Actinic Keratosis
Actinic keratosis, also known as solar keratosis, is a skin condition that is the result of years of sun exposure, indoor tanning, and skin damage. It appears as scaly rough patches of skin on the neck, scalp (typically only if bald), hands, forearms, ears, lips, and face. Actinic keratosis may take years to develop; it is usually considered to be pre-cancerous, and can sometimes be cancerous. The condition can develop in people of any skin tone and the scaly, rough patches may be a variety of colors including red, pink, and tan. When it appears on the lips, there is usually a whitish discoloration, cracking, and chipping.
Symptoms
Lesions generally appear on areas of the skin that have sustained considerable sun exposure and often have a sandpaper-like texture. Usually white with surrounding redness, these rough, scaly, crusty lesions may be a range of colors or may be the same color as the surrounding skin. Each lesion measures between 2 and 6 millimeters, but without treatment can grow to be several centimeters in diameter. People with AK usually have lesions on multiple sites of the body.
AK lesions may be flat on the skin or raised, or resemble a bump on the skin’s top layer. They may also have a wart-like appearance and be hard to the touch.
Most people affected by actinic keratosis are asymptomatic and feel nothing from the lesions, but on occasion the lesions can sting, bleed, itch,or produce a burning sensation.
Who is Affected
While anyone can develop actinic keratosis, there are certain risk factors that increase the chances of AK appearing. You may have an elevated risk of developing AK if you:
- Are over the age of 40
- Have sustained numerous sunburns in the past
- Live in a sunny climate
- Burn or freckle from sunlight exposure
- Have a weakened immune system due to AIDS, organ transplant medications, chemotherapy, or leukemia
- Have blond hair or red hair, and/or have light-colored eyes or blue eyes
- Are bald: bald individuals have a 7 to 10 fold higher chance of developing AK
There are other risk factors for developing actinic keratosis that involve various medical issues. These include:
- HPV or Human Papillomavirus: Research has discovered that a type of HPV, betapapillomavirus, is strongly associated with an increased risk for developing actinic keratosis.
- Taking immunosuppressive drugs: Those who take medication to suppress their immune system, such as transplant patients, have a 250x increased risk of developing actinic keratosis.
- Various genetic disorders like Bloom syndrome (Bloom-Torre-Machacek syndrome) and xeroderma pigmentosum: These disorders create a higher risk for developing the disease because the individual’s DNA isn’t able to properly repair itself after sun exposure.
Causes
The leading cause of developing actinic keratosis is excessive exposure to solar radiation, specifically UVB radiation, that over time can lead to cellular mutations. People of any skin tone can develop the disease, but those who are fair skinned (and do not have the protection that increased levels of melanin provide) are even more susceptible.
In addition to an accumulation of sun exposure over many years, another cause for the development of this skin condition is frequenting tanning beds. Tanning beds expose skin to UVB radiation just like the sun does and therefore, over time, can generate the necessary elements for the development of AK.
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How to Diagnose Actinic Keratosis
Diagnosing actinic keratosis involves the keen eye of a dermatologist. The doctor examines your skin for lesions that are thick and scaly, or patches that may be identified as skin cancer. Biopsies are usually performed for the proper diagnosis of malignant or benign skin growths.
Dermatologists generally recommend that these skin screenings take place annually for optimal prevention and detection—especially in those with increased risk factors for developing AK.
Variants of Actinic Keratosis
- Common, classic: These are scaly, white macules that may vary in thickness and are often surrounded by red skin. Generally, they are 2-6mm in diameter but can reach much larger sizes.
- Atrophic: These growths are not scaly, and are usually less than 10mm in diameter. They are smooth and red.
- Pigmented AK: Often confused with solar lentigo or lentigo maligna, these macules are uncommon and are tannish to brown in color.
- Hyperkeratotic: These present as a rough papule with a thick scale and often have a red base.
- AK with cutaneous horn: This type of AK projects out and is conical-shaped. Its height is often at least half of its diameter.
- Actinic cheilitis: This is a common actinic keratosis lesion that develops on the lips. Dry mouth and split lips accompany these growths.
- Bowenoid AK: This type of lesion has a well-defined border and is usually a single scaly patch with a red base.
How to Treat Actinic Keratosis
On occasion, actinic keratosis will disappear on its own with no treatment, but will likely return after additional sun exposure. There are a number of actinic keratosis treatments including surgery, medications, and photodynamic therapy. Your dermatologist might recommend complete removal of existing lesions because even though they might be non-cancerous now, they could become cancerous in the future.
