Actinic Keratosis

The actinic keratosis is a condition also known as solar keratosis or under the acronym AK. It is caused by years of constant sun exposure and looks like a scaly area on the skin, with a rough surface. It can appear anywhere but it's most common on areas exposed to the sun, like the face, neck, scalp, lips, ears, forearms or the back of the hands.

Actinic keratosis usually starts with a small spot on the skin and doesn't have any additional symptoms for a long time. The affected area expands very slowly and only becomes a problem after many years, in most cases after the age of 40. The biggest risk associated with this condition is that it can transform into potentially lethal skin cancer. Since it is caused by the sun, actinic keratosis can be prevented by avoiding exposure and protecting the skin with special products that stop UV rays.

The condition builds up in time and it is more likely to affect older people, since sun exposure accumulates every year. The risk is higher for individuals with fair skin. The lesions can be unpleasant to touch but they don't cause any pain. Actinic keratosis might lead to cancer if left untreated and is considered to be one of the cancer precursors.

In almost every case, the lesions can be removed from the skin safely, before they morph into cancerous tumors. However, if they are ignored it is possible to transform into squamous cell carcinoma. This is a form of cancer but not a particularly dangerous one, which is treatable if detected in an early stage.

What are the symptoms?

Actinic keratosis starts with small spots or patches on the skin. These have a visibly different color than the rest of the skin, can be red or dark, and persist in time. They are usually found in groups and can emerge anywhere on the body but typically on areas exposed to the sun like the head, hands or neck.

The patches have a number of distinctive features. Their size starts from 1 mm in diameter but can be larger than 3 mm, with a trademark rough surface. They can be grouped in clusters, close to each other. Sometimes they itch or burn, without severe pain, or are surrounded by areas of red and inflamed skin.

If you suspect that you have actinic keratosis, you should ask for medical advice. If the patches start bleeding, expand in size, become painful, get infected or transform into sores, the condition could be serious.

Who is at risk?

Actinic keratoses can start at any age but there are a number of factors that increase the risk. The disease usually appears after the age of 40 and people from sunny climates are more likely to develop it. The risk is higher if your skin is fair, with blue eyes and red or blond hair. Sensitive people get burned or covered with freckles quickly when exposed to sun and tend to have a past history of sunburn from short periods in the open. A malfunctioning immune system, which can be caused by diseases much as AIDS and leukemia or external factors like organ transplant medications and chemotherapy, also increases the associated risks. People who have already suffered from actinic keratosis or skin cancer are especially vulnerable.

However, actinic keratosis can affect anyone after sun exposure, regardless of the above factors. It is more likely to emerge on the skin of elder people, because they have spent more hours in the sun and the exposure accumulates in time. The condition seems to target people with weak immune systems, which can be the result of some aggressive drugs, as well are the ones with fair skin tones. The risk is a lot higher if your skin already shows symptoms of damage caused by the sun, such as hyperpigmentation, discoloration, mottled skin or wrinkles.

Treatment options

There are several treatment options available that can be selected by your doctor. One of the most innovative is cryotherapy, also known as cryosurgery. Liquid nitrogen is used to literarily freeze the lesion, which is then destroyed. The area will be painful for about 3 days and needs one or two weeks to fully heal. It can be performed in an office and doesn't require hospital admission. It usually leaves no scar at all but if the skin is dark it might become lighter in the area.

Curettage and electrosurgery is another method to remove patches of actinic keratosis. After a local anesthetic is applied, a curette (surgical instrument that resembles a spoon) is used to cut off the growth. Electrosurgery follows, in order to kill any other tissues in the area and stop bleeding. This technique is fast and effective but has a number of downsides. Scars are very frequent and can sometimes evolve into thicker scars of a keloid nature. These are not dangerous for health but can be itchy and look unpleasant.

The growth can also be cut with a blade, a surgical procedure known as shave excision. Besides removing the lesion, it also allows the doctor to investigate the risk of squamous cell carcinoma or basal cell cancer. It might result in scars or loss of skin color and needs between one or two weeks to heal.

Chemical peeling uses chemical agents to remove the first layer of skin. It can cure the condition sometimes, as new cells will grow and replace the damaged ones.

Another modern option is laser resurfacing. Lasers are strong focused light beams, the type commonly used in therapy is the carbon dioxide or CO2 laser. The principle is the same as in the case of chemical peeling: the laser beam destroys the first skin layer and forces it to regenerate.

Finally, there are a number of drugs that can be applied directly on the skin, with various levels of success. These include Solaraze (diclofenac), Picato (ingenol mebutate), fluorouracil (5-FU) or Aldara (imiquimod).