I have actinic keratosis on the backs of my hands, effudex does not work, how do I treat it?

Anon, thank you so much for your question. I'm sorry you're having to deal with this, but it seems encouraging that the actinic keratosis has cleared up on your arms and face. You are not alone; up to 50 percent of Americans over age 50 has an AK. Let's see what I can find for you regarding your hands. It's possible that the sun damage they received over the course of your lifetime was more than your face or arms received.

Can you possibly answer a couple more questions for me?

On the areas where the Efudex has not worked, are there just small lesions, or are you dealing with larger areas? Are they merely rough and raised patches or are they more serious? How long did it take the Efudex to work on your face and on your arms?

Portrait Plasma has been approved by the FDA for treatment of actinic keratosis, and unlike some other skin resurfacing treatments, it leaves the surface of the skin intact during the healing process. The nitrogen plasma is a highly energized gas that penetrates the skin's surface. Patients do peel quite a lot after the treatment; here's a forum of cosmetic medicine physicians where patients and physicians are discussing different results from the treatment in general:

http://www.medicalspamd.com/the-blog/2007/4/25/portrait-plasma-skin-regeneration-the-power-of-high-powered-wrinkle-gas.html

One dermatological site discusses all of the following treatments in great detail, and believes that liquid nitrogen works the best:

Liquid Nitrogen
5 Fluorouracil
Retin A (et al)
Fluorhydroxyacid Peel
Levulan Kerastick
Solaraze
Celecoxib
Glycoalkaloids (SunSpot ES)
Imiquimod
Laser Resurfacing

Here is that site:

http://www.dermadoctor.com/article_Actinic-Keratoses_38.html

Depending on how many lesions you have on your hands, you might be interested in this comparison piece on laser removal, chemical peel and a topical cream. This comparison was done on facial lesions, and the chemical peel edged out the other two:

http://www.medpagetoday.com/Dermatology/SkinCancer/3972

Photodynamic also gets high marks in a 2007 issue of the Journal of the American Academy of Dermatology. Here is an article that discusses this therapy:

http://www.medscape.com/viewarticle/551337

Dimericine has been singled out by Prevention Magazine, CBS's The Early Show and the Dermatology Times as a "breakthrough" DNA repair lotion in clinical trials. Here is a quote from Prevention:

"In tests on humans who were extremely sensitive to sunlight, Dimericine reduced the incidence of skin cancer by a third and the number of precancers by two-thirds. If used daily, experts say, this lotion will very likely reduce the occurrence of basal and squamous cell skin cancer and possibly malignant melanoma."

Here's an article discussing Dimericine:

http://www.drugs.com/nda/dimericine_050309.html

Dermatological trials also find great promise with Ingenol Mebutate. Here is an article from the Dermatology Times that discusses it:

http://dermatologytimes.modernmedicine.com/dermatologytimes/Modern+Medicine+Now/Striking-gold-for-AKs-Trials-show-ingenol-mebutate/ArticleStandard/Article/detail/563266

There clearly are a lot of good options here. Are you working with a dermatologist who is familiar with these therapies, and not just a general practitioner? If not, that might be the next stop on your journey. If you need help finding someone with a particular expertise, please let us know where in the country you live so we can see if we can get you some specifics.

Thanks for writing, and please let us know which option you choose and how it works for you.