Fair-skinned and older people are at highest risk
Over 50 and light-skinned: This describes most of the people in Germany who contract actinic keratosis every year. The name comes from the Greek and means: keratinization of the skin caused by radiation. But it can also affect dark-skinned and younger people. Anyone who frequently exposes themselves to the sun’s rays – whether in their free time or at work – increases their risk. If light-induced keratoses remain untreated, there is a risk of white skin cancer, which sometimes has to be operated on or irradiated. In rare cases it can be fatal.
Diclofenac and other means in comparison
Several adjacent or large-area actinic lesions cannot be easily cut away or destroyed. Especially with this form of the disease, medication can help to apply. They all require a prescription. Our drug experts have examined the following active ingredients on the basis of current medical studies:
- Diclofenac. The remedy is also often used for mild to moderate inflammation and pain. Gels are represented in the test of drugs against actinic keratosis.
- In fact This active ingredient is also used against genital warts. The imiquimod drugs in our review are creams, also known by the trade names Aldara and Aksunim.
- Fluorouracil. In the test of drugs against actinic keratosis, this active ingredient is represented in two dosage forms – high doses as a cream under the name Efudix and lower doses under the name Actikerall as a solution with salicylic acid.
Drug test: the choice is yours
We have prepared our drug ratings in different versions.
- Heftartikel.
- Are you interested in a quick overview of suitable remedies for actinic keratosis? Then unlock the PDF for the test report from test 7/2022 for EUR 3.50. You will learn which remedies are recommended for which forms of light-induced skin cornification and which side effects can occur during treatment.
- Datenbank.
- Would you like to know more? Our Drugs in Test database offers in-depth information. As a flat-rate user or as a one-off for 5 euros, you can read the Stiftung Warentest evaluations of more than 9,000 medicines for over 100 diseases. For actinic keratosis, you will learn all the details about the effectiveness and side effects of the investigated remedies against light-induced skin changes.
Ingenol mebutate no longer approved due to suspected cancer
Another drug against actinic keratosis has not been studied by our drug experts: ingenol mebutate. The reason: The active ingredient, known as a drug under the name Picato, can itself cause skin cancer. The risk of treatment with it exceeds its benefit, according to a review by the European Medicines Agency in April 2020. Doctors have been allowed to use the drug since the beginning of 2020 Federal Institute for Drugs and Medical Devices (BfArM) no longer prescribe.
Important: Anyone who has used Picato should see a doctor if they notice any unusual skin changes or growths.
Agents rarely cause scars
In a manufacturer-independent study carried out in 2019, researchers from the University of Maastricht published in the prestigious New England Journal of Medicine was compared drug treatment options for light-induced keratinization of the skin. Result: All rarely cause cosmetic problems such as scars or permanent redness. Photodynamic therapy performed best in this regard.
This is how photodynamic therapy works
Photodynamic therapy combines drug treatment with radiation. First a cream with a special active ingredient is applied to the affected area of skin, which is then covered for a few hours. The active ingredient methylaminolevulinate accumulates in the changed skin cells and increases their sensitivity to light. Later, the doctor irradiates the areas with red light. The active ingredient then releases reactive oxygen, which destroys the skin cells.
Only a few insurance companies pay for photodynamic therapy
According to a recent study, photodynamic therapy appears to be the most lastingly effective remedy for large-area actinic keratosis. Because the evidence for their superiority is still incomplete, the costs are only covered by a few statutory health insurance companies.
Tipp: Insured persons should inquire with their insurance company before starting treatment.
Weigh the pros and cons
Photodynamic therapy does not offer a guarantee that the pathological cornifications will not return. What is certain, however, is that it is significantly more painful than other drug treatments. In the Maastricht University study, for example, more than 60 out of 100 people with this treatment complained of severe pain or burning – more than with the other treatment options examined.
These funds protect against white skin cancer
Individual positions can be removed
If only individual skin areas are affected, they can often be easily removed with mechanical methods – by freezing, for example, by surgery or by lasers.
Tipp: Ask the dermatologist’s office about the various treatment options. Let us explain why which treatment makes sense in your case.
Self-observation: early detection of skin cancer
To prevent actinic keratosis from developing into white skin cancer, dermatologists advise people at risk, such as light-skinned people and the elderly, to check for suspicious areas of skin every few weeks. Here’s how to recognize three common types of skin cancer:
© Hauttumorcentrum Charity
- Actinic keratosis. When patches of skin look red and feel rough, actinic keratosis may be the cause. Affected areas of skin may also itch or bleed. Over time, they become horny and often turn whitish. If left untreated, warty bumps can develop.
© Hauttumorcentrum Charity
- White skin cancer. Like its precursor, actinic keratosis, white skin cancer is often found in areas exposed to the sun: bald head, forehead, cheeks, bridge of the nose, neck, décolleté, arms, backs of the hands. The appearance is also similar to untreated actinic keratosis: whitish, keratinized to warty bumpy. Caution: If left untreated, an operation may be necessary.
© Hauttumorcentrum Charity
- Black Skincancer. Malignant melanoma is the most dangerous, but also the most visually striking skin cancer. The tumors are deep brown to blue-black, only rarely light in color and only then can they be mistaken for white skin cancer. They are often found in places that are only occasionally exposed to the sun and are sometimes difficult to see: back, legs, mucous membranes or genital area.
Skin cancer screening: What statutory health insurance pays
If there are any abnormalities, you should go to a dermatologist. Only healthcare professionals can determine if an abnormal spot is skin cancer. Even without any suspicions, people with statutory health insurance from the age of 35 are entitled to a full body examination every two years.
Tipp: Our health insurance comparison shows which statutory health insurance companies pay for skin cancer screening more frequently than every two years or for younger insured persons.
The simplest skin cancer prevention: protect against sunburn
The risk of skin cancer can be easily reduced – by protecting yourself from sunburn. Direct sun contact is taboo for babies up to six months. Older children, but also teenagers and adults should avoid the midday sun and protect themselves with hats, long clothing and sunscreen
Tipp: Stiftung Warentest regularly tests sun creams. Here you will find all sunscreen tests. Our FAQ sun protection clarifies questions about sun cream and sun protection for young and old.