Actinic Keratosis Treatment in London – Consultant Dermatology Care for Sun-Damaged Skin

What Are Actinic Keratoses?

Actinic keratoses (AKs) are small, rough or scaly patches caused by long-term ultraviolet (UV) exposure. They are extremely common on sun-exposed skin such as the face, scalp, ears, neck, forearms and the backs of the hands. AKs are sometimes easier to feel than to see — the classic description is “like sandpaper”. Although individual lesions are often harmless in the short term, they are markers of cumulative sun damage. A proportion of AKs can progress to squamous cell carcinoma (SCC) over time, which is why assessment and treatment are recommended, particularly when lesions are thick, tender, enlarging or numerous.

Why AKs Develop: Cumulative UV Exposure

Our skin remembers every hour of sun and artificial UV. Years of outdoor work, sport, holidays and incidental daily exposure gradually alter the DNA in epidermal cells. Fairer skin tones (especially those that burn easily) are less protected by melanin and therefore more prone to AKs. Sunbeds/indoor tanning add further risk. In addition to visible patches, there is often a wider area of “field cancerisation” — sun-damaged skin that looks slightly blotchy or rough and harbours early changes that may not yet be visible. Treating the field as well as the obvious lesions reduces recurrence and helps prevent SCC.

Who Is at Higher Risk?

• Outdoor lifestyles or occupations: construction, gardening, farming, watersports and year-round cyclists/runners.
• Fair skin, light eyes/hair: lower natural UV protection; AKs often appear earlier and in greater numbers.
• Ageing skin: AKs accumulate with decades of UV exposure; men with thinning hair commonly develop scalp AKs.
• Immunosuppression: organ transplant recipients and others on long-term immunosuppressants develop more AKs and require closer follow-up.
• Past skin cancer: a history of BCC or SCC increases the chance of significant sun damage elsewhere.

Typical Signs and Symptoms

AKs range from tiny, dry, rough spots to larger scaly plaques. They may be skin-coloured, pink, red or brown; some feel tender or sting when catching on clothing or when you shave. Thick, warty or horn-like lesions (sometimes called hyperkeratotic AKs) stand out and are prioritised for treatment. Any lesion that becomes painful, tender, crusted, bleeds easily or grows quickly needs prompt assessment to exclude SCC.

How We Diagnose Actinic Keratoses

Diagnosis is usually clinical. We examine the pattern, feel and distribution of patches and assess the surrounding field of sun damage. Dermoscopy (a magnified, polarised light examination) helps differentiate AKs from look-alikes such as seborrhoeic keratoses or early skin cancers. In uncertain cases, or where a lesion is atypical or fails to respond as expected, we may recommend a biopsy. Capturing baseline photographs is useful for monitoring change over time.

Treatment Principles: Lesion-Directed and Field-Directed

AK care has two arms. Lesion-directed treatments remove individual, bothersome or thick lesions. Field-directed treatments address the wider zone of sun-damaged skin, clearing visible AKs and many “subclinical” ones at the same time to reduce recurrence. Your plan will usually combine both approaches, tailored to the site (face vs scalp vs hands), your tolerance for downtime, and your goals.

Lesion-Directed Options

Cryotherapy (Freezing)

Brief application of liquid nitrogen freezes and destroys abnormal cells. It is fast and effective for isolated lesions. Expect temporary whiteness, tingling, then redness and a small blister or crust that heals over 1–3 weeks depending on the site. On the shins and hands it may take a little longer.

Curettage & Cautery

For thick, warty AKs, gently scraping (curettage) followed by light cautery smooths the surface and removes bulk, allowing the skin to remodel. Healing creates a flat area that gradually blends in. This is helpful when we need a tissue sample for analysis at the same time.

Ablative Laser

Selective removal of the outer skin layer with an ablative laser can clear isolated or clustered lesions with high precision, particularly in cosmetically sensitive areas. Aftercare focuses on barrier protection and sun avoidance during healing.

Field-Directed Options

5-Fluorouracil (5-FU) Cream

An anti-metabolite that targets abnormal, sun-damaged cells. Applied once or twice daily for a defined course (often 2–4 weeks on the face, sometimes longer on the hands), it creates predictable redness, crusting and then shedding as damaged cells are cleared. We set expectations carefully and plan the course around your calendar.

Imiquimod

An immune-response modifier used several times a week in cycles. It stimulates your skin’s defences to remove abnormal cells. Redness and crusting indicate that sun-damaged areas are being treated; breaks between cycles allow the skin to settle.

