A doctor may diagnose actinic keratosis visually, but may also request a skin biopsy to be certain.
Actinic keratosis often appears in groups of several growths. The condition surfaces most often on areas of the body that are exposed to sunlight regularly.
Precancerous means that the condition can progress to cancer if it is not treated. As a result, actinic keratosis should be monitored and treated if appropriate.
What is actinic keratosis?
Actinic keratosis is a rough and often bumpy patch or lesion that forms on the skin. Typically, actinic keratosis is found on the scalp, back of the hands, the face, ears, back of the forearms, the neck, and the shoulders.
The size of actinic keratosis varies from tiny to an inch or more in diameter. Similarly, color variations range from light to dark with variations throughout the patches.
Actinic keratosis develops over a number of years. In most cases, people who develop actinic keratosis are in their 40s or older. The patches often grow over time.
Symptoms are usually limited to the patch of scaly, crusty skin that forms. In most cases, there are no other signs of symptoms. Even under the care of a doctor, many people will experience recurring patches for the rest of their lives.
Knowing what to look for can help a person spot actinic keratosis early so they can bring it to their doctor's attention.
No two cases of actinic keratosis will look the same, but they may share the following similar features:
- red scales
- raised patches
- crusty patches
- sandpaper texture
Actinic keratosis is referred to regularly as solar keratosis. This name describes the cause of the skin lesions, which is overexposure to or damage caused by ultraviolet (UV) light.
Unlike sunburn, which is an immediate reaction to prolonged exposure to UV light, actinic keratosis takes years of regular sun exposure for the lesions to develop.
Anyone can develop actinic keratosis over time. However, there are risk factors that make people more likely to develop actinic keratosis.
Actinic keratosis may develop after a number of years of UV light exposure.
These factors include:
- age with people 40 and over at the highest risk
- a long history of sunburn or extreme exposure to sun
- living in a sunny environment
- using tanning beds
- having a history of developing actinic keratosis
- having lighter color hair or eyes
- having a tendency to burn in the sun
In many cases, a person will notice the small patch of skin that develops with this condition. As with all skin changes or newly discovered bumps, a person should see their doctor, as soon as possible, to help catch any problems early.
A doctor or dermatologist is likely to be able to diagnose actinic keratosis with a simple visual examination. If in any doubt, a skin biopsy may be done where a small sample of the affected skin is examined in a lab.
The sample is often taken during the same doctor or dermatologist's visit as the visual examination and requires only a numbing injection.
Wearing a hat outdoors and covering the body with loose-fitting clothes may help to prevent actinic keratosis.
Image credit: Future FamDoc, 2014
The main methods of prevention of actinic keratosis are through lifestyle changes and a person being aware of their exposure to UV rays.
A person should take proper precautions when outside, such as wearing hats, loose-fitting clothes that cover most areas of the body, and sunscreen.
They may want to avoid being in the sun for prolonged periods of time, as well.
People should avoid excessive exposure to UV light from tanning either indoors or outdoors.
It is important to remember that this condition may occur from any source of UV light, including indoor tanning beds
While some cases of actinic keratosis may resolve naturally on their own, a person is highly recommended to seek medical treatments. Action is needed, as the condition is considered to be precancerous.
There are several different potential treatment options, which may include a combination of the following:
- photodynamic therapy, using drugs and light to kill cancer cells
Treatment for more advanced or widespread cases of actinic keratosis includes medication in the form of various creams and gels. Some medicated creams include:
- diclofenac gel
- imiquimod cream
- fluorouracil cream
- ingenol mebutate gel
These creams and gels are applied directly to affected areas of the skin. They may produce side effects in some people who may experience rashes, redness, and swelling at the site of application.
In cases where a person only has a few spots or patches, a doctor may recommend removing the affected area through minor surgery. Two of the more common surgery options are curettage and cryotherapy.
Scraping, which is referred to as curettage, involves a device called a curette, to scrape off the damaged skin cells. In some cases, electrosurgery is used immediately after scraping. Electrosurgery involves a doctor using a pen-shaped instrument, to destroy and cut away the affected tissue with an electric current.
Both procedures require a local anesthetic. Some people experience side effects, including scarring, discoloration, and infection.
Freezing, referred to as cryotherapy, removes the lesions by freezing them with liquid nitrogen. A doctor applies the liquid nitrogen to the skin when the extreme cold causes the affected area to blister and peel. As the skin heals, the lesions fall off, allowing new, undamaged skin to appear.
Cryotherapy is the most common treatment for actinic keratosis. This is partly because it can be done in the doctor's office and takes only a few minutes. Side effects may include:
- changes to skin texture
- discoloration of the skin at the site of treatment
Photodynamic therapy involves the application of a chemical to the affected areas of skin. The doctor then shines an artificial light on the chemical, which, in turn, kills the damaged cells and removes the actinic keratosis.
Side effects may include redness, swelling, and burning, which may be felt during the procedure.
A person and their doctor will work together to decide the best option or options. In some cases, a person may have regular treatment for recurring patches.
Actinic keratosis is a marker of severe skin changes and damage to the skin, as a result of UV exposure. These changes put a person with actinic keratosis at high risk for developing skin cancer.
People who catch actinic keratosis early tend to have a good chance of removing the risk of developing cancer. However, if left untreated, actinic keratosis may develop into skin cancer.
Once treated for actinic keratosis, a person will probably need to schedule yearly dermatologist appointments, to screen for recurrence and check for other signs of skin cancer.