What to do about those unsightly skin growths as we age

What to do about those unsightly skin growths as we age

If you're middle-aged or older and spent a lot of time in the sun or tanning beds, you may have some actinic keratoses on your face, neck or other sun-exposed areas.

These common skin lesions are caused by sun exposure and may appear as reddish or pink spots or as rough or irritated patches, according to the American Academy of Dermatology Association. Although considered precancerous, very few ever become cancer, said Kevin J. Moore, MD, who works at Contemporary Dermatology offices in Barnstable and Plymouth. Sometimes a patient's immune system will clear a lesion without treatment, he said.

"The rate of progression to squamous cell cancer is pretty low - about one percent or less. That number is higher if the patient is older or immunocompromised. If someone's younger, it's probably less."

Actinic keratoses are quite common. People with light skin and hair are more likely to have them, but they can affect people of any complexion, Dr. Moore said.

"Almost 40 percent of Caucasian adults over 50 have or have had an actinic keratosis," he said, adding that "sunscreen wasn't really popular" when these people were young.

Treatment

Patients may have these lesions destroyed with cryotherapy - liquid nitrogen that freezes a keratosis, causing it initially to swell, then shrivel and drop off.

The American Academy of Dermatology Association says other options for in-clinic treatment include:

• Chemical peel
• Photodynamic therapy, in which a substance that makes your skin extra sensitive to light, is applied to an area, which is then exposed to a special light. It can take two or more sessions to be effective and may be reserved for patients who have had previously treated lesions return.
• Laser resurfacing, which may be used for actinic keratoses on the lips, called actinic cheilitis.

For treatment at home, Dr. Moore said he prefers patients apply a combination cream containing 5-fluorouracil, a standard treatment for actinic keratoses, and calcipotriene, used for plaque psoriasis. He explained that the skin constantly renews itself through cells dividing and shedding. Too much ultraviolet radiation from sunlight or tanning beds damages DNA in skin cells, causing them to divide too rapidly. The chemical 5-fluorouracil targets rapidly dividing cells while not affecting healthy skin. It not only attacks visible actinic keratoses, but other sun-damaged skin, reducing the chances of other growths springing up in the treated area. This chemical can be used by itself in creams, with twice daily application for up to four weeks, which makes skin red and irritated, but after healing, the skin is smooth and healthy.

Dr. Moore said the combination cream has two advantages over using 5-fluorouracil, alone. One, it reduces treatment time from several weeks to only 4-5 days, which cuts the time patients must endure unpleasant effects. These effects are also milder with the combination cream, according to a Sept. 28, 2024 article in Clinical Drug Investigation. Two, it reduces the chances of developing skin cancer for three years, as opposed to one year for 5-fluorouracil alone.

"I always tell patients to plan around their social calendar" as to when to have the combination cream treatment done, as it doesn't have to be done immediately and will affect their appearance, he said.

According to the dermatology association, other topical treatments include:

• Imiquimod cream, applied one or twice daily for 12-16 weeks, which causes less irritation and crusting; or nightly for two weeks, then none for two weeks, then nightly again for two weeks.
• Diclofenac sodium gel, twice daily for two to three months. Also causes less irritation than 5-fluorouracil cream.
• Tirbanibulin ointment, once daily for five days, while avoiding nearby skin.

Whatever treatment method is used, "all come with side effects," Dr. Moore said.

Another option is no treatment, and monitoring for any progression. A Jan. 26, 2026 article in JAMA Internal Medicine questioned whether all actinic keratoses should be treated, given their very low incidence of progression to squamous cell cancer. The dermatology association recommends anyone with several actinic keratoses regularly see a dermatologist, as they likely have sun-damaged skin that will continue to develop more lesions and possibly cancer. It noted that skin cancer is highly treatable if found early.

Other Common Keratoses

Keratosis pilaris is a noncancerous condition when dead skin cells build up inside hair follicles and plug them, causing red and bumpy patches, sometimes called strawberry skin or chicken skin.

"It's super common. We see it a lot in clinic - it's completely benign," Dr. Moore said.

He estimated 75-80 percent of children and 40 percent of adults have the condition, which often occurs on the upper thigh or arm. Some people are genetically more likely to develop keratosis pilaris, and most kids will outgrow the condition, he added.

Scrubbing an affected area won't solve the problem and may just make it more inflamed, Dr. Moore said. He recommended using a chemical exfoliant, such as a retinoid or salicylic acid. The dermatology association says the condition doesn't have to be treated, but if it's dry and itchy, a moisturizer containing urea or lactic acid could be applied to damp skin after bathing.

Seborrheic keratoses are another benign type of skin growth that affects "probably close to 100 percent of Caucasian people" and, unlike actinic keratoses, "is not necessarily related to sun exposure," but likely does have a genetic component, Dr. Moore said. Because people tend to develop more of them as they age, they're sometimes called "wisdom spots," he added.

Seborrheic keratoses often have a "stuck-on" appearance, and can be waxy or wart-like, flat or raised and the same color as a person's skin or darker brown or black, Dr. Moore said.

"I've seen some pretty large ones. Sometimes patients will pick them off."

Because they are benign, health insurance may not cover removal of seborrheic keratoses. The dermatology association says doctors don't typically treat them unless they resemble skin cancer, are easily irritated, get caught on clothing or affect a patient's appearance. Removal usually is done by freezing with liquid nitrogen or slicing it off followed by electrodessication.