Diclofenac in Hyaluronan

A well-tolerated anti-inflammatory gel used over weeks to months; improvement is gradual and downtime is lighter, which many people prefer for work or public-facing roles.

Tirbanibulin (Short-Course)

A newer, 5-day topical option for appropriate small fields, offering a concise course with a defined healing window. We will advise if this suits your pattern and location.

Photodynamic Therapy (PDT)

A photosensitising cream is applied to the field and then activated with a specific light source to selectively destroy abnormal cells. Daylight PDT uses natural outdoor light after preparation and is often more comfortable with minimal downtime; conventional PDT uses a controlled lamp in clinic. PDT is especially helpful for facial AK fields and yields cosmetic improvement in texture and tone.

Which Treatment Is “Best”?

There is no one-size-fits-all answer. For a few scattered lesions, cryotherapy may be ideal. For clusters or widespread sun damage, a field cream or PDT gives more comprehensive clearance. Thick, warty lesions often benefit from curettage first, then a field treatment to tidy the edges and reduce recurrence. We will explain options, show typical timelines and photos of the healing stages, and help you choose a plan that balances efficacy and downtime.

Comfort, Downtime & Aftercare

• Redness and crusting: expected with many field treatments; this represents damaged cells being shed. We provide step-by-step aftercare and emollient routines to keep you comfortable.
• Work and social planning: face treatments are often scheduled outside major events; hands and scalp can be treated in cooler months to make hats/gloves more comfortable.
• Sun protection: daily SPF and shade habits are essential during and after treatment to prevent re-activation and new lesions.

Prevention: Habits That Make the Biggest Difference

• Daily SPF: broad-spectrum 30–50 on the face, scalp (if thinning), ears and hands, even on overcast days; reapply when outdoors.
• Shade and clothing: hats with a brim, UV-protective sunglasses, long sleeves when practical.
• Timing: seek shade when the sun is highest; avoid sunbeds.
• Skin checks: get to know your skin; report tender, growing or bleeding lesions promptly.
• Lip protection: use SPF lip balm; actinic cheilitis (sun damage of the lip) benefits from early care.

Follow-Up and Monitoring

AKs reveal how much UV your skin has accumulated. After initial clearance, new lesions can appear in the same field. We schedule proportionate follow-up: sooner if you are immunosuppressed or had numerous/thick AKs, and at longer intervals if the field is quiet. If a lesion changes rapidly, becomes persistently tender or bleeds, contact us — early review rules out SCC and keeps care on track.

Special Situations

Immunosuppressed Patients

Transplant recipients and others on long-term immunosuppression may develop AKs earlier and in greater numbers with a higher risk of progression. We plan more frequent field treatments, a lower threshold for biopsy, and close liaison with your wider medical team.

Scalp AKs in Thinning Hair

The scalp is a high-risk field for cumulative UV. Daylight PDT or carefully timed field creams are effective options. Hats and daily SPF to the scalp make a significant difference to recurrence.

Hands and Forearms

These sites heal more slowly and are exposed daily. Courses may be gentler and longer; emollients and protective gloves for outdoor tasks help comfort and outcomes.

Results You Can Expect

Many people see visible improvement within weeks for lesion-directed options and within 4–12 weeks for field therapies as redness settles and texture smooths. PDT often yields a cosmetic “refresh” in addition to clearance. Because UV exposure continues in everyday life, maintenance habits and occasional touch-ups keep skin clear over the long term.

When to Seek Prompt Help

• A lesion that grows quickly, becomes tender/painful or bleeds.
• A thick, horn-like growth or a sore that does not heal.
• Any patch that looks or behaves differently from your usual AKs.

Why Choose Skinhorizon?

We provide high-quality advanced dermatology with consultant oversight. Our approach combines precise diagnosis, evidence-based lesion and field treatments, clear aftercare, and long-term prevention strategies. We tailor plans to your skin type, lifestyle and downtime needs, with rapid access for concerns and proportionate follow-up so you feel supported throughout.

Your First Visit — What to Expect

1. Assessment: mapping lesions and the surrounding field; dermoscopy to distinguish look-alikes; photographs for baseline.
2. Plan: lesion removal where needed (e.g., cryotherapy/curettage) plus a field strategy (cream or PDT) timed to your calendar.
3. Education: simple sun-smart habits and aftercare steps to reduce recurrence and improve comfort.
4. Follow-up: review to confirm clearance, address any new lesions early and refine maintenance.