Actinic KeratosisA Brief Overview

What is Actinic Keratosis

• Also called solar keratosis• It’s a rough, scaly, crusty growth (lesion) on your skin

caused by damage from the sun’s ultraviolet (UV) rays.• It's most commonly found on sun exposed areas of your

body such as your face, lips, ears, back of your hands, forearms, scalp or neck.

• These lesions take years to develop, usually first appearing in older adults.

Signs and Symptoms of Actinic Keratosis

• Rough, dry or scaly patch of skin, usually less than 1 inch (2.5 centimeters) in diameter

• Flat to slightly raised patch or bump on the top layer of skin

• In some cases, a hard, wart-like surface• Color as varied as pink, red or brown, or flesh-colored• Itching or burning in the affected area

Causes of Actinic Keratosis• Chronic sun exposure is the cause of almost all actinic keratosis. Sun damage

to the skin is cumulative, so even a brief period in the sun adds to the lifetime total.

• Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

• The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so dermatologists warn against indoor tanning.

• Occasionally, actinic keratosis may be caused by extensive exposure to X-rays or a number of industrial chemicals.

Risk Factors for actinic Keratosis• Although anyone can develop actinic keratoses, you may be more likely to develop the condition if

you:• Are older than 40• Live in a sunny climate• Have a history of frequent or intense sun exposure or sunburn• Have pale skin, red or blond hair, and blue or light-colored eyes• Tend to freckle or burn when exposed to sunlight• Have a personal history of an actinic keratosis or skin cancer• Have a weak immune system as a result of chemotherapy, chronic leukemia, AIDS or organ

transplant medications (Also, individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or excessive UV exposure are less able to fight off the effects of the radiation and thus more likely to develop actinic keratoses)

Preventing Actinic Keratosis• The best way to prevent actinic keratosis is to protect yourself from the sun. Here are some sun-safety habits

that really work.• Seek the shade, especially between 10 AM and 4 PM.• Do not burn.• Avoid tanning and never use UV tanning beds.• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.• Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor

activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.• Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply

every two hours or after swimming or excessive sweating.• Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.• Examine your skin head-to-toe every month.• See your doctor every year for a professional skin exam.

Complications of Actinic keratosis

• If treated early, almost all actinic keratoses can be eliminated 

• However, if left untreated, up to 10% of AKs develop into squamous cell carcinoma (SCC), the second most common form of skin cancer. ( a type of cancer that usually isn't life-threatening if detected and treated early.)

• In rarer instances, AKs may also turn into basal cell carcinomas, the most common form of skin cancer.

Tests and diagnosis of Actinic Keratosis

• Your doctor can usually diagnose actinic keratosis simply by looking at it.

• If there's any doubt, your doctor may do other tests, such as a skin biopsy.

• During a skin biopsy, your doctor takes a small sample of your skin for analysis in a lab.

• A biopsy can usually be done in a doctor's office after a numbing injection.

Treatment options for Actinic Keratosis: Topical Medications

• When AKs are numerous and widespread, topical creams, gels and solutions are especially useful by themselves or in combination with another form of treatment. They treat both visible and invisible lesions with a minimal risk of scarring.

• Includes: 5-Fluorouracil cream (Carac, Fluoroplex, Efudex), miquimod cream (Aldara, Zyclara), Ingenol mebutate gel (Picato), and Diclofenac gel (Voltaren, Solaraze)

Treatment options for Actinic Keratosis: Photodynamic Therapy

• In photodynamic therapy, a medicine that makes your damaged skin cells sensitive to light (photosensitizing agent) is applied to the affected skin.

• Your skin is then exposed to intense laser light to destroy the damaged skin cells.

• Side effects may include redness, swelling and a burning sensation during therapy.

Treatment options for Actinic Keratosis: Freezing (cryotherapy)

• Used if you have only a few actinic keratoses• An extremely cold substance, such as liquid nitrogen, is applied to skin

lesions.• The substance freezes the skin surface, causing blistering or peeling.

As your skin heals, the lesions slough off, allowing new skin to appear.• Cryotherapy is the most common treatment; it takes only a few

minutes and can be performed in your doctor's office. • Side effects may include blisters, scarring, changes to skin texture,

infection and darkening of the skin at the site of treatment.

Treatment options for Actinic Keratosis: Scraping (curettage)

• Used if you have only a few actinic keratoses• In this procedure, your surgeon uses a device called a curette to

scrape off damaged cells. • Scraping may be followed by electrosurgery, in which a pencil-

shaped instrument is used to cut and destroy the affected tissue with an electric current.

• This procedure requires a local anesthetic. Side effects may include infection, scarring and changes in skin coloration at the site of treatment.

References

• http://www.skincancer.org/skin-cancer-information/actinic-keratosis

• http://www.mayoclinic.org/diseases-conditions/actinic-keratosis/basics/definition/con-20030382