Actinic Keratosis

What is Actinic Keratosis?

Actinic keratosis is a scaly, rough patch of skin that is caused by prolonged exposure to the sun. It is also known as solar keratosis and commonly appears on sun-damaged skin, especially in areas frequently exposed to UV rays. They can often be found on the face, lower lip (particularly the vermilion border), lips, ears, scalp, neck, forearms, or the back of the hands, as these areas are often exposed to sunlight. These patches grow slowly and usually appear in people over 40 years old. If left untreated, actinic keratosis can turn into squamous cell carcinoma, a form of skin cancer.

Actinic keratoses can vary in appearance. Common signs include:

• Dry, rough, or scaly patch of skin.
• Flat or slightly raised patch or bump on the top layer of skin.
• Pink, red, brown, tan, or a combination of these colors; the base of an actinic keratosis may be light or dark.
• Burning, itching, crusting, or bleeding.
• Mild itching or stinging, or sensitivity to touch.
• New bumps or patches forming on sun-exposed areas.

Individuals with red or blonde hair and light skin, who have a history of sunburn, are older than 40, live in a sunny place, work outside, or have a weakened immune system, may be at a higher risk for developing actinic keratosis.

Risk factors for actinic keratosis include long-term UV exposure, fair skin, older age, weakened immune status, and genetic conditions that increase skin sensitivity to UV damage, such as albinism or xeroderma pigmentosum. People with pale skin, blonde or red hair, and blue, green, or gray eyes are at higher risk for actinic keratosis. UV rays from the sun and tanning beds cause almost all actinic keratoses, and the damage from UV rays builds up over time, increasing the risk. Actinic keratosis is very common and many people have them.

Symptoms of Actinic Keratosis

Actinic keratosis (AK) often presents as a rough, scaly spot or patch on areas of the skin that receive frequent sun exposure, such as the face, ears, bald scalp, neck, and the backs of the hands. These lesions may feel like sandpaper to the touch and can be either flat or slightly raised.

Many people notice a prickly or sore feeling in the affected area, and it’s not uncommon for the skin to itch, bleed, or feel irritated. The color of actinic keratoses can range from pink, red, or tan to gray or even match the surrounding skin, making them sometimes difficult to spot. In some cases, the only noticeable symptom is a persistent rough scaly patch that doesn’t heal.

When actinic keratosis develops on the lips, a condition called actinic cheilitis, it can cause dryness, cracking, and a rough texture. Because these symptoms can be subtle, it’s important to pay attention to any new or changing spots on sun-exposed skin and consult a dermatologist if you notice anything unusual.

Diagnosis of Actinic Keratosis

Diagnosing actinic keratosis typically begins with a thorough visual examination by a healthcare provider, who will look for signs of sun damage and abnormal skin cells on sun-exposed areas. To get a closer look at the skin, your provider may use a dermatoscope, which magnifies the surface and helps identify subtle changes.

If there is any uncertainty about the diagnosis or concern that the lesion could be a type of skin cancer called squamous cell carcinoma, a small skin biopsy may be performed. This involves removing a tiny sample of the affected skin and examining it under a microscope to check for abnormal skin cells.

Early diagnosis of actinic keratosis is important, as it allows for timely treatment and reduces the risk of progression to squamous cell skin cancer. If you notice persistent rough patches or other symptoms of actinic keratosis, scheduling a skin check with a dermatologist is a proactive step toward protecting your skin health.

Actinic Keratosis Treatment

Sometimes, an actinic keratosis will disappear on its own but may return when the area is exposed to the sun. Actinic keratosis is often diagnosed by a healthcare professional through visual and tactile examination of the skin, and sometimes a biopsy may be needed to confirm the diagnosis and distinguish it from skin cancer. Because it is difficult to determine when an actinic keratosis will develop into skin cancer, they are usually removed as a precautionary measure. Most actinic keratoses can be treated and cured, but they may recur, so regular skin exams are important after having actinic keratosis treated. Treatment options include:

Medications

FDA-approved topical medications, including creams and gels such as fluorouracil, imiquimod, ingenol mebutate, or diclofenac, can be prescribed to remove actinic keratoses. Topical chemotherapy involves applying these medications directly to the skin to treat actinic keratosis lesions. Topical creams are effective field treatments for areas with multiple actinic keratoses, especially on facial skin. These products may cause scaling, redness, or a burning sensation for a couple of weeks.

Surgery and Other Procedures

• Cryosurgery: This treatment targets individual lesions by freezing them with liquid nitrogen, causing the damaged skin cells to die. As the area heals, new healthy skin grows in place of the treated lesions.
• Curettage: This involves the use of a special device called a curet to scrape away damaged cells. Local anesthesia is used, and side effects may include changes in skin color or scarring.
• Photodynamic Therapy: A light-sensitive chemical solution is applied to the affected area. A special light is then shone on the area to destroy the actinic keratosis. Side effects include swelling, redness, and a burning sensation.

Following actinic keratosis treatment, patients are suggested to see a dermatologist for a skin check yearly to ensure they do not have skin cancer.

Complications of Actinic Keratosis

While most actinic keratoses are not immediately dangerous, leaving them untreated can lead to serious complications. The primary concern is the potential for these lesions to develop into squamous cell carcinoma, a common type of skin cancer.

According to the American Academy of Dermatology, almost all actinic keratoses are caused by UV rays from the sun or tanning beds, which damage the DNA in skin cells and can trigger abnormal growth. Individuals with repeated sun exposure, fair or pale skin, blonde or red hair, or a weakened immune system are at increased risk for complications. In addition to the risk of skin cancer, actinic keratoses can be cosmetically bothersome, affecting self-confidence due to their rough, scaly appearance.

If not treated early, actinic keratosis can also increase the risk of developing other types of skin cancer, including basal cell carcinoma and melanoma. Prompt treatment and regular monitoring are essential to prevent these potential health issues.

Prevention of Actinic Keratosis

The best way to prevent actinic keratosis is to protect your skin from harmful UV radiation. Wearing sun protective clothing, applying a broad-spectrum sunscreen with a high SPF, and using lip balm with sun protection can significantly lower your risk. It’s also important to avoid tanning beds and seek shade during peak sun hours to minimize exposure to UV rays.

Regular skin exams, both at home and with a dermatologist, are key for early detection and treatment of actinic keratosis and other skin conditions. The American Academy of Dermatology recommends that people with risk factors, such as pale skin, light colored eyes, a history of sun damage, or frequent sun exposure, take extra precautions and schedule regular check-ups. By adopting these sun safety habits, you can help prevent actinic keratosis and reduce your risk of developing skin cancer, keeping your skin healthier and more resilient for years to come.

Actinic Keratosis FAQS

Candidates for Actinic Keratosis Treatment

Sometimes, it can be difficult to tell between noncancerous and cancerous spots on the skin. If you notice any changes in your skin over time, be sure to see a dermatologist for a skin exam. If you have been diagnosed with actinic keratosis or have any of the symptoms listed above, you should see Dr. Erwin for a skin assessment for a proper diagnosis and treatment.

Contact Us Today

If you are interested in learning more about actinic keratosis or would like treatment, contact our office by calling 979-543-9933 to schedule your consultation appointment with Dr. Erwin.