Actinic (Solar) Keratosis

AK should routinely be managed in primary care. 


When to consider referral:


For consideration of Photodynamic Therapy (PDT)


  • Multiple AK in high risk patients e.g. Previous SCC/organ transplant/immunosuppression
  • Failure of or intolerant to topical therapy in patients with multiple AK/actinic field change/high risk patients


Topical treatments to trial in primary care:


  • Efudix
  • Picato
  • Actikerall – useful for low or moderately thick hyperkeratotic AK


A punch biopsy is not usually necessary but can be useful if there is a poor response to treatment/diagnostic uncertainty.