Actinic keratoses back after Efudix - what next?
New actinic keratoses after Efudix are common, and are caused by persistent sun damage that remains under the surface even when the treatment is effective. Efudix treats the keratoses present at the time. Low-level sun exposure over many decades causes damage to the DNA in the skin, and this cannot be fully removed. Sun-damaged skin will keep producing new actinic keratoses, so many people need treatment repeated from time to time, along with protection from further damage.
Is it a new keratosis or one that did not clear?
A spot that never cleared, or that is growing, thickening, tender or bleeding, should be checked. A small proportion of actinic keratoses can turn into squamous cell carcinoma, and a thick or tender spot should always be checked by a dermatologist and may need a biopsy or other treatment.
Options for keratoses that come back
- A further course of Efudix: to the affected area, or the shorter Efudix and Dovonex course.
- Photodynamic therapy: a light-activated cream that treats a whole area of sun damage at once, with a good cosmetic result.
- Cryotherapy: freezing individual keratoses.
- Other creams: imiquimod or Klisyri.
Reducing new keratoses
Daily sunscreen and avoiding sunburn matter most. For people with a lot of sun damage or previous skin cancer, treating the damaged skin and taking nicotinamide can reduce the chance of new ones. See Treating sun damage to reduce the risk of skin cancer.
Keratoses keep coming back?
I can check any spot that has not cleared and plan treatment for the whole area of sun damage.
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Test yourself: how well can you recognise skin cancer? Try Dr Lynch's skin cancer recognition quiz - real lesion photographs with instant feedback - or read the visual guide, How to Recognise Skin Cancer.
