Actinic keratosis
Definition :
An actinic keratosis (ak-TIN-ik ker-uh-TOE-sis) is a rough, scaly patch on your skin that develops from years of exposure to the sun. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck — areas of skin typically exposed to the sun.
An actinic keratosis, also known as solar keratosis, enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on your skin. An actinic keratosis takes years to develop, usually first appearing in older adults. Many doctors consider an actinic keratosis to be precancerous because it can develop into skin cancer.
You can reduce your risk of actinic keratosis by minimizing your sun exposure and protecting your skin from ultraviolet (UV) rays.
Symptoms:
The signs and symptoms of an actinic keratosis include:
An actinic keratosis sometimes resolves on its own, but typically returns again after additional sun exposure. If just scratched or picked off, an actinic keratosis will return.
When to see a doctor
Because it can be difficult to distinguish between noncancerous spots and cancerous ones, it's best to have new skin changes evaluated by a doctor, especially if a spot or lesion persists, grows or bleeds. See your doctor or ask for a referral to a dermatologist if a skin lesion:
Frequent or intense exposure to UV rays, typically from the sun, causes an actinic keratosis.
An actinic keratosis begins in your skin's top layer — the epidermis. The epidermis is as thin as a pencil line, and it provides a protective layer of skin cells that your body continually sheds.
Normally, skin cells within the epidermis develop in a controlled and orderly way. In general, healthy new cells push older cells toward the skin's surface, where they die and eventually are sloughed off. When skin cells are damaged through UV radiation, changes occur in the skin's texture and color, causing blotchiness and bumps or lesions.
Most of the damage to skin cells results from exposure to UV radiation from sunlight and commercial tanning lamps and beds. The damage adds up over time, so the more time you spend in the sun or in a tanning booth, the greater your chance of developing skin cancer. Your risk increases even more if most of your outdoor exposure occurs at times of the day or in locations where the sunlight is most intense.
Complications:
If treated early, almost all actinic keratoses can be eliminated before developing into skin cancer. However, if left untreated some of these spots or patches may progress to squamous cell carcinoma, a serious form of skin cancer.
An actinic keratosis may be the earliest form of squamous cell carcinoma. This type of cancer usually isn't life-threatening if detected and treated early. In a few cases, however, squamous cell carcinoma can grow to be large and invade surrounding tissues, with some even spreading (metastasizing) to other parts of your body.
Treatments and drugs:
It's impossible to tell exactly which patches or lesions will develop into skin cancer. Therefore, actinic keratoses are usually removed as a precaution. Your doctor can discuss with you which treatment is appropriate for you. With most of these procedures, the treated area takes a few days to several weeks to heal.
Actinic keratosis treatment options may include:
An actinic keratosis (ak-TIN-ik ker-uh-TOE-sis) is a rough, scaly patch on your skin that develops from years of exposure to the sun. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck — areas of skin typically exposed to the sun.
An actinic keratosis, also known as solar keratosis, enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on your skin. An actinic keratosis takes years to develop, usually first appearing in older adults. Many doctors consider an actinic keratosis to be precancerous because it can develop into skin cancer.
You can reduce your risk of actinic keratosis by minimizing your sun exposure and protecting your skin from ultraviolet (UV) rays.
Symptoms:
The signs and symptoms of an actinic keratosis include:
- 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 ranging from pink to red to brown, or flesh-colored
- Itching or burning in the affected area
An actinic keratosis sometimes resolves on its own, but typically returns again after additional sun exposure. If just scratched or picked off, an actinic keratosis will return.
When to see a doctor
Because it can be difficult to distinguish between noncancerous spots and cancerous ones, it's best to have new skin changes evaluated by a doctor, especially if a spot or lesion persists, grows or bleeds. See your doctor or ask for a referral to a dermatologist if a skin lesion:
- Is painful
- Itches or burns
- Oozes or bleeds
- Becomes scaly or crusty
- Changes in size, shape, color or elevation
Frequent or intense exposure to UV rays, typically from the sun, causes an actinic keratosis.
An actinic keratosis begins in your skin's top layer — the epidermis. The epidermis is as thin as a pencil line, and it provides a protective layer of skin cells that your body continually sheds.
Normally, skin cells within the epidermis develop in a controlled and orderly way. In general, healthy new cells push older cells toward the skin's surface, where they die and eventually are sloughed off. When skin cells are damaged through UV radiation, changes occur in the skin's texture and color, causing blotchiness and bumps or lesions.
Most of the damage to skin cells results from exposure to UV radiation from sunlight and commercial tanning lamps and beds. The damage adds up over time, so the more time you spend in the sun or in a tanning booth, the greater your chance of developing skin cancer. Your risk increases even more if most of your outdoor exposure occurs at times of the day or in locations where the sunlight is most intense.
Complications:
If treated early, almost all actinic keratoses can be eliminated before developing into skin cancer. However, if left untreated some of these spots or patches may progress to squamous cell carcinoma, a serious form of skin cancer.
An actinic keratosis may be the earliest form of squamous cell carcinoma. This type of cancer usually isn't life-threatening if detected and treated early. In a few cases, however, squamous cell carcinoma can grow to be large and invade surrounding tissues, with some even spreading (metastasizing) to other parts of your body.
Treatments and drugs:
It's impossible to tell exactly which patches or lesions will develop into skin cancer. Therefore, actinic keratoses are usually removed as a precaution. Your doctor can discuss with you which treatment is appropriate for you. With most of these procedures, the treated area takes a few days to several weeks to heal.
Actinic keratosis treatment options may include:
- Freezing (cryotherapy). 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. This is the most common treatment, 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.
- Scraping (curettage). In this procedure, your surgeon uses a device called a curet 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.
- Creams or ointments. Some topical medications contain fluorouracil (Carac, Fluoroplex, Efudex), a chemotherapy drug. The medication destroys actinic keratosis cells by blocking essential cellular functions within them. Another treatment option is imiquimod (Aldara), a topical cream that modifies the skin's immune system to stimulate your body's own rejection of precancerous cells. Diclofenac gel (Voltaren, Solaraze), a nonsteroidal anti-inflammatory topical drug, may help, too. Side effects may include skin irritation such as pain, itching, stinging or burning sensation, crusting, and sensitivity to sun exposure at the site of treatment.
- Chemical peeling. This involves applying one or more chemical solutions — trichloroacetic acid (Tri-Chlor), for example — to the lesions. The chemicals cause your skin to blister and eventually peel, allowing new skin to form. Skin peeling usually lasts for five to seven days. Other side effects may include stinging or burning sensation, redness, crusting, changes in skin coloration, infections and, rarely, scarring. This procedure may not be covered by insurance, as it's often considered cosmetic.
- Photodynamic therapy. With this procedure, an agent that makes your damaged skin cells sensitive to light (photosensitizing agent) is either injected or applied topically. 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.
- Laser therapy. A special laser is used to precisely remove the actinic keratoses and the affected skin underneath. Local anesthesia is often used to make the procedure more comfortable. Some pigment loss and scarring may result from laser therapy.
- Dermabrasion. In this procedure, the affected skin is removed using a rapidly moving brush. Local anesthetic is used to make the procedure more tolerable. The procedure leaves skin red and raw-looking. It takes several months for the skin to heal, but the new skin generally appears smoother.
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