Actinic Keratosis

What is actinic keratosis?

Actinic keratosis (AK) is one of the most common skin conditions that dermatologists treat. It is estimated that more than 40 million Americans develop actinic keratoses (AKs) each year.

These precancerous skin growths are common because many people seldom protect their skin from the sun with sunscreen, clothing, and shade. Without sun protection, the sun’s harmful rays can damage your skin. While your body may repair some of this damage, the sun’s rays continue to damage unprotected skin. Over the years, this damage builds up and can cause precancerous changes to your skin.

Causes

An actinic keratosis often appears as a reddish spot (as shown here) that develops on skin you seldom protected from the sun over the years.

People who use (or have used) tanning beds, sunlamps, or both also get AKs. The amount of the harmful radiation produced by a tanning bed is similar to that of the sun, and in some cases might be stronger.

AKs tend to appear on skin that’s been the most badly damaged by the sun. That’s why they often appear on the face, ears, balding scalp, hands, neck, or lips. These areas tend to get the most sun.

Image used with permission of Journal of the American Academy of Dermatology: 1J Am Acad Dermatol. 2018; 79:1148-50.

When an AK forms on a lip, the medical name for this precancerous growth is actinic cheilitis.  Many people who develop AKs and actinic cheilitis are otherwise healthy. They don’t feel ill or rundown.

It’s important to know if you have any of these precancerous growths on your skin. Some AKs and actinic cheilitis turn into a type of skin cancer called squamous cell carcinoma.

Risk Factors

The risk factors for AKs are:

  • Fair skin (burns easily and rarely tans)
  • Naturally red or blond hair
  • Light-colored eyes
  • Sun exposure (seldom protected your skin from the sun)
  • 50 years of age or older
  • Tanning bed use
  • Organ transplant recipient
  • Weakened immune system
  • Albino skin
  • Xeroderma pigmentosum, Rothnord-Thomson syndrome, or Bloom syndrome

Most people who get AKs have spent a lot of time outdoors without protecting their skin from the sun and are now 50 years of age or older.  The people most likely to develop precancerous skin growths on their skin have fair skin, light-colored eyes, and signs of sun damage that show they rarely protected their skin from the sun over the years.

If you used tanning beds or lived in a region that is warm and sunny year-round, you may develop AKs at a younger age. AKs can appear in your 20s or earlier.

Anyone who has received a transplanted organ tends to develop many AKs. The medication you take to prevent your body from rejecting the transplanted organ suppresses your immune system so greatly that your body has difficulty healing any damage caused the sun’s UV light. This causes AKs to develop more quickly. 

Symptoms

What are the signs of actinic keratosis?

The brown spots on this man’s face may look like age spots, but they’re actually actinic keratoses.

Left untreated, some actinic keratoses (AKs) turn into a type of skin cancer called squamous cell carcinoma. That’s why it’s important to know if you have any of these precancerous growths on your skin.

 

The following pictures show some diverse ways that it can appear.

9 ways a precancerous growth can appear on your skin or lips

1. A rough-feeling patch on skin that's had lots of sun. You can often feel an AK before you see it.

2. One or more rough, scaly bumps that may look like pimples or spots of irritated skin.

3. Many scaly, raised spots on the skin that may look like a rash or acne breakout.

4. A raised, rough-feeling patch on your skin that may be red, pink, skin-colored, or gray.

5. Flat, scaly area that looks like an age spot. AKs more commonly look like age spots in people who have skin of color.

6. A dry, scaly lip that never heals (or heals and returns).

7. Scaly, white patches on one (or both) lips. White patches on your lips can be a sign that you have a precancerous condition on your lips.

8. Loss of color on one or both lips.

9. Growth that looks like an animal’s horn. When an AK appears in this form, it often indicates that the person has a higher risk of developing a type of skin cancer called squamous cell carcinoma. A board-certified dermatologist should examine any horn-like growth on your skin ASAP.

While most people see only a change to their skin, an AK can:

  • Itch
  • Burn or sting
  • Feel tender or painful when touched
  • Stick to your clothing, causing discomfort
  • Bleed

If you notice a rough patch on your skin or a chapped lip that won’t heal, dermatologists recommend that you have it examined. Left untreated, some AKs turn into a type of skin cancer called squamous cell carcinoma.

