Ask the Doctor: Advances in the Treatment of Skin Actinic Keratoses

By Peter C. Friedman, MD

Actinic keratoses, also known as AK, are the dreaded precancerous lesions that usually develop on sun exposed areas such as the face, bald scalp, lips, the back of the hands, and on the lower legs.

They appear as little scaly red bumps that you can just scratch off like dry skin. Except, they won’t go away. If not properly treated, they keep growing deeper in the skin until they reach a point where they can turn into a skin cancer, squamous cell carcinoma.

Dermatologists treat these growths regularly using freezing sprays, cautery, creams, deep peels, and photodynamic therapy. These treatments do work, but they are far from perfect. They can be painful, cause inflammation, redness, scabs, and blisters that can last days or even weeks after the treatment. The cure rate is low and the recurrence rate is high.

This is where non-thermal atmospheric pressure plasma (NTAP)—also known as cold plasma—comes into play. Cold plasma is essentially ionized gas. Its characteristics are determined by the way it is produced, using a very carefully designed electric discharge. It can be generated using a handheld electrode placed on the treated area, be it a cell culture in a petri dish or human skin. It is very safe, does not hurt and does not irritate the skin. Laboratory studies have shown that cold plasma can destroy cancer cells and that it can increase anti-cancer immune response.

As we reported in the February 2017 Journal of the American Academy of Dermatology, our team treated AK in real patients using cold plasma in a small clinical trial. It turned out that not only was cold plasma just as effective as other treatments, but it is also completely painless and has no side effects. We believe the effectiveness of cold plasma can be further improved while keeping it free of side effects and discomfort.

More research needs to be done and many more patients will have to be treated successfully before it can be widely used as an approved treatment option.

According to the Skin Cancer Foundation, 58 million Americans suffer from actinic keratosis. Using cold plasma could lower their chances to develop skin cancers while eliminating all the side effects from currently used actinic keratosis treatments.

The story doesn’t end here. Actinic keratosis is a precancerous lesion because its cells behave very much like cancer cells. Our team believes that with the right settings, cold plasma can be just as effective against skin cancers as it is against precancerous growths.

Reference: Friedman PC, Miller V, Fridman G, Lin A, Fridman A. Successful treatment of actinic keratoses using nonthermal atmospheric pressure plasma: A case series. J Am Acad Dermatol. 2017 Feb;76(2):349-350

Dr. Peter Friedman is in private practice and works as an Instructor in Clinical Dermatology at the Department of Dermatology, Columbia University—New York Presbyterian Hospital. skincenterderm.com

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