Actinic Keratosis: Treat Early, Treat Gently, Treat the Field 

Managing actinic keratoses (AKs) well requires more than freezing what we see. In this episode of The Spot Check, Jamie Restivo, PA-C, is joined by dermatology nurse practitioner David Seiter, NP, for a grounded, practical conversation on treating AKs with a broader, more preventive lens. 

At the center of the discussion is field therapy. While cryotherapy remains useful for isolated lesions, Seiter emphasizes the importance of addressing the underlying field of UV-damaged keratinocytes, much of it invisible. Starting earlier, when photodamage is still mild, can make treatment more tolerable and more sustainable for patients over time. 

From there, the conversation moves into the realities of clinical practice: how to choose between commonly used topicals, how to counsel patients through expected reactions, and how small decisions, including cost, access, and even how instructions are framed, can shape whether a patient is willing to repeat treatment. The goal is not maximal reaction, but a manageable one. 

Prevention threads throughout, from sunscreen counseling to adjunctive options like Polypodium leucotomos and nicotinamide, always with an emphasis on meeting patients where they are. 

The takeaway is a familiar one, but easy to overlook: treating AKs is not just about clearing lesions. It is about recognizing the field early and helping patients stay with a plan they can return to over time. 

 

The views expressed in this episode are those of the speakers and do not necessarily reflect those of Dermsquared. This program is intended for health care professionals and is provided for educational purposes only.  

 Clinicians are responsible for applying independent clinical judgment in patient care.