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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. Typical patches can be assessed and treated with creams by video; freezing, scraping and any suspicious patch need in-person care.
- What it is: a dry, rough, scaly patch on sun-damaged skin, also called solar keratosis, usually 1 to 2 cm across.
- Where: skin that sees the sun: the face, ears, scalp, backs of the hands and the arms.
- Cancer risk: not usually serious, but there is a small chance a patch turns into a skin cancer, so changes need checking.
- Emergency: actinic keratosis is not an emergency, but call 112 for swelling of the face, lips or tongue, or difficulty breathing.
A video consultation suits typical rough, scaly patches. A patch that is bleeding, growing, tender, thickened into a lump or breaking down into a sore needs an in-person examination, and so does a patch on the lip. Swelling of the face, lips or tongue, or difficulty breathing, needs 112.
Can an online doctor treat actinic keratosis?
Partly. Actinic keratoses are usually easy to recognise by their look and feel, so a doctor by video, with good photos, can often confirm typical patches and prescribe a treatment cream for them. A patch that is thick, tender, growing, bleeding or on the lip needs an in-person examination, because it could be turning into a skin cancer. Freezing, scraping and light treatment are also done in person.
How an online consultation helps with actinic keratosis
- Patches checked: Which patches look typical, and which need an in-person look because of how they have changed.
- Treatment that suits you: A cream for one patch or a whole area of sun-damaged skin, chosen for your skin and routine.
- Help through the reaction: What to expect while a cream works, and how to get through the redness and soreness.
- Protection from now on: Sun protection that keeps new patches away, and how often to check your skin.
What the doctor checks in an online consultation
The doctor asks about:
- The patches: how many, where, how long they have been there, and whether they feel rough, sore or itchy.
- Changes: bleeding, growth, tenderness, thickening into a lump, or a sore that does not heal.
- Your sun history: fair skin, sunburn, outdoor work or sport, time in hot countries and sunbeds.
- Earlier skin cancer: basal cell carcinoma, squamous cell carcinoma or melanoma in the past.
- Your health: a weakened immune system, pregnancy, and the medicines you take.
- Treatment so far: creams, freezing or other treatment, and how your skin reacted.
Before the call, take sharp photos in daylight, one close up and one of the whole area, and run a finger over the patches so you can describe how they feel.
Actinic keratosis symptoms
Actinic keratoses are dry, scaly patches of skin damaged by the sun. They:
- feel dry, rough and scaly, like sandpaper
- are usually 1 to 2 cm across
- can be skin-coloured, pink, red or brown, with a white or yellow scaly surface
- may itch
- appear on skin that is often in the sun: the face, ears, bald scalp, backs of the hands and arms
People often have several, and an area of sun-damaged skin, such as the forehead or scalp, can have many small patches close together. On white skin, patches are usually pink or red; they can also be tan, brown or the colour of the skin around them, and are then easier to feel than to see. On the head and neck they tend to lie flat; on the arms and hands they are more often raised bumps. Some prickle or feel sore.
Patches that need an in-person check
See a doctor in person if a patch:
- starts to bleed
- gets bigger or changes colour
- feels tender or develops into a lump
- breaks down into a sore
- appears on your lip
These changes can mean a patch is turning into a squamous cell skin cancer. A shiny, pearly bump or a sore that will not heal may be basal cell carcinoma, and a changing mole needs checking for melanoma.
Actinic keratosis or something else?
Swipe sideways to compare →
| What it could be | What you notice | What happens next |
|---|---|---|
| Actinic keratosis | A rough, dry, scaly patch on sun-exposed skin, often easier to feel than to see | A treatment cream, or freezing in person |
| Basal cell or squamous cell skin cancer | A raised growth, smooth or crusty, or a flat patch, that grows, changes, or bleeds, crusts or scabs for more than 4 weeks | An in-person examination |
| Bowen’s disease | A flat, red or pink, scaly or crusty patch with clear edges, a few centimetres across, often on the lower legs, and harder to see on brown or black skin | An in-person examination; creams, freezing, scraping or surgery |
| Seborrhoeic keratosis | A waxy or warty spot that looks stuck on, from skin-coloured to dark brown or black, anywhere except the palms and soles | Harmless; a doctor checks it if it changes |
Bowen’s disease is a very early form of skin cancer that is easily treated: an estimated 1 in 20 to 1 in 30 patches turn into a more serious skin cancer if left untreated. Seborrhoeic keratoses are not precancerous, and more than 90% of adults over 60 have at least one.
