Also known as ‘sun spots’ or ‘solar keratoses’, actinic keratoses are rough scaly patches that are often felt before they are seen. They can occur anywhere but most frequently occur on areas with high cumulative sun exposure such as the face, balding scalp in men, forearms and hands. They are caused by sun damage and are more likely to occur in fair skinned individuals.

Actinic keratoses are ‘pre-malignant’ and may turn in to skin cancers (of the squamous cell carcinoma type). The risk of each actinic keratosis developing in to a cancer is low, but we are unable to predict which one might evolve. In addition, there are often multiple actinic keratoses in a sun-damaged area of skin and the risks are then multiplied. Therefore, we normally advise treatment. If an AK starts to become thick and crusty or ulcerated and painful – seek medical advice.

Actinic keratoses are a sign of high cumulative sun exposure and therefore it is also advisable to see a dermatologist for a complete skin check, to exclude other problems associated with sun damage, such as basal cell carcinoma, squamous cell carcinoma and melanoma.

Treatment at The Skin Hospital

There are many treatment options. As the risks, benefits, downtime and costs of the treatments are quite variable, our specialists at The Skin Hospital will be able to discuss the relevant treatment options with you.

Prevention is better than cure – using good sun protection measures including daily broad spectrum sunscreen, can not only help prevent further sun damage and development of further actinic keratoses, but may decrease the number of actinic keratoses already present.

  • Cryotherapy - using liquid nitrogen to freeze the actinic keratoses. This might be a good option if there are only a few actinic keratoses. However,  it is usually not a practical treatment if there are many actinic keratoses and it may leave the skin lighter in colour (hypopigmented) in the treated area.
  • ‘Field’ treatments treat a whole area, not just the sun spots that can be seen. Examples are: 5-flurouracil cream (efudix), ingenol mebutate gel (picato) and imiquimod cream (aldara). Photodynamic therapy (PDT) is another technique which uses a cream that increases sensitivity to light in combination with light treatment (either laser, non-laser light or daylight) to destroy abnormal cells.
  • Surgery. When the lesion is thicker, removing the lesion with curettage and cautery or excision may be the preferred treatment option – the tissue will be examined under a microscope to ensure that it has not developed in to a skin cancer.
  • Other treatments. At The Skin Hospital we frequently run clinical trials for products treating actinic keratoses. If you are interested in taking part in a trial or would like to know more, please contact the clinical trials team.

Here is a link to trusted sites for further information:


Authors: Dr Charlotte Thomas & Dr Nicholas Stewart, last updated 14th December 2015

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