Lasers for solar keratosis

  • Best Results1-2 sessions
  • Treatment Recovery5-8 days
  • Procedure Time30 minutes
  • Skin SpecialistDavin Lim, nurse
  • Duration of Results2-5+ years
  • AnaestheticLocal, sedation
  • Back to Work2-7 days
  • Cost$$-$$$$

Lasers for solar keratosis

There are many ways to treat solar keratosis or sunspots, including the use of over a dozen lasers. Ask your skin specialist about these treatment options as the latest studies have shown that laser assisted delivery of chemicals such as ALA yields the best results with the least amount of downtime. Your doctor will have a logical reasoning for using their preferred method.

FactsFacts on Lasers for Solar & Actinic Keratosis

  • Lasers can be used alone or combined with chemicals to treat solar keratosis
  • My most common laser used is the thulium 1927 in high density passes
  • This can be combined with retinoic acid or aminolevulinic acid, or PDT
  • Limited joule, high density CO2 can also be combined with the above
  • Lasers in combination with PDT can address thicker & pigmented sun spots
  • Laser assisted PDT has the highest clearance rates of actinic keratosis
  • Recovery from laser therapy is much quicker compared to Efudix or Aldara
  • There are over 25 ways to use lasers for sunspots, hopefully this page will clarify what is in the scientific literature

What types of lasers are used to treat sun spots?

I use three main lasers to treat sunspots. They include-

Thulium 1927 in a high-density setting. This laser wavelength accounts for the majority of sunspot treatments that I perform.  High density means high pass, resulting in 92% coverage of treated skin. Recovery takes 4-6 days. This can be a stand-alone treatment, combined with PDT or photodynamic therapy, or retinoic acid.

CO2 fractional laser resurfacing; low energy high density. This is best for sunspots associated with age spots, sebaceous hyperplasia & wrinkling. CO2 can be a stand-alone or combined with retinoic acid or PDT.

Erbium & CO2 full resurfacing; this treatment is performed by me. It is an epic treatment that gives epic results. Best for severe wrinkles, laxity, sun damage, smokers’ lines & marked photoaging. 8-14 day recovery but takes your skin back 10 to 20 years.

What is the best laser based upon the severity of sunspots?

Mild sun damage: opt for a thulium high density session. One session in most cases.

Recovery: 4-6 days

Cost: From $1290

Comments: Best for mild to moderate sun damage, will also improve fine lines.

Moderate sun damage: Thulium HD & CO2. One session.

Recovery: 5-7days

Cost: From $1790

Comments: Also treats wrinkles, spots, warts & pigmentation.

Severe sun damage: Erbium, HD Thulium & CO2 mix. One session.

Recovery: 8-14 days

Cost: From $1990 – $6990

Comments: Treats deep wrinkles, smokers’ lines, rejuvenation of 1-2 decades.

How do you know what is the best treatment for your skin?

Confused? If you have mild sun damage, & would like a reduction in solar keratosis, book an appointment with my nurses at Clinic Cutis.

If you have a history of solar keratosis, with moderate to severe sun damage, or you would like to have an assessment done, book an appointment with myself or one of my colleagues. We are all dermatologists; a referral is required.

How does laser therapy compare to other treatments for solar keratosis?

Favourably. To date the highest clearance rate of over 90% has been reported with fractional CO2 assisted short contact (30 minutes) laser assisted PDT. The illumination was with blue light.

The main advantage of lasers compared to creams for solar keratosis is the much faster recovery following laser treatment. Lasers also address the cosmetic issues of photoaging, including lines, wrinkles, pigment & barnacles. 

Davin’s Viewpoint on Lasers for Solar Keratosis

This is, by far, one of the biggest & most confusing topics for consumers (and also many junior physicians to understand). There is a dearth of energy devices used to treat sunspots or solar keratosis. An overview is as follows-

Lasers & devices to assist in delivery of chemicals include, fractional CO2, fractional erbium, fully ablative erbium with a micropeel, microneedling, CO2 & RF, lasers with shock wave pulse, non-ablative 1927, 1940, 1440, 1540, 1550 more. Some of these have been used in isolation, & in other cases combined with each other.

Add the various chemicals that have been used (in the context of solar keratosis treatment), and they include ALA, mALA, retinoic acid from 0.5 to 5%, 5FU. They range from short contact, 15 minutes, to long contact 3 hours. 

Now add the illumination sources. They include daylight action spectrum with varied exposure time of 1-3 hours, varied longitude & lux. Other sources include LEDs, including blue & red in various power (joules). IPL with different filters have been used, as have Pulse Dye Lasers. 

Now, multiple the three variables, namely lasers for delivery, chemicals, & illumination together with various sites of solar keratosis (scalp, face, chest, arms, hands), then look at the follow ups, 3, 6, 12, 8 months. Consider the different types of solar keratoses, pigmented, hypertrophic, confluent, as well as the immunology of the patient, immunocompetent vs immunosuppressed. Get it? Every month there is a new paper that adds to the variables.

If I could simplify things, the best treatment for most people is high density thulium. I do use PDT if there is significant dysplasia. For solar keratosis with age related changes, it is the above with CO2 fractional. My preferred PDT is daylight.

For really sun weathered skin, namely patients living in high UV exposure areas like Gold Coast, Sunshine Coast, my preferred is Erbium & CO2 fully ablative resurfacing.

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