Solar keratoses


If you are a fair-skinned Australian, look out! You are going to get these. Aggressive treatments leave you with white scars, but we at Peach can do better, and can even treat your skin to actually improve your general appearance as well.
Solar kerastoses treatment Erbium laser resurfacing 1 from Dr Prochazka The photos speak for themselves
Case study
Solar kerastoses treatment Erbium laser resurfacing 2 from Dr Prochazka Again, the photos tell the story
Case studyJust about everyone with white skin who grows up in Australia will develop these. Often mistakenly called “skin cancers”, these are the flaky scaly spots our grandparents took along to their GP to have “burnt off” their faces.


Our grandparents then developed lots of white marks where the treatment had been too harshly applied. It became arguable as to whether the treatment produced a better look than the original problem.


Solar keratoses, aka actinic keratoses, do represent spots of abnormal epithelial cell overgrowth, and very rarely one of these will progress to a true skin cancer of the SCC or squamous cell carcinoma type. Solar keratoses are sometimes called “pre-cancerous”, but they are not, in themselves, actual skin cancer.


The treatment of solar keratoses (or “SKs”) is never an urgent matter, but it is wise to treat them, firstly because they are unsightly, secondly because it is possible they may develop into an actual skin cancer, but thirdly and most importantly their removal leaves a cleaner smoother skin on which any new skin cancer will be more easily seen. SKs, you see, can become so numerous on some patients that any new skin cancer that develops amongst the SKs goes unnoticed for too long. So, getting your SKs treated also affords your doctor the opportunity to look at all your skin for other, nastier skin problems, since anyone with many SKs is by definition at high risk of developing true skin cancers.




The simplest and fastest way to treat solar keratoses is with liquid nitrogen. A short spray freezes the rogue surface cells, and they are destroyed. The treatment stings momentarily, and sometimes a blister will develop at the treatment site, but it all heals up well.


Unless of course the treatment has been too strong. Aggressive liquid litrogen treatment will leave a white mark, Therefore, we treat SKs very carefully with a light spray of liquid nitrogen. In doing so, we accept that there is a risk that the SK will not be fully removed in a single treatment, and that a second treatment may be later necessary, but white marks are avoided.


The remaining problems with liquid nitrogen are that it cannot be used to treat the whole face and it does not prevent new SKs from arising. As a doctor, one is always faced with deciding which little areas of flaking to treat, and which to leave until next time. And whilst treatment makes the skin look smoother than it was, it is impossible to get a good overall result with liquid nitrogen when SKs are numerous.


In such cases the best approach today is Photodynamic Therapy (PDT). With photodynamic therapy it is possible to specifically destroy the abnormal cells of solar keratoses before they become apparent to the naked eye. Therefore, visible solar keratoses are prevented. The treatment leaves a smooth finish without any risk of white marks, and the whole face is treated at a single session.


The process of Photodynamic therapy first involves a session of microdermabrasion. This clears some of the surface flaking and creates a smoother and receptive skin surface for the next step, which is the application of a solution of 5aminolevulinic acid.


5 aminolevulinic acid, or 5ALA, is produced naturally in our cells and is converted into protoporphyrin 9 (PP9). Protoporphyrin 9 is very sensitive to light, and under exposure to light PP9 will create substances that can destroy the cell. Usually, though, there are only very tiny quantities of PP9 in our cells, and they are illuminated without risk. However, if a solution of 5ALA is applied onto the skin, then metabolically active cells like SK cells will rapidly soak up the 5ALA and will convert it to an oversupply of PP9. Other, normal epidermal cells do this very slowly. So, after an hour or so following the application, the SK cells are very sensitive to light, and your normal cells are not.


The third step involves the application of light. We use our Omnilux, which activates the PP9 to kill the cells in which its concentration is high, which are SK cells and, by the way, active cells at the base of acne lesions and sebaceous glands. Normal cells remain.


We need you for two hours at least to perform photodynamic therapy. 30 minutes for the microdermabrasion, at least an hour for the 5ALA application (for most of that you are just resting and waiting), then at least half an hour for the light treatment. You will find the microdermabrasion quite comfortable and even relaxing. The 5ALA application may sting at first, but will settle in minutes. The third part of the treatment, under the light, may hardly bother you at all or it may be quite painful, depending on the amount of sun damage on your face and the concentration of 5ALA we have used. If we use the Omnilux light alone we allow half an hour, but if you need IPL as well we may need yet another 45 minutes, tallying up to 2hours 45 minutes for the whole process. As the hours pass after the treatment, your skin will become red. You may feel like the area has been sunburnt (although it has not). The following day your face is likely to be quite red, and you may not want to go to work or do anything social. You may want to take Panadol or Nurofen, and apply cool packs to the skin. Be reassured, then, that the more the redness in the short term, the better the result in the longer term.


Duration of redness is hard to pick, and can be anything from 2 days to 2 weeks. Other doctors quote even longer. Duration of redness depends on the 5ALA dose and strength, amongst other things. Primarily for this reason we prefer to start at a lower dose than is usual elsewhere, generally employing just 5% ALA in the first treatment despite global scientific literature focusing on the 20% strength. Those who find the 5% treatment too gentle can have a stronger treatment on a following occasion, and many patients find the 5% treatment very adequate and are glad they haven’t had a 20% treatment.


Other possible treatments for solar keratoses include Efudix treatment, electrocautery and surgery. In the great majority of cases we have found that these other treatments do not offer any advantage over a combination of cryotherapy and photodynamic therapy for solar keratoses.


At a consultation a treatment program for your skin can be designed using the best of all treatment modalities as applied in your own specific case.