Actinic (Solar) Keratosis
AK should routinely be managed in primary care.
We have not included much on management here as PCDS have a useful summary of how to manage this condition in primary care: (includes grades, pictures, treatment and referral advice) https://www.pcds.org.uk/files/gallery/AK_guidelines_Macrh_2020.pdf1
SKIN CARE ADVICE:
- Although less than 1/1000 of AK progress to SCC the presence of multiple AKs (7 or more) the risk of one transforming in 10 years is 10%1.
Important to stress skin cancer prevention to patient to prevent new lesions/SCC
- Wearing regular sunscreen- factor 50 and 4-5 star UVA rating
- Protective clothing – long sleeved, trousers and wide brimmed hat
- Limit sun exposure 11am-3pm
CONSIDER REFERRAL:(For consideration of Photodynamic Therapy (PDT))
- Young patients (<35 years)
- Evidence of extensive UV damage
- Past history of skin cancer
- Periocular AK
- Xeroderma pigmentosum
- Failure to respond to primary care management
- Possibility of SCC (refer via 2ww)
KEY ADDITIONAL POINTS: (In addition to PCDS guidelines)
Treatment of actinic keratosis does not result in reduction of progression to SCC2 but it will help highlight those not responding to normal therapy.
- 3% diclofenac with Hyaluronic acid (Solaraze) – useful for thin lesions/wide areas
- 5% 5-FU (Efudix) – For areas up to 500cm2. Assess treatment outcome 1-2 months after 4-6 week treatment complete. Ignore any sustained inflammation until 3 month review. Caution in poorly healing areas (e.g. legs) – may need supervision or lower dose (e.g. OD for 3/52 periods)
- 0.5% 5-FU + 10% Salicyclic acid (Actikerall) – useful for thick hyeprkeratotic lesions - small areas up to 252
- Imiquimod 5% (Aldara)– for areas up to 25cm2
- Imiquimod 3.75% (Zylclara)- Licensed for lesions on face and scalp upto 25cm2
- Caution re excluding SCC with ear lesions as if they are SCC they are more likely to
Actinic keratosis: https://www.bad.org.uk/shared/get-file.ashx?id=66&itemtype=document
Imiquimod cream: https://www.bad.org.uk/shared/get-file.ashx?id=209&itemtype=document
- Berker, D., McGregor, J., Mohd Mustapa, M.F., Exton, L.S., & Hughes, B.R. (2017). British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017. British Journal of Dermatology, 176.