Can the Thulium Laser Treat Actinic Keratosis?

By Alexander E. Bonato, MD — Board-Certified in Internal Medicine · Medically reviewed October 2026

TL;DR: Small studies suggest that 1927 nm thulium lasers can reduce actinic keratosis lesion counts, but the results belong to specific devices and protocols—not every laser sharing that wavelength. Our clinic uses NOUVADerm; we have not verified a device-specific FDA clearance for treating AK and do not claim one here. Laser treatment does not replace appropriate diagnosis, established AK treatments or ongoing skin surveillance.

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I am, in my own kitchen, banned from high heat. Nobody printed a certificate. But somewhere between the third pan-too-hot incident and the sauce that went from "reducing nicely" to "small emergency" in about ninety seconds, my wife quietly reassigned me. I still cook. Barbecue and sauces, that's the whole portfolio now. Anything that requires actual heat management, I've been relieved of.

Which is a little funny, because heat management is basically my entire job description on the laser side of the practice. Too much and you injure tissue you didn't mean to touch. Too little and nothing happens. The whole trick with the 1927 nm thulium laser , the same device I use for general sun damage and pigment, is that it's built to deliver a very specific, very controlled amount of heat to a very specific depth of skin. I trust a machine to do precisely what I clearly can't be trusted to do with a cast-iron pan.

Some 1927 nm systems have an FDA-cleared indication for actinic keratosis. That clearance belongs to the named device, not to the wavelength as a whole—and it should not be assumed to apply to our NOUVADerm. AK, those rough, scaly, sandpaper-feeling spots that show up after years of sun exposure, is precancerous. So the question worth asking honestly is whether a laser known mostly for smoothing texture and evening tone can also do something about the spots that actually carry risk. Let's go through what the evidence says.

What Actinic Keratosis Actually Is

Actinic keratosis is what chronically sun-exposed skin looks like when it's had enough. The spots show up as rough, scaly, often pink or tan patches, usually on the face, ears, scalp, and forearms, the places that catch the most sun over a lifetime. It's the most common precancerous skin lesion there is, and if you're over 50 and grew up outside, there's a good chance you have at least one whether you've noticed it or not.

Here's the part that actually matters: a percentage of untreated AK lesions progress to squamous cell carcinoma. Nobody can tell you in advance which specific spot on your face is the one that's going to do that, which is exactly why dermatology treats the whole affected area, called the "field," instead of just the lesions you can see. That's the frame everything below sits inside. This isn't a cosmetic conversation wearing a medical costume. It's a field-cancerization conversation that happens to have a cosmetic side benefit.

How the Thulium Laser Actually Works

The 1927 nm wavelength is absorbed almost entirely by water, which happens to be the one thing skin has an enormous amount of. That absorption is so strong that the laser's energy gets soaked up right at the surface, penetrating only about 200 to 300 micrometers. That's roughly the thickness of the epidermis and the very top of the dermis. Not deeper. Not by accident. That's exactly where AK lives.

The laser fires in a grid of tiny columns, creating what's called microthermal zones, thousands of precise little injuries surrounded by untouched skin. Each column heats and damages a small cylinder of tissue, including the abnormal cells sitting there, while the stratum corneum on top stays intact. Over the following days, your skin pushes that damaged material, along with some melanin, up and out through the surface. It's called microscopic epidermal necrotic debris, a genuinely unglamorous name for what shows up as a few days of fine, sandpapery flaking.

That's the heat-management trick I mentioned earlier, minus the small emergency. Enough energy to injure the cells that need injuring. Not enough to ablate the whole surface the way a fully ablative laser would. It's a narrow window, and hitting it consistently, session after session, is the actual engineering problem this device is solving.

What the Evidence on Actinic Keratosis Actually Shows

A useful recent study comes from the University of São Paulo. It used the Lavieen 1927 nm laser, not our NOUVADerm. Twenty-three patients, mostly lighter skin tones, with visible AK and general sun damage went through four monthly thulium laser sessions. By three months after the last treatment, their average AK count had dropped 61% from baseline, and most of that improvement showed up in the first three sessions rather than building slowly across all four.

