being treated.
• Skin type and pigmentation risk.
• Previous skin cancers or actinic keratoses.
• Medical history and medications.
• Desired downtime and recovery.
• Cosmetic and preventive treatment goals.

Yes. Treatment can remove or improve existing actinic keratoses, but it cannot eliminate the cumulative ultraviolet damage that caused them. New lesions may develop over time, particularly in patients with extensive sun exposure or a previous history of actinic keratosis or skin cancer.

Ongoing sun protection, self-examination, and professional skin checks remain important after treatment. Some patients may also benefit from periodic field treatments, such as Efudex or photodynamic therapy, to manage recurrent or widespread sun damage.

Recovery and results depend on the treatment selected.

Cryotherapy-treated lesions may blister, crust, and gradually clear over one to several weeks. Efudex treatment often lasts several weeks and commonly produces redness, inflammation, crusting, and peeling before the treated skin heals. Photodynamic therapy may also cause redness, peeling, crusting, and sensitivity during recovery.

Fraxel and fractional CO₂ laser results develop as the skin heals and remodels. Some improvement may become visible within several weeks, while continued changes can occur over the following months. More than one treatment may be recommended depending on the extent of the actinic keratoses and sun damage.

Coverage depends on the clinical circumstances, the treatment being performed, and whether it is considered medically necessary or elective.

A medically necessary assessment, biopsy, or treatment of a suspicious lesion may be handled differently from treatments intended to improve broader sun damage, pigmentation, texture, or cosmetic appearance. Prescription medications such as Efudex, photodynamic therapy, and laser treatments may not be covered in all circumstances.

The DRS Skincare team can explain anticipated fees and treatment options before proceeding.

Consistent ultraviolet protection is the most important step. Recommended strategies include:

• Apply a broad-spectrum sunscreen with SPF 30 or higher every day.
• Reapply sunscreen when outdoors for extended periods.
• Wear a wide-brimmed hat, protective clothing, and sunglasses.
• Seek shade and reduce exposure during peak ultraviolet hours.
• Avoid tanning beds.
• Examine your skin regularly for new or changing lesions.
• Attend professional skin examinations as recommended.

Sun protection remains necessary even after Efudex, photodynamic therapy, Fraxel, CO₂ laser, cryotherapy, or other actinic keratosis treatments.

Regular skin examinations may be particularly valuable for people with:

• Fair skin or a tendency to burn easily.
• Significant cumulative sun exposure.
• A history of outdoor work or recreation.
• Previous actinic keratoses.
• A personal history of basal cell or squamous cell carcinoma.
• Multiple areas of visible sun damage.
• A weakened immune system.
• New, changing, bleeding, painful, or non-healing lesions.

Early assessment allows suspicious lesions to be examined and helps determine whether monitoring, treatment, or biopsy is appropriate.

DRS Skincare provides assessment and treatment for actinic keratosis, sun-damaged skin, and suspicious skin lesions in Hamilton, Ontario.

Treatment options may include cryotherapy, prescription topical therapy such as fluorouracil cream (Efudex), photodynamic therapy, Fraxel laser, fractional CO₂ laser, and individualized combination treatments.

Contact DRS Skincare to request a consultation and determine the most appropriate treatment approach for your skin.

Actinic keratosis, also known as AK or solar keratosis, is primarily caused by cumulative exposure to ultraviolet radiation from sunlight or tanning beds. Over time, repeated ultraviolet exposure damages the DNA within skin cells, which can result in rough, scaly, or crusted patches on sun-exposed skin.

Actinic keratoses commonly develop on the face, ears, scalp, lips, neck, forearms, and backs of the hands. Risk factors include:

• Fair skin or a tendency to burn easily.
• Frequent or prolonged sun exposure.
• A history of repeated sunburns.
• Outdoor work or recreation.
• Tanning-bed use.
• Older age.
• A weakened immune system.
• A previous history of actinic keratosis or skin cancer.

Actinic keratosis is considered a precancerous skin change because some lesions can progress to squamous cell carcinoma. Professional evaluation is important, particularly when a spot becomes thicker, painful, rapidly changing, bleeding, or slow to heal.

Actinic keratosis can often be diagnosed through a careful skin examination. A dermatologist assesses the lesion’s appearance, texture, thickness, location, and surrounding signs of sun damage.

Dermoscopic examination may also be used to examine structures beneath the skin more closely. However, dermoscopy does not replace clinical judgment or biopsy when a lesion has suspicious features.

A skin biopsy may be recommended when a lesion:

• Is unusually thick or tender.
• Grows rapidly.
• Bleeds or ulcerates.
• Does not respond to treatment.
• Has an atypical appearance.
• May represent squamous cell carcinoma or another form of skin cancer.

At DRS Skincare, each lesion is assessed individually to determine whether monitoring, treatment, or biopsy is most appropriate.

The cost of actinic keratosis treatment depends on the recommended treatment type, the number of lesions, the size of the treatment area, and whether a lesion-directed or field-directed approach is required.

Cryotherapy for actinic keratosis is covered by OHIP when medically indicated. Other field therapies, including prescription medications such as Efudex, photodynamic therapy, Fraxel, and fractional CO₂ laser, may have additional costs depending on the treatment and the patient’s insurance coverage.

DRS Skincare will review the recommended treatment plan and any applicable fees before proceeding.