Follow-Up Care for Actinic Keratosis: A Case Study in Sun Safety and Treatment Options
By Dr. Neda Nosrati, Village Dermatology
Actinic keratosis (AK) is a common skin condition among older adults, often resulting from years of sun exposure. While these lesions are usually harmless, they are considered precancerous and have the potential to develop into squamous cell carcinoma if left untreated. Today, I’d like to share the follow-up care plan for a 70-year-old male patient with an actinic keratosis lesion on his forehead. This case highlights our approach to AK management, from topical treatments to preventive skin care.
Case Overview: Initial Evaluation and Treatment
The patient, a 70-year-old non-smoker with no family history of melanoma, first presented with a brown lesion on his left forehead in June 2024. Given the nature of the lesion, we started him on a treatment plan with fluorouracil (5-FU) combined with calcipotriene, a topical therapy designed to target precancerous cells in sun-damaged areas.
Treatment Instructions: He was instructed to apply the 5% fluorouracil compound twice daily for 7–10 days. This medication works by targeting abnormal skin cells, which results in crusting and scaling as the skin clears. He returns now for follow-up, having used the cream for five days.
Follow-Up Evaluation and Current Findings
Upon examination, the treated area showed flaking and minimal residual scaling, indicating that the fluorouracil was working as intended. We recommended that he use desonide ointment, a mild topical steroid, to reduce any remaining irritation and scaling over the next two weeks.
For further support, he was counseled on continuing broad-spectrum sunscreen with SPF 30+ daily to protect his skin from additional sun damage. For more on protecting against sun damage, visit our Sun Protection page.
Preventative Skin Care for Actinic Keratosis
To prevent the formation of new AKs, we advised the patient to take additional preventive measures, including:
Wearing sun-protective clothing: Long sleeves, wide-brimmed hats, and UV-blocking sunglasses can shield the skin from harmful UV rays.
Applying sunscreen: Daily use of broad-spectrum sunscreen, especially on exposed areas like the face, is key to reducing the development of AKs.
For more information on actinic keratosis, check our Actinic Keratosis page.
Understanding Actinic Keratosis and Treatment Options
Actinic keratosis represents abnormal skin cell growth due to UV exposure. Although not all AKs become cancerous, a small percentage may progress into squamous cell carcinoma, a common type of skin cancer. In addition to 5-FU, other treatment options include:
Cryotherapy: Freezing the lesion to destroy abnormal cells.
Photodynamic therapy: Using light-activated chemicals to treat large or numerous lesions.
Imiquimod: Another topical cream that stimulates the immune system to target abnormal skin cells.
If you’re interested in learning more about these treatment options, visit our Actinic Keratosis Treatments page.
When to Contact the Dermatologist
We instructed the patient to return to our office if he experiences severe side effects from the 5-FU, such as:
Unbearable redness, crusting, or tenderness
Persistent flaking beyond the treatment period
New lesions that do not heal, ulcerate, or bleed
Monitoring these symptoms is essential, as early intervention can prevent complications. We also discussed the possibility of a biopsy if the lesion fails to improve.
Next Steps: Planning Future Care
While the patient expressed a preference to delay further interventions, such as a biopsy, until after the holidays, we emphasized the importance of ongoing skin care and self-monitoring. Regular follow-up visits allow us to monitor his response to treatment and ensure any new or concerning lesions are managed promptly.
This case reinforces the value of preventive care, effective treatment, and close follow-up in managing actinic keratosis. With proper attention to sun safety and regular skin evaluations, patients can greatly reduce the risk of progression and maintain healthier skin.
For more information on protecting your skin and managing actinic keratosis, visit our Village Dermatology Skin Conditions page.