TREATMENTS
Fractional laser for solar keratoses
Laser may be an option for selected solar keratoses and surrounding sun-damaged skin, following medical assessment.
- Treatment tailored to the affected area
- Options discussed after examining your skin
- No referral needed
Solar keratoses (actinic keratoses) are rough, scaly patches caused by accumulated sun damage. Some can develop into squamous cell carcinoma, so assessment helps determine which spots need treatment or further investigation.
Your doctor considers the number and thickness of the spots, the surrounding skin, your skin cancer history and your preferences about recovery and cost. Fractional laser may be an option in selected cases.
Treating individual spots or a wider area
Individual solar keratoses can be treated directly, for example with cryotherapy (freezing). When several occur across an area of sun-damaged skin, your doctor may recommend field treatment.
Field treatment addresses the wider affected area, including changes that may not yet be clearly visible. Options include prescription creams, photodynamic therapy and, in selected cases, laser treatment. Individual spots and the surrounding area may need different approaches.
New solar keratoses can develop after treatment. Ongoing sun protection and skin checks remain important.
How fractional laser works
Fractional laser delivers energy to many tiny points within the treatment area, leaving skin between those points untreated. This allows healing from the surrounding tissue and stimulates skin remodelling.
The treatment settings and number of passes are selected according to the skin changes being treated and the expected recovery.
Ablative and non-ablative treatment
Ablative treatment removes tiny areas of surface tissue. It may cause pinpoint bleeding, crusting and redness, and usually requires more recovery time.
Non-ablative treatment heats tissue without removing the skin surface. Recovery is generally shorter, although redness, swelling and sensitivity can still occur.
Your doctor will explain which approach is appropriate for the visible spots and surrounding sun damage, whether numbing cream is needed and how much downtime to expect. Different areas may be treated with different settings during the same appointment.
MBBS, MA (Virtual Comm), Grad Cert Hlth Info, Grad Dip Comp Inf Sci
Ten minutes after fractional laser treatment. The cheek was treated with a deep ablative setting, and the nose and forehead with a shallow ablative setting. In this patient, redness of the forehead, nose and temples settled in two days; cheek redness resolved in a week. Recovery varies with the treatment settings and the individual.
We normally recommend a course of four sessions, with the plan reviewed according to your skin’s response. The improvement and number of treatments needed vary between patients.
Evidence and expected results
Studies of fractional laser have reported reductions in solar keratoses. Some research has also found an association with fewer subsequent skin cancers in treated areas. However, studies use different laser devices, settings and patient groups, so their results cannot be assumed to apply directly to every treatment.
Laser may be considered as part of an individual treatment plan. It does not guarantee clearance or prevent all future solar keratoses or skin cancers. Ongoing sun protection and skin checks remain important.
Other skin concerns
Treatment may also improve the texture and appearance of sun-damaged skin. If you have concerns about age spots or visible capillaries, your doctor can discuss whether these could be addressed with different laser settings or a separate treatment.
Treatment alternatives
Your doctor will discuss the options according to the number, thickness and location of the solar keratoses, your skin cancer history, recovery preferences and cost.
For individual spots:
- Cryotherapy uses liquid nitrogen to freeze selected lesions.
- Precision radiofrequency treatment may be considered for selected lesions after assessment.
- Excision or shave removal may be recommended when tissue needs examination, particularly if skin cancer is suspected.
For a wider affected area:
- Prescription creams treat multiple solar keratoses and surrounding sun-damaged skin. The treatment course and skin reaction depend on the medication.
- Photodynamic therapy combines a light-sensitive preparation with light to treat the affected area. Discomfort and recovery vary with the approach used.
For some patients, your doctor may also discuss oral vitamin B3 (nicotinamide) as an additional preventive measure.
Some solar keratoses may be monitored rather than treated immediately. Your doctor will explain which spots need treatment and which changes should prompt review.
How to prepare
Follow our preparation instructions before your appointment. Tell your clinician about your medications and any history of cold sores so they can advise on preparation. Do not stop prescribed medication without advice from your prescribing doctor.
How it’s done
Appointments usually take about one hour, or about two hours if numbing cream is needed beforehand. Your clinician will confirm this when planning your treatment.
Your skin is cleaned and you wear protective eyewear. Numbing cream and cooling measures may be used to reduce discomfort, depending on the treatment settings.
The doctor or nurse guides the laser across the treatment area. You may feel a snapping or stinging sensation and hear clicking sounds as the laser delivers each pulse. Ear protection may be provided for louder settings.
After treatment, your skin is cleaned and suitable aftercare products are applied. Your clinician will explain how to care for the area at home.
Recovery and side effects
Recovery depends on the treatment settings and the area treated. Redness and sensitivity may settle within a few days after lighter treatment. Stronger ablative treatment can cause crusting and require a week or more of recovery; pinkness may last longer.
Possible side effects include:
- Sunburn-like discomfort, redness and swelling
- Pinpoint bleeding and small crusts after ablative treatment
- Bruising, flaking or temporary darkening of treated pigmentation
- Increased or decreased skin pigmentation
Your clinician will explain the risks relevant to your skin and treatment settings.
Follow our fractional laser aftercare instructions for skin care during healing. Protect the area from sun exposure and avoid irritating skin products until your clinician advises that you can resume them.
Before treatment
Tell your clinician about medical conditions, medications, pregnancy or breastfeeding, recent tanning and any products on the treatment area, including fake tan. They will assess whether treatment should be adjusted or deferred.
Fees
Fees depend on the treatment and area involved. Assessment and treatment are charged separately. See our assessment fees and laser treatment fees.
References
- Nourmohammad Pour P, et al. Nonablative fractional laser therapy for treatment of actinic keratosis with 3-months follow-up. Journal of Cosmetic Dermatology. 2020;19(11):2893–2897.
- Benson TA, Hibler BP, Kotliar D, Avram MM. Nonablative fractional laser treatment is associated with a decreased risk of subsequent facial keratinocyte carcinoma development. Dermatologic Surgery. 2023;49(2):149–154.
Discuss treatment for solar keratoses
A doctor assesses your skin and explains suitable treatment options. No referral needed.
Book a skin condition assessment