Surgery
Surgical treatments for actinic keratosis include:
- Scraping: Requiring a local anesthetic, a doctor scrapes the lesion off your skin with a curette. This scraping is generally followed by electrosurgery–a more precise method for removing affected tissue. Scraping does leave the possibility for scarring, infection, and skin discoloration.
- Freezing: Liquid nitrogen is used to freeze the lesions. In due time, the skin blisters and peels and the affected skin sloughs off. New, healthy skin grows in its place. This treatment is quick and effective but may include side effects such as scarring, skin texture changes, infection, blisters, and a darkening of your skin where the treatment took place.
- Dermabrasion: This procedure is most useful in areas of large patches of lesions. A hand-held instrument is used by the doctor to sand your skin and remove the affected layer. A hospital stay is often required as a general anesthetic may be used to help with the painful process.
Medications
These are some of the medications used for actinic keratosis treatment:
- Diclofenac gel: brand names include Solaraze and Voltaren
- Imiquimod cream: brand names include Zyclara and Aldara
- Fluorouracil cream: brand names include Efudex, Carac, and Fluoroplex
- Ingenol mebutate gel: brand named Picato
- Retinoids: include adapalene gel, topical tretinoin, and low dose acitretin
Photodynamic Therapy
- Another actinic keratosis treatment involves applying a chemical solution to the lesions–which makes them extremely sensitive to light. The doctor then exposes the areas to artificial light which, in turn, destroys the treated cells. Side effects to this method include a burning sensation during treatment, redness, and swelling.
How to Prevent Actinic Keratosis
The leading cause of actinic keratosis is prolonged, accumulated sun exposure. Prevention is based on limiting your time in the sun and covering your skin to prevent UV exposure.
- Solar radiation (especially UVB) is usually strongest between noon and 4PM. Limit your sun exposure during this time.
- Wearing protective clothing during sun exposure is recommended, including hats, pants or long skirts, long-sleeved shirts, and sunglasses.
- Application of sunscreen lotion with SPF of at least 30—which can block or absorb UVB (and some UVA)—is also encouraged. Make sure any sunscreen lotion you use only contains zinc oxide and titanium dioxide as active ingredients, and avoid all the other toxic active ingredients in sunscreen.
- There are quite a few natural ingredients in the foods we eat that help us better handle sun exposure. Ingredients such as astaxanthin, zeaxanthin, lutein, lycopene, and other carotenoids, present in some colorful fruits and vegetables, can help prevent sun damage. As can green tea, polyphenols in grape seeds, and an extract from a rare fern called polypodium leucotomos.
- HPV prevention (via the vaccine for younger individuals) has also been shown to help prevent the development of AK later in life.
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Prognosis/Outlook
Actinic keratosis is responsible for over 8 million visits to the dermatologist every year. While most of these cases are non-cancerous, a small percentage lead to skin cancer. Fortunately, when detected early, cases of actinic keratosis can be treated before skin cancer develops.
Summary
Actinic Keratosis, also known as solar keratosis, is a skin condition that develops most often in people over the age of 40 who have accumulated a lot of time in the sun or in tanning beds. While anyone of any skin tone can develop AK, people with lighter skin tones, blond or red hair, and blue or green eyes are most at risk. It usually develops on the parts of the skin that have had the most sun exposure including the face, shoulders, arms, chest, back, neck, and scalp.
There are numerous variants of actinic keratosis; however, they are all usually comprised of scaly, rough patches of skin with a red base. These lesions can sometimes be accompanied by a burning sensation, itching, and stinging.
You are most at risk of developing actinic keratosis if you are fair-skinned, over the age of 40, and have spent abundant time in the sun or in tanning beds. The condition is also linked to various medical issues like HPV, and to those with weakened immune systems.
Actinic keratosis develops when solar radiation causes cellular mutations in the skin. UV light, whether it comes from the sun or from tanning beds, damages your skin and can eventually lead to cancer.
A dermatologist examines an individual who may have actinic keratosis for one or more lesions on the skin. If any lestions are identified, a biopsy is usually performed to determine the course of treatment.
There are a number of ways to treat actinic keratosis, including with prescription creams and gels, minor surgical procedures like freezing and scraping, and photodynamic therapy. While it’s possible for actinic keratosis to go away on its own, it’s best to contact a dermatologist for proper actinic keratosis treatment. Lesions that have been removed, however, may return after additional sun exposure.
Because the leading cause of developing actinic keratosis is exposure to UV light, the first measure of prevention is to limit the amount of time spent in the sun or in tanning beds. Take particular care to avoid sun exposure when the sun is at its highest in the middle of the day. Wear sunscreen lotion and protective clothing as needed. And consider taking an oral antioxidant supplement.