What makes that study more interesting than a lesion count is that the researchers also took skin biopsies before and after, from normal-looking skin next to the treated area, not just the visible spots. They found measurable improvement at the tissue level: less depth of cellular abnormality, thicker dermis, more of the collagen-building tissue you want to see after an injury heals. That matters because AK isn't really about individual spots. It's a whole field of sun-damaged skin where some of it looks abnormal and a lot of it just hasn't announced itself yet. Finding improvement in skin that looked completely normal to the naked eye is a genuinely useful signal.

An earlier study using the Fraxel re:store Dual followed 24 patients for six months and reported an 86.6% reduction in AK lesion count. A separate study cited in the settings literature a panel of laser specialists relies on reported up to a 95% reduction at six and twelve months using higher energy and denser coverage, though that one was presented at a conference and hasn't gone through full peer review, so I'd weight it lower than the others until it does.

These findings support further investigation of 1927 nm treatment. They are not measured outcomes from our clinic or proof that NOUVADerm produces the same results.

The Honest Catch: What This Laser Can't Promise Yet

Here’s where I want to be straight with you, because a physician’s name is on this. The published studies discussed here are small and have limited follow-up. They do not establish a durable cure, elimination of every abnormal cell, or prevention of future skin cancer. The longer follow-up mentioned in the conference report carries less weight than a fully published study.

There's also an older study on a closely related wavelength worth knowing about. It's not the same laser, and I want to be honest about that limit, but it used a very similar non-ablative approach on facial AK and found something worth sitting with: even though the visible lesion count dropped by more than half, biopsies taken from those same treated areas still came back positive for AK, or worse, in nearly every patient. Clinically better does not automatically mean histologically gone. That gap between visible improvement and what remains under the skin matters. Established AK treatments include cryotherapy, topical medicines such as 5-fluorouracil and imiquimod, and photodynamic therapy. These have guideline support; choosing among them depends on the lesions, the surrounding field and the patient—not cosmetic benefit alone.

None of that makes the thulium laser useless. It means I use it as an addition to a real AK strategy, not a replacement for one, especially for anyone with a heavier lesion burden or a personal history of skin cancer.

What Treatment Actually Involves

Research schedules are examples, not a universal prescription. The 2026 Lavieen study used four monthly sessions. Separate expert recommendations for the Fraxel system describe a different schedule: three to five sessions, eight to twelve weeks apart.

Those schedules should not be combined into one supposedly proven protocol or transferred automatically to NOUVADerm. Device settings and treatment timing require individual assessment.

Before considering laser treatment, the lesions need an appropriate diagnosis and a management plan. A suspicious spot may require biopsy or another treatment first.

For practical information about treatment at our clinic, visit our thulium laser skin rejuvenation page. The consultation covers suitability, alternatives, expected recovery and follow-up.

Recovery and Safety

Pain during treatment is real. Patients in the São Paulo study rated it around 7 out of 10 on a standard pain scale, consistently across all four sessions, and topical numbing cream is standard before we start. Afterward, expect a few days of redness, swelling, and a burning sensation, followed by the skin shedding the treated layer over about a week. Most of that resolves within 48 to 72 hours.

The main risk worth knowing about is post-inflammatory hyperpigmentation, a patch of skin that darkens instead of clearing after treatment. In that same study, it happened to exactly one person out of twenty-three, who'd gotten unintentional sun exposure against instructions, and it resolved with a few months of topical treatment. If you have a deeper skin tone, that risk runs higher across laser treatments generally, and it's worth its own honest conversation before you start.

Who's Actually a Good Candidate

Laser treatment may be considered for selected patients with AK and accompanying photodamage, but suitability depends on clinical assessment and the overall AK management plan. A shorter recovery or cosmetic benefit does not establish equivalent disease control compared with another treatment.

