Actinic Keratosis

Actinic keratoses (AKs) are rough and scaly lesions that form on the surface of the skin. They are most commonly seen in fair skinned, older adults who have had a high amount of sun exposure throughout their lives. The lesions usually start out very small, but can enlarge over time. They vary in color from skin-tone to red.

Due to their rough texture, actinic keratoses can easily be detected by touch. Lesions typically occur on sun-exposed areas of skin, such as the face, back of the hands, and forearms, as well as on the lower legs in women. It is also seen on the scalp of bald men as well as on the ears and lips. When the lips are involved, the condition is termed actinic cheilitis.

Although first appearing in the ’30s, actinic lesions become increasingly common with age. It is estimated that 80% of those with fair skin over 70 years have actinic keratoses. It’s important to keep an eye on AKs because they can develop into invasive skin cancer over time. The presence of an AK can also be a marker for progression to skin cancers such as basal cell carcinoma or squamous cell carcinoma.

Common features of actinic keratosis include:

Roughness:
Small areas of skin will have a dry and rough texture to them. Sometimes they can be felt more easily than seen.

Tenderness:
Affected areas of the skin can be tender to the touch.

Changes in color:
Actinic keratoses start out skin colored or slightly brown and may become pink or reddish as they enlarge.

Changes in size:
Most lesions are usually 1-3 mm although they may be as large as 1-2 cm in diameter. AKs may also thicken and grow outwards from the skin, these are also known as hypertrophic actinic keratosis or cutaneous horn.

Chronic exposure to the sun’s ultraviolet (UV) rays is the primary cause of actinic keratosis. UVA radiation from tanning beds can also be a cause.

Over time, skin damage from UV radiation can accumulate, so limiting unnecessary exposure and using sun protective measures can significantly reduce your chances of developing skin cancer.

Proper skin care is important in maintaining healthy skin.

Considering actinic keratosis is caused by sun exposure, look for moisturizers that contain UV filters, which can offer additional safeguards against UV radiation.

Make sure to apply sunscreen frequently and generously, especially if you’re doing physical activity or perspire a lot. Use gentle cleansers that are free of fragrances and allergens to avoid skin irritation.

Since actinic keratosis is caused by sun exposure, it’s important to take preventive measures when going outdoors. If you spend a lot of time under the sun (either for work or recreation), you need to be especially vigilant.

Limit sun exposure:
Reducing your time in the sun is the easiest way to avoid damage to your skin caused by UV rays. When outdoors, set a time limit and seek shade when possible. Also keep in mind that UV radiation is the strongest between the hours of 10 a.m. to 4 p.m. UV light not only damages DNA, but it also has an effect on suppressing the immune system, increasing the risk for developing skin cancers.

Use Sunscreen:
Sunscreens are an essential part of protection against the sun. Look for sunscreens labeled “broad spectrum” for protection against both UVA and UVB rays. Make sure to apply generously and frequently. Select a sunscreen that feels comfortable on your skin, otherwise you may not use it regularly.

Cover and protect:
Wrap-around sunglasses, wide-brimmed hats and clothing that covers your arms and legs can offer extra protection against the sun’s harmful UV rays.

Look for any changes in your skin:
If you notice any changes to existing lesions or unusual new growths, consult with a dermatologist immediately to determine if they may be precancerous.

OTC
Daily sunscreen use has actually been shown to reduce the number of AKs that can develop on the skin. Look for sunscreens that contain the following ingredients: oxybenzone, avobenzone, ecamsule, titanium dioxide and zinc oxide. These are all active ingredients that are helpful in preventing sun damage. Make sure your sunscreen offers protection against both UVA and UVB rays. These will be simply labeled “broad spectrum”.

Prescription
A doctor may prescribe topical treatments, such as retinoids (vitamin A derivatives), which can smooth the skin and slow down the appearance of new lesions. Medications such as imiquimoid and 5-fluorouracil (5-FU) are also helpful in treating actinic keratosis.

Procedures
A number of procedures are available to treat Actinic Keratosis: Cryosurgery is the most commonly used procedure to freeze off the area of affected skin. Lesions may also be surgically removed by excision.Laser skin resurfacing can be used to restore the skin’s smooth texture. In certain cases, photodynamic therapy is used to treat actinic keratosis. In individuals who have multiple AKs or a history of AKs, it is common for doctors to combine approaches, such as cryotherapy with imiquimod, to treat both visible and developing lesions.