I find the use of topical treatments (Efudix) etc quite intrusive and protracted in terms of repair. I am considering Fraxel Laser, but am not convinced its the right treatment for actinic keratosis. But is patently good for photo damage. SA dermatologists do not appear to have sufficient product experience to endorse with real confidence. Will Fraxel Laser work for this condition?
Fraxel Laser for Extensive Facial Actinic Keratosis?
Doctor Answers 4
Fraxel probably not strong enough
Efudex and CO2 laser skin resurfacing have been the gold standard for treatment of actinic keratosis. We offer fraxel laser treatments in our clinic, but I am not convinced that they are adequate for the treatment of AC. We also offer DOT laser treatments. At their highest setting I believe they would come close to the CO2 laser's effectiveness, but again the data isn not there.
Aldara, Caroc, or Active FX
If you want to do a laser for actinic keratosis, do an ablative treatment. Fractional or traditional CO2, or dermabrasion are the most effective options. Fraxel Restore is non-ablative and not that effective for AK. Fraxel Repair would be an option, as it is ablative. Non-procedural options are Aldara and Caroc. Your board certified dermatologist can best guide you regarding the pros and cons of your options. Good luck and remember your sunscreen to prevent new actinic keratoses.
PDT and Solaraze
There is much more evidence regarding the role of photodynamic therapy in the treatment of actnic keratoses than there is for Fraxel.
In this treatment, a liquid is applied to the skin, Levulan, and then the patient is asked to sit in a waiting room where reading material and the gentle music enhance the PDT experience. After a half hour wait, the patient sits in front of a Blu-light. It is important to wear a sunscreen home and not go in the sun for two days.
What is happening is the Levulan is attracted to atypical cells. When the Blu-light is turned on it is attracted to the Levulan and the atypical cells are destroyed. One also gains a cosmetic benefit from the procedure, probably the equivalent of a series of light chemical peels.
Since this is a relatively inexpensive procedure, roughly $200, and prevents future office visits and treatments, most insurance companies do cover this. I am not so sure for the Fraxel.
I would also recommend Solaraze if you had problems with Efudex. This is a far milder cream which causes little reaction. The downside is that you must use if for three months twice a day
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Actinic keratoses and fractionated laser treatments?
I'm going to assume that when you mention the "Fraxel" laser, you are referring to the Fraxel Re:pair (which is a fractionated "ablative" laser). . . The Fraxel Re:store is a fractionated nonablative laser, and, as such, does not treat the upper layers of the skin from which actinic keratoses arise.
Since the Fraxel is "fractionated," it is not treating/ablating 100% of the surface area of the epidermis (upper layer of skin). This is one of the reasons why this laser is able to deliver reliable results with much less potential for side effects than older ablative lasers, which were not fractionated.
However, since the Fraxel is fractionated, it is not the gold-standard treatment for actinic keratoses because portions of the actinic keratoses may be spared from treatment. Think of it this way. . . if you are only treating a fraction of the total surface of the epidermis, you are leaving areas that still could potentially have those precancerous cells.
To treat the entire "field" of skin that has actinic keratoses (or could soon develop them), I'd recommend photodynamic therapy (PDT). As has been mentioned elsewhere in the responses to this question, PDT involves the application of Levulan (aminolevulinic acid) to the skin followed by exposure to blue light, which activates the Levulan to target the precancerous cells. In my opinion/experience, adding IPL to the mix as well as exposure to red light (+/- spot treating with pulse dye laser) further boosts its aesthetic results.
Needless to say, there are always the at-home topical treatments that you can use to treat areas with actinic keratoses. However, in my opinion, if you would rather forgo the hassle of protracted at-home treatments, I highly recommend PDT.