It makes less sense as a first move for someone with a heavy AK burden, a personal or family history of skin cancer, or anyone whose dermatologist has already flagged a spot as concerning enough to biopsy. That's a conversation for the guideline treatments with the longer track record, which I broke down here, not a laser chosen mostly for its cosmetic upside.

The honest version of my advice is this: establish what the spots are and what treatment they need first. Then discuss whether laser treatment has a useful role, including its evidence limits and the follow-up required. If you're not sure which category you're in, that's exactly what the consultation is for.

Frequently Asked Questions

Does this replace cryotherapy or the freezing spray?

No. Cryotherapy treats selected individual lesions, while field-directed treatments address a broader area of sun-damaged skin. Laser treatment should not replace an appropriate diagnosis or a dermatologist’s recommended AK treatment plan.

How many sessions will I actually need?

There is no single established schedule for every device or patient. The studies and expert recommendations discussed above used different intervals. Any proposed course needs an individual assessment, rather than a promise based on another machine’s protocol.

Does it hurt?

It can be uncomfortable. Patients in the 2026 Lavieen study reported average pain scores around 7 out of 10 despite topical numbing. That describes the study protocol, not a prediction of your experience. We discuss comfort measures and expected recovery before treatment.

Will my spots come back?

AK can persist, recur, or develop elsewhere in sun-damaged skin. A reduction in visible lesions is not a guarantee of lasting clearance. Continued sun protection and appropriate skin surveillance remain important.

Is this actually FDA-approved for actinic keratosis?

FDA clearance is device-specific. Some 1927 nm systems, including Lavieen, have clearance covering AK. Our clinic uses NOUVADerm, and we have not verified an FDA clearance document for that device that includes AK. We therefore do not claim that indication for NOUVADerm. Its documentation would need to be verified separately.

Is this safe if I have darker skin?

Skin type, pigment history, the condition being treated and treatment settings all affect the assessment. The 2026 AK study included Fitzpatrick I–III patients, so its safety findings should not be generalized to darker skin types. Our article on thulium treatment in skin of color discusses those limitations further.

The Bottom Line

If you've got rough, scaly patches that keep showing up in the same spots, or you're just curious whether the sun damage you've accumulated over the years is worth actively treating instead of moisturizing and hoping, come in and let's look at it together. I'll tell you honestly whether the thulium laser makes sense for what's actually going on with your skin, or whether one of the guideline treatments is the better first move. We're in Medford, with patients coming in from Ashland and Grants Pass too, and the conversation starts with a real look at your skin, not a sales pitch. Book a consultation

References

1. Salviano LMO, Hirayama AB, Pincelli MS, et al. Clinical and Histopathological Assessment of the Field of Cancerization in Human Skin Before and After Treatment With a 1927-nm Thulium Fractional Laser. Lasers Surg Med. 2026;58(4):311-320.
2. Weiss ET, Brauer JA, Anolik R, et al. 1927-nm Fractional Resurfacing of Facial Actinic Keratoses: A Promising New Therapeutic Option. J Am Acad Dermatol. 2013;68(1):98-102. (As cited in Salviano et al. 2026 and Friedman et al. 2022.)
3. Friedman PM, Dover JS, Chapas A, et al. 1,550 nm Erbium-Doped and 1,927 nm Thulium Nonablative Fractional Laser System: Best Practices and Treatment Setting Recommendations. Dermatol Surg. 2022;48(2):195-200.
4. Katz TM, Goldberg LH, Marquez D, et al. Nonablative Fractional Photothermolysis for Facial Actinic Keratoses: 6-Month Follow-Up With Histologic Evaluation. J Am Acad Dermatol. 2011;65(2):349-356.
5. U.S. Food and Drug Administration. Lavieen: 510(k) clearance K241406, including Indications for Use. June 28, 2024. https://www.accessdata.fda.gov/cdrh_docs/pdf24/K241406.pdf
6. American Academy of Dermatology. Actinic keratosis: Clinical practice guideline highlights. Accessed October 19, 2026. https://www.aad.org/member/clinical-quality/guidelines/actinic-keratosis