Source: American Academy of Dermatology

Diagnosis

Most people who have AKs (or think they may have an AK) see a dermatologist. This is actually one of the most common conditions that dermatologists diagnose and treat, so these doctors have a lot of experience with AKs.  Treatment for AKs can get rid of AKs as well as reduce signs of aging on your skin.

When you see a board-certified dermatologist about AKs, your dermatologist will:

  • Examine your skin carefully
  • Ask questions about your health, medications, and symptoms

If you have one or more AKs on your skin, a board-certified dermatologist can often diagnose you by looking carefully at your skin. While examining your skin, your dermatologist will also look for signs of skin cancer. People who have skin that’s been badly damaged by ultraviolet (UV) light develop AKs and have a higher risk of getting skin cancer.

If you have one or more AKs, your dermatologist will talk with you about whether to treat these precancerous skin growths. Usually, treatment is recommended.

Treatment

For a few people, a dermatologist may recommend frequent skin exams rather than treatment. Skin exams are recommended for patients who are frail and may find it hard to tolerate treatment. To be effective, treatment must destroy the AKs. When this happens, your skin will feel raw. It may be red and swollen for a brief time.

The treatment that is right for you depends on several considerations, including:

  • How many AKs you have
  • Where the AK(s) appear on your body
  • What the AK(s) look like
  • Whether you’ve had skin cancer
  • Your other medical conditions, such as living with a transplanted organ

You can often complete treatment in 1 or 2 office visits. The procedures that dermatologists use to treat AKs include:

  • Cryosurgery: During cryosurgery, your dermatologist freezes the AK. The goal is to get the AK to fall off after a few days. Some AKs need more than one cryosurgery treatment before they fall off.
    To freeze the AK, your dermatologist will apply a very cold substance like liquid nitrogen to the AK. Your dermatologist can do this during an office visit while you remain awake. After cryosurgery, you may see crusting or a blister on your treated skin. This is normal and expected.
  • Chemical peel: This is a medical-grade chemical peel used to destroy the top layers of skin. You cannot get this type of chemical peel at a salon or from a kit sold for home use.
    After a medical-grade chemical peel, the treated skin will be red, swollen, and sore. As the area heals, you will see new healthy skin.
  • Curettage: If you have an extremely thick AK, this may the best treatment. During this procedure, your dermatologist first scrapes the AK from your skin, using a technique called curettage. Your dermatologist may follow this with an electrodesiccation, which heats the treated area to destroy any remaining AK cells.
  • Photodynamic therapy: This may be recommended for a patient who continues to get new AKs or has AKs that return after treatment. This procedure is a bit time-consuming because it consists of 2 parts.

    During the first part of treatment, a solution that makes your skin extremely sensitive to light is applied to the area with AKs. You’ll sit in the office with this on your skin for about 60 to 90 minutes. Afterward, you’ll be treated with either a blue or red light.

  • Laser resurfacing: This may be a treatment option for actinic cheilitis, a precancerous growth on the lip. It works by removing the surface layer of the skin. After treatment, the skin will feel raw and sore. When it heals in 1 or 2 weeks, you see new, healthier skin.

If you have many AKs or AKs that you can feel but not see, your dermatologist may recommend at-home treatment.

When you treat at home, you apply medication to your skin as directed.

The medications that dermatologists prescribe include the following, which have all been approved by the US. Food and Drug Administration (FDA) to treat AKs:

  • 5-fluorouracil (5-FU) cream: You apply this once or twice a day for 2 to 4 weeks.

    5-FU is not a treatment option for a woman who is pregnant. This medication can harm an unborn baby.

  • Diclofenac sodium gel: This medication tends to cause less of a skin reaction than 5-FU, but it can still be very effective. You will need to apply it twice a day for 2 to 3 months.
  • Imiquimod cream: This can be a good option for the face because you can apply it once (or twice) a week, so you don’t get lots of redness and crusting. You may need to apply it for 12 to 16 weeks.
  • Tirbanibulin ointment: This may be an option for treating AKs on your face and scalp. You apply this medication for five days in a row. After five days, the treatment ends.

To effectively treat the AKs, your dermatologist may prescribe both a procedure and medication that you apply at home.  Avoid using hydrocotisone or another coticosteroid medication

Source: American Academy of Dermatology

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