Is actinic keratosis cancer?
No. Actinic keratosis is a precancerous patch: it is not a cancer, but there is a small chance it turns into one, a squamous cell carcinoma. The risk across all patches grows with their number: in people with more than 10, the chance of a squamous cell carcinoma at some point is thought to be about 10 to 15%. Checking the patches for change catches a problem early.
For any single patch, the yearly risk is very low: a European guideline puts it at up to 0.075% per patch per year, and up to 0.53% for people who have already had a basal cell or squamous cell skin cancer. It is not possible to predict which patch will change, or when, which is why treatment is usually advised.
Can actinic keratosis go away on its own?
Sometimes. Between 15% and 63% of single patches clear by themselves within a year, but between 15% and 53% of those come back within a year, so patches can seem to come and go. Daily sunscreen helps some patches settle. A single patch may be watched to see if it goes away, while several patches, or patches that are sore or itchy, are usually treated.
How common is actinic keratosis, and who gets it?
Actinic keratosis is very common in people with white skin, and it becomes more common with age. In the UK, 15.4% of men and 5.9% of women have at least one patch, rising to 34% of white people over 70. In Spain, patches were found in 28.6% of people over 45, and surveys found them in 27.4% of people examined in Italy and 25.3% in Switzerland. The risk is highest with:
- fair skin that burns or freckles easily, light hair and light eyes
- age over 45, and being male
- years of sun from outdoor work, sport or living in a hot, sunny country, and a history of sunburn
- sunbeds or sunlamps, now or in the past
- an earlier skin cancer
- a weakened immune system, for example after an organ transplant or during chemotherapy
People with darker skin can get actinic keratoses too, after years of sun without protection. Actinic keratosis is not contagious.
Creams, freezing or light: which treatment works best?
Freezing is the usual first treatment for one or a few patches, and fluorouracil cream clears the most patches across an area. In a Dutch trial of 624 people with actinic keratoses, 74.7% of those treated with fluorouracil cream were still clear of treatment failure a year later, compared with 53.9% with imiquimod cream and 37.7% with photodynamic therapy.
Swipe sideways to compare →
| Treatment | How it is done | How long it takes | Online or in person? |
|---|---|---|---|
| Freezing (cryotherapy) | Liquid nitrogen on each patch, which blisters and falls off | Healing takes 5 to 10 days on the face, 3 to 4 weeks on the hands, and 6 weeks or more on the legs | In person |
| Fluorouracil cream | Put on at home, on a patch or a whole area | 2 to 8 weeks of use, then 2 to 4 weeks for the skin to heal | Online, if the doctor prescribes it |
| Imiquimod cream | Put on at home, on set days of the week | 4 to 16 weeks | Online, if the doctor prescribes it |
| Tirbanibulin ointment | Put on at home, on the face or scalp | 5 days | Online, if the doctor prescribes it |
| Diclofenac gel | Put on at home; the mildest skin reaction, but it works less well | About 3 months | Online, if the doctor prescribes it |
| Photodynamic therapy | A cream, then daylight or a special lamp; daylight is almost painless | Often 2 sessions, 3 weeks apart, keeping out of daylight for 48 hours after a lamp session | In person |
| Scraping (curettage) | Under local anaesthetic, for thick patches; the tissue is checked in a laboratory | One procedure | In person |
Tirbanibulin, the newest option, was approved in the EU in July 2021 for actinic keratoses on the face or scalp in adults.
Which actinic keratosis treatment might the doctor recommend?
Treatment depends on how many patches there are, how thick they are, and where they are. This is the framework the doctors use, in line with NHS and dermatology guidance.
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| One or a few thin patches | Freezing, or a treatment cream on the patches | Yes | For freezing |
| Many patches across an area | A cream such as fluorouracil or imiquimod on the whole area | Yes | Not usually needed |
| Mild patches, gentler treatment preferred | Diclofenac gel for about 3 months | Yes | If it does not respond |
| A thick, tender or growing patch, or a lump | Examination, and often removal | Yes, to advise | Always |
| A patch on the lip | Examination | Yes, to advise | Always |
Rough patches on your face or hands? A doctor can check them on camera and plan treatment in one consultation.
