Solar keratosis – sun spots

Solar keratosis or sunspots affect one quarter of Queensland residents over the age of 45. Solar keratosis also known as ‘sun spots’ or actinic keratosis, commonly occur on the face, and hands. They can be considered as pre-cancerous, and treated. Treatments will depend on the extent of sun-damage, the location of sunspots, and your downtime. Your Skin Cancer Doctor will discuss treatment options for your sunspots. An individualized approach will give you the best results.

Facts on solar keratosis

Brisbane has the highest number of solar keratosis per capita in Australia
Solar keratosis present as rough, scaly, dry, red patches on exposed areas of the nose, temples, face and hands
Solar keratosis also known as actinic keratosis can be considered to be pre-cancerous, and should be treated
Treatments include freezing with nitrogen, creams, lasers, and photodynamic therapy
The type of treatment for solar keratosis will depend on the location of your sunspots, the extent of sun-damage and your downtime
A tailored treatment for sun-damage will give you the best balance

What is solar keratosis or actinic keratosis?

Solar keratosis or sun-spots is due to an abnormal development of skin cells, and is secondary to Ultraviolet light exposure. Sun-damage most frequently occur in areas exposed to the environment, including the face, neck and back of hands. Other areas affected include the top of the ears, nose, upper lip and temples. Solar keratosis present as red, often scaly, rough and persistent spots.

Solar keratosis can also present on the lips, a condition known as actinic chelitis.

Why is it important to treat sun-spots or solar keratosis?

Solar keratosis – actinic keratosis or sun-spots, much like plaque buildup, will worsen over time. If left untreated, these lesions have the potential to transform into skin cancers known as IEC (Bowen’s Disease) or a more serious form of skin cancer called an SCC (Squamous cell cancer).

Why do people that reside in Brisbane have more sun-damage compared to other Southern cities?

The principle case of solar keratosis or sun-damage is UV exposure and genetics. Brisbane receives more UV radiation than other cities such as Sydney, and Melbourne. Up to a quarter of middle aged Brisbane population will exhibit early changes of solar keratosis.

What treatments are available for solar keratosis and sun-spots?

Efudix – time tested, this is a chemotherapy cream for sunspots. The downside about Efudix is the prolonged recovery time – up to 4 weeks.

Picato Gel – Picato gel (Ingenol Mebutate) is a Brisbane invention, and is now used all over the world to treat sunspots. Picato is derived from a common plant known as Milkweed and is now used to treat actinic keratosis (sunspots) and precancerous lesions.

Aldara Treatment – can be used for sunspots; however the disadvantage is the long application regime, often extending months.

PDT or Photodynamic therapy – is an excellent method to treat sunspots. The recovery is within a week, however costing is an issue. PDT is a very effective treatment for sunspots, especially on the scalp and face.

Fraxel Laser – is the very latest in the fight against sunspots and is extremely effective in removing sun spots, solar keratosis, skin pigmentation and overall sun-damage. Recovery is within 5-7 days, and the results can be outstanding.

Liquid nitrogen or freezing – is a time tested method of treating sunspots, however if performed incorrectly, can lead to blistering, and scarring. This method can only be used to treat a few spots at a time.

Will sun spot treatments clear up all my sun damage?

No. No treatment will clear up ALL sun-damage; however the aim is to decrease the amount of solar keratosis and sun damage. As a guide, treatments such as Fraxel Laser, PDT, Efudix, and Picato will clear up 80-85% of sunspots with one treatment cycle.

Most people will need to repeat treatment every 4-10 years, depending on the severity of sun damage.

Can laser treatment be used to treat sun-damage?

Yes, laser is the newest method of treating sunspots. This procedure is conducted by specialist dermatologists at Westside Laser Dermatology. Laser treatment can be tailored according to the level of sun-damage. Lasers include erbium, CO2, or Fraxel Laser.

This procedure is conducted at a Specialist Level by Laser Dermatologists, Dr. Davin S. Lim and Dr. Shobhan Manoharan.

Laser treatments start from $990 for Fraxel Laser, using the latest in Fractional Laser technology.

How much does it cost to treat solar keratosis?

Your skin cancer specialist will discuss treatment options with you based upon factors such as your downtime, cost, and expected cosmetic results.

Efudix is the cheapest method of removing sunspots, but has a downtime of nearly one month. Fraxel laser on the other hand, has a downtime of less than a week, but costing can be an issue. Our aim is to give patients options to treat their sun damage.

TreatmentModality	Efficacy of treatment	Duration of treatment	Cosmetic outcome	Down time of treatment	Price of treatment
PDT	+++++	3 hours	Good	6-8days	$700-$2200
Fraxel 1927 laser	++++	30 min	Excellent	6 days	$990
Efudix	+++++	3-4 weeks	Satisfactory	25 days	$60-$80 per tube
Picato Gel	+++++	3-4 days	Satisfactory	7days	$ 145 per tube
Glycolic / AHA peels	++	15 min, series of peels needed	Good	1 hour(Recommended for mild photo-damage)	$95

What treatment will give me the least amount of downtime?

There are two outstanding treatments for sunspots and solar keratosis. These treatments are highly effective, with the quickest recovery. Like creams, the clearance rate from PDT and Fraxel laser is around 80%- depending on the level of sun-damage.

PDT: downtime of 7 days, conducted by Specialists at Westside Laser Dermatology. This treatment is ideal for DVA patients – Veteran Affairs patients as there is no out of pocket cost.

Fraxel Laser: downtime of 5-7 days, performed by laser specialists. Rejuvenates skin as well as removing sun spots.

Read more aboutFraxel laser

What can be done to help prevent solar keratosis or sun-spots?

Several steps can be taken to help reduce or prevent sun spots including-

Regular sunscreen use and sun protection
Specialist prescribed vitamin A cream
Glycolic AHA chemical peels
Fraxel Laser treatment for sun-damage and sunspots
Regular skin checks by your skin cancer doctor, GP or dermatologist

My Skin Cancer Clinic – simplified guide for the patient

If patients are not concerned in regards to cosmetic outcome and can tolerate a downtime of 4 weeks, Efudix is an excellent time tested method of removing sunspots. The cost of the cream is around $70 dollars+, and it works!
If patients want a great treatment for sunspots with additional benefits of skin rejuvenation and removal of brown spots and dots, as well as improvement of wrinkles, then Fraxel laser is the solution. The downside is that treatments are $990. Depending on the level of sun-damage, you may require a series of treatments.
If you would like a cream that can clear up sunspots quickly, consider Picato Gel. This is a Brisbane invention and a ‘natural’ treatment for solar keratosis. Treatment cycle is only 3 days, and cost approximately $400- $600 to treat the temples- forehead area.
If you would like a makeover with removal of sun spots, sun-damage, wrinkles, fine lines, warts, lumps, bumps, dots, scars and the whole lot done – see a laser dermatologist for consideration of full laser resurfacing. Price range is $4100- $7800. This is the ‘make over package’