It’s easy to dismiss a rough patch of skin that looks more like dryness than anything serious. However, when those spots keep coming back or never entirely go away, it’s worth a closer look.

Actinic keratosis (AK) is a common skin condition caused by long-term sun exposure. It often shows up as a scaly, slightly raised area on the face, scalp, ears, or hands, all of which are places that get the most sun over time. These lesions aren’t cancer, but they can turn into it, which is why early diagnosis and treatment matter.

The good news is that AKs are very treatable when caught early, and with the proper skin care and sun protection, many can be prevented in the first place. Let’s take a deep dive into this condition.

What Causes Actinic Keratosis?

Every time your skin is exposed to UV radiation, damage occurs at the cellular level. The process is gradual and cumulative. Even short exposures—15 minutes on a patio, years of driving with one arm in the sun—can add up. Most of the time, your body catches the damage and repairs it, but over the years those repair systems get overwhelmed, allowing the DNA inside skin cells to start to mutate.

The cells most affected are keratinocytes, which make up the bulk of your outer skin layer. When they stop growing and shedding in a healthy pattern, they begin to cluster and thicken in irregular patches of mutated keratinocytes that haven’t yet become cancerous, but aren’t behaving like normal skin either. This is why dermatologists refer to AK as a precancerous condition: it’s a visible warning sign that your skin is suffering from chronic stress and isn’t recovering the way it used to.

Some of these lesions will never progress further, but there’s always a chance that they can turn into squamous cell carcinoma (SCC) if the abnormal growth continues unchecked.

Factors that increase the risk of this cellular damage include:

  • Fair skin that burns easily (Fitzpatrick types I–III)
  • Early-life sunburns, especially during childhood or adolescence
  • Cumulative sun exposure over many years
  • Use of tanning beds
  • Immunosuppressive conditions or medications
  • Age, due to cell-repair processes naturally slowing over time

Research shows that approximately 10% of actinic keratoses will progress to SCC within a decade, and people with multiple AKs are at significantly higher risk of developing it elsewhere on the body as well. AKs can look almost identical on the surface, so one of the challenges is that we can’t predict which lesions will be a problem later on. Because of this unpredictability, dermatologists recommend treating them early to lower the risk of future cancers.

Early intervention also preserves healthy tissue. SCCs that grow thicker or invade deeper require more extensive procedures to remove, and when they appear on the face, ears, or scalp, that can mean longer healing times and visible scarring.

Identifying Actinic Keratosis

Actinic keratoses don’t all look the same, which is part of why they’re so often overlooked. Common features include:

  • A persistent rough patch that doesn’t soften with moisturizer
  • A surface that feels dry, gritty, or scaly under your fingertips
  • Pink, red, tan, or skin-colored tone, sometimes with subtle discoloration
  • Edges that aren’t sharply defined; the lesion may blend into the skin
  • Mild sensitivity or tenderness, especially if rubbed or picked
  • A tendency to come back in the same spot after flaking off

The lesions don’t typically bleed, and they rarely itch, but they also don’t heal like normal skin. If a spot keeps reappearing or slowly thickens over time, it’s worth bringing to your dermatologist’s attention, even if it seems harmless.

Actinic Keratosis Treatment Options

There’s no one-size-fits-all approach to treating AKs. Your provider will decide based on several factors, including the number of lesions, their location, and whether they’re also targeting “field damage,” the broader area of skin that’s been affected by UV exposure, even if it doesn’t show visible lesions yet.

In-Office Procedures

  • Cryotherapy: The most common treatment for AK. Your provider freezes the lesion with liquid nitrogen, destroying the abnormal cells. The area may blister or scab before healing, usually within a week or two.
  • Photodynamic Therapy (PDT): Ideal for treating larger areas with multiple lesions. Your providor applies a light-sensitive medication, then exposes it to a special light source. The resulting reaction selectively destroys abnormal cells while sparing healthy tissue.
  • Medium-Depth Chemical Peels: A peel solution, often trichloroacetic acid or glycolic acid, removes the outer layers of sun-damaged skin, promoting healthy cell turnover and treating multiple AKs at once.
  • Laser Resurfacing: Fractional or ablative lasers can vaporize superficial skin layers and stimulate new skin formation.
  • Curettage and Electrodessication: For thicker or suspicious lesions, a provider may scrape the area and cauterize the base. This option is more common when SCC is suspected and a biopsy is needed.

Topical Therapies

  • 5-Fluorouracil (5-FU): A chemotherapy cream that targets fast-dividing abnormal cells. Treatment usually lasts 2–4 weeks and can cause redness, crusting, and peeling as damaged cells are cleared.
  • Imiquimod: A topical immune response modifier that stimulates your body to attack the abnormal cells. Often used on the face or scalp for more subtle lesions.
  • Diclofenac (Solaraze): A non-steroidal anti-inflammatory gel that targets precancerous cells with milder side effects, though it requires longer treatment, sometimes up to 90 days.
  • Tretinoin or Adapalene: While not primary treatments, retinoids can improve skin texture and reduce recurrence by supporting healthy cell turnover in previously damaged areas.

Your provider may combine treatments, such as using cryotherapy on a few thicker spots while prescribing a topical to treat the surrounding field.

Supporting Your Skin Through Treatment

Most treatments for actinic keratosis work by deliberately triggering inflammation, which destroys abnormal cells so healthy ones can take their place. During that process, it’s normal to experience redness, discomfort, flaking, stinging, and tenderness.

To wrap up, we’re going to show you a few of our favorite products to support your skin barrier as the treatments do their work.

Stick with a gentle, non-foaming cleanser that doesn’t strip or sting. Skip anything with exfoliating acids, fragrance, or strong actives like retinoids unless your provider tells you otherwise.

We recommend:

Moisturizer matters more than usual. Choose a formula that calms inflammation and reinforces the lipid layer with ingredients like ceramides, squalane, niacinamide, and hyaluronic acid.

We recommend:

Sun protection is non-negotiable. Your skin will be more susceptible to UV damage while it heals, and additional sun exposure during this time can undo your progress or worsen irritation. Use a mineral-based sunscreen free from alcohol or fragrance.

We recommend:

To make sure your skin is healing properly or to catch early signs of damage before they become more serious, schedule a consultation or annual skin exam at Advanced Dermatology & Cosmetic Institute. Dr. Elizabeth Briden can offer in-depth evaluations, then recommend personalized treatments and the best lineup of medical-grade skincare to support long-term skin health.