See available times →Treatment options for actinic keratosis
What you can do yourself
- Use a broad-spectrum sunscreen of SPF 30 or higher on exposed skin, and reapply it regularly.
- Wear a hat and clothing that covers your arms and legs, and stay out of direct sun between 11am and 3pm.
- Avoid sunbathing, sunlamps and sunbeds.
- Check your skin regularly for new patches or changes.
Prescription treatment
A prescription is never issued without a consultation. Prescription creams, gels and ointments treat a single patch or a whole area of sun-damaged skin. The doctor may prescribe fluorouracil or imiquimod cream, tirbanibulin ointment for the face or scalp, or the gentler diclofenac gel, each for the length of time shown in the table above. Fluorouracil and imiquimod work by inflaming the damaged skin: after a week or so, the treated patches become red, scaly and tender, and sores and crusts may appear. This reaction is expected, and the skin heals over 2 to 4 weeks after stopping. Treated skin must be kept out of the sun. Fluorouracil cream must not be used in pregnancy. If the doctor prescribes, use the prescription at a pharmacy near you.
In-person treatments
Freezing with liquid nitrogen (cryotherapy), scraping or cutting away thick patches under local anaesthetic, and photodynamic therapy are done in a clinic, as set out in the table above.
What does not help
Sunbathing and sunbeds add to the damage that causes actinic keratoses. Using a treatment cream without protecting the skin from the sun makes the skin reaction much stronger. A steroid cream, such as hydrocortisone, on skin that is being treated can stop the treatment from working, so use one only if the doctor advises it. Salon and home peel kits are no substitute for a medical chemical peel.
How to prevent new patches
Sun protection prevents new patches and helps existing ones settle:
- Apply a broad-spectrum sunscreen to sun-damaged skin every day, all year round, as well as on holiday, including the rims of the ears and the lips.
- Wear a broad-brimmed hat; a bald scalp and the ears are common sites.
- Cover your arms and legs, and seek shade in the middle of the day.
- Check the UV index: from 3 to 7, seek shade around midday; at 8 or above, avoid being outdoors around midday.
- If you always cover up outdoors, consider a vitamin D supplement.
For people with many patches, a vitamin B3 supplement called nicotinamide may reduce the number of new ones. In people with a normal immune system who had had at least two basal cell or squamous cell skin cancers in the previous five years, nicotinamide lowered the rate of new squamous cell skin cancers by 30%, but the benefit stopped when they stopped taking it. Ask the doctor whether it suits you.
Special situations
A weakened immune system
After an organ transplant or with another cause of a weakened immune system, skin cancers are more common, so regular checks with a skin specialist matter.
Lips
Sun damage can cause dry, scaly, rough patches on the lips, called actinic cheilitis. A patch on the lip needs an in-person examination.
Pregnancy
Fluorouracil cream must not be used in pregnancy. Tell the doctor if you are pregnant or planning a pregnancy.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When actinic keratosis is treated online, and when you need in-person care
Treated online: typical rough, scaly patches, prescription creams and gels for single patches or whole areas, help with the skin reaction during treatment, sun protection, and follow-up after treatment.
In-person care: any patch that is bleeding, growing, tender, thickened or on the lip, freezing, scraping or surgery, photodynamic therapy, and regular checks after skin cancer or with a weakened immune system.
When to get in-person care
Call 112 or go to an emergency department now for:
- swelling of the face, lips or tongue, or difficulty breathing after a new cream or medicine
Get medical advice the same day for:
- a treated area that is oozing pus, with spreading redness or a high temperature
- a severe reaction to a treatment cream that spreads well beyond the treated skin or makes you feel unwell
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about the patches: show them on camera in good light, share close-up photos, and say whether any patch has bled, grown or become tender.
- Leave with a plan: what to do, what to use and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s actinic keratosis? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Basal cell carcinoma can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about actinic keratosis
What is actinic keratosis?
Actinic keratosis, also called solar keratosis, is a dry, rough, scaly patch on skin damaged by the sun, usually on the face, ears, scalp, hands or arms.
Is actinic keratosis skin cancer?
No. Actinic keratosis is a precancerous patch. Most never become cancer, but there is a small chance one turns into a squamous cell carcinoma, so changes need checking.
