Care for the management of actinic keratosis

Patient Guideline Summary

Publication Date: April 1, 2021
Last Updated: November 1, 2023



This patient summary means to discuss key recommendations from the American Academy of Dermatology (AAD) for care for the management of actinic keratosis. It is limited to adults 18 years of age and older and should not be used as a reference for children.



  • Actinic keratosis is a common skin condition in the United States (U.S.).
  • We will use the abbreviation AK throughout this summary to refer to actinic keratosis.
  • AK is mostly diagnosed and managed by a dermatologist (a skin doctor).
  • AK appears on skin that has had long-term exposure to ultraviolet radiation.
  • It is not cancer but can develop into cancer. This is mainly concerning in patients with a previous history of skin cancer, old age, or a lower immunity.
  • The classic appearance is a rough scaly elevated area on a red base. However, it can have other presentations.
  • Usually, you do not need a biopsy to confirm the diagnosis, but your doctor may obtain a biopsy to determine the severity.
  • Because the treatment of AK is an ongoing process for most patients, the choice of the best therapy will ideally involve shared decision-making between you and your doctor.
  • This patient summary focuses on the management of actinic keratosis.



UV protection:
  • Your healthcare provider will probably advise you to avoid the sun, wear sun-protective clothing, and use a broad-spectrum sunscreen.

Topical agents:
  • Your doctor will probably prescribe one of the following topical agents:
    • 5-fluorouracil (5-FU), which may cause local irritation.
    • Imiquimod which may cause local irritation or influenza-like symptoms.
    • Diclofenac, which has bleeding and stomach side effects, even in its gel form, like other anti-inflammatory drugs.

Cryosurgery (a surgery that uses an intense cold topically to destroy unwanted tissue):
  • You may have discomfort during the treatment and dyschromia (irregular skin color) after treatment.
  • These can be minimized with shorter freezing times, but this may reduce the response to the treatment.

Photodynamic therapy [PDT] (a procedure that uses a drug called aminolevulinic acid (ALA), a photosensitizer that is activated by light):
  • Alpha hydroxy acid solution is not recommended before ALA-blue light PDT or imiquimod after ALA-blue light PDT.

Combination therapy:
  • Your healthcare provider may suggest the use of 5-FU or imiquimod with cryotherapy.


  • 5-FU: 5-fluorouracil
  • AAD: American Academy Of Dermatology
  • AK: Actinic Keratosis
  • ALA: Aminolevulinic Acid
  • PDT: Photodynamic Therapy
  • U.S.: United States
  • UV: Ultraviolet

Source Citation

Eisen DB, Asgari MM, Bennett DD, Connolly SM, Dellavalle RP, Freeman EE, Goldenberg G, Leffell DJ, Peschin S, Sligh JE, Wu PA, Frazer-Green L, Malik S, Schlesinger TE. Guidelines of care for the management of actinic keratosis. J Am Acad Dermatol. 2021 Oct;85(4):e209-e233. doi: 10.1016/j.jaad.2021.02.082. Epub 2021 Apr 2. PMID: 33820677.


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.