What does actinic keratosis look like?
Actinic keratosis is a rough, scaly patch, usually 1 to 2 cm across, skin-coloured, pink, red or brown, with a white or yellow scale. It often feels like sandpaper and can be easier to feel than to see.
Is it actinic keratosis or something else?
Actinic keratosis is a flat, rough, sandpaper-like patch on sun-exposed skin that comes and goes over months. Seborrhoeic keratosis is a raised, waxy, stuck-on brown growth that is not caused by sun. Squamous cell carcinoma is thicker and tender, grows over weeks and may bleed or form a sore. Bowen’s disease is a persistent red, scaly, well-defined patch. A patch that changes needs an in-person check.
How is actinic keratosis treated?
Actinic keratosis is treated with prescription creams or gels such as fluorouracil, imiquimod or diclofenac, by freezing with liquid nitrogen, by scraping or cutting away thick patches, or with photodynamic therapy, which uses a light-activated cream; the choice depends on how many patches there are, where they sit and how thick they are.
What is the best cream for actinic keratosis?
Fluorouracil cream clears the most actinic keratosis patches. In a Dutch trial, 74.7% of people treated with it were still clear of treatment failure after a year, compared with 53.9% with imiquimod. Diclofenac gel is the gentlest but works less well, and tirbanibulin ointment is the shortest course, at 5 days.
What is the fastest way to get rid of actinic keratosis?
For a single actinic keratosis, freezing with liquid nitrogen in a clinic, often in one or two visits. The patch blisters and falls off after a few weeks. The shortest prescription course is tirbanibulin ointment, used for 5 days on the face or scalp.
Can I remove actinic keratosis at home?
The actinic keratosis treatments used at home are prescription creams, gels and ointments, used for 5 days to about 3 months once a doctor has confirmed the diagnosis. Daily sunscreen helps some patches clear. Salon and home peel kits are no substitute, and a changing patch needs a doctor to look at it.
Can actinic keratosis go away on its own?
Sometimes. Between 15% and 63% of single actinic keratosis patches clear by themselves within a year, but many come back. A single patch may be watched, while several patches, or sore or itchy ones, are usually treated.
Why is my skin red and sore on fluorouracil cream?
Redness, scaling, tenderness and crusting are the expected reaction as the cream destroys the sun-damaged skin of an actinic keratosis. The skin heals over 2 to 4 weeks after stopping.
When should I worry about actinic keratosis?
See a doctor in person if an actinic keratosis patch bleeds, grows, changes colour, feels tender, develops into a lump or a sore, or appears on your lip. These changes can mean it is turning into a skin cancer.
How can I prevent actinic keratosis?
Use a broad-spectrum sunscreen of SPF 30 or higher every day on exposed skin, wear a hat and covering clothes, stay out of strong midday sun, and avoid sunbeds; daily sunscreen also helps existing actinic keratosis patches clear and lowers the number of new ones, so prevention and treatment overlap.
Can an online doctor treat actinic keratosis?
Partly. A doctor can assess typical actinic keratosis patches on camera, confirm what they are and prescribe treatment creams or gels, with the prescription usable at a pharmacy near you. Freezing, scraping, photodynamic therapy and any patch that has changed, bled or become a lump need in-person care, and the doctor says how soon.
- Actinic keratoses (solar keratoses), NHS, National Health Service (UK), reviewed 14 June 2023.
- Actinic keratosis, DermNet, New Zealand, updated November 2025.
- 5-Fluorouracil cream, DermNet, New Zealand, updated September 2016.
- European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, EADO, EDF, EADV and UEMS (Kandolf L et al.), guideline text 2023, published in JEADV 2024.
- Actinic keratosis: diagnosis and treatment, American Academy of Dermatology Association, updated 23 February 2022.
- Actinic keratosis: overview, American Academy of Dermatology Association, accessed 15 October 2026.
- Actinic keratosis (a precancerous condition), Johns Hopkins Medicine, accessed 15 October 2026.
- Non-melanoma skin cancer: symptoms, NHS, National Health Service (UK), reviewed 16 September 2026.
- Bowen’s disease, NHS, National Health Service (UK), reviewed 6 October 2022.
- Seborrhoeic keratosis, DermNet, New Zealand, updated January 2016.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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