Actinic keratosis

Dr. Apratim GoelMBBS,MD,DNB

December 12, 2020

December 12, 2020

Actinic keratosis
Actinic keratosis

Actinic keratosis, also known as solar keratosis, is usually a harmless—but rough and scaly—patch on your skin. As the name suggests, it develops due to years of sun exposure and almost never causes any secondary symptoms.

The condition is usually seen in older adults and takes years to fully develop. A very small percentage of people with this skin condition are considered precancerous, that is, they may eventually develop a type of skin cancer called squamous cell carcinoma.

The condition is different from a skin rash which can occur at any age and may be caused by factors other than prolonged exposure to the sun. It is also different from solar lentigines or liver spots which are brown or black spots that mostly develop in people over 40 years of age.

Continue reading to find out about actinic keratosis, its symptoms, causes and treatments.

Symptoms of solar keratosis

The condition is primarily found on certain areas of the skin, such as the face, scalp, lips, arms, ears and the neck. The most easily noticeable symptom is a small raised bump on the skin. Usually less than one inch, this rough and scaly patch could be either pink or brown. In some cases, it could be hard and wart like, accompanied by some irritation in the affected area.

While age spots are common and nothing to worry about, it is a good idea to get them checked by your doctor periodically to detect any problems like skin cancer early on.

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Actinic keratosis causes

With advancing age, we can see the effects of a lifetime of photodamage to the skin (damage due to exposure to the sun). This may include wrinkles, liver spots (where melanin collects under the skin), and also actinic keratosis—a condition wherein abnormal skin growth occurs. This takes place due to intense exposure to short length UVB rays which cause damage to the DNA.

Actinic keratosis is also known as age spots, and it can appear in areas like the scalp, arms, hands and neck—basically, any area that is exposed to the sun for a long time.

Risk factors for age spots or actinic keratosis

Anybody can get actinic keratosis but some factors may put certain people at greater risk than others. You are more likely to develop the condition if you:

  • Are aged 60 and above
  • Live in tropical and subtropical regions
  • Have a weak immune system
  • Have fair skin 
  • Have a history of sunburn
  • Have a history of skin cancer
  • Have had chemotherapy or radiation therapy for cancer
  • Have a history of intense sun exposure 

Diagnosis of age spots

The condition is diagnosed very easily. In most cases it can be done clinically, however, sometimes a skin biopsy may also be done.

It is a good idea for everyone to see a general physician at least once annually, even when they aren't sick. This is doubly important for older people, as age is a risk factor for many conditions including skin-related issues.

If you are developing any spots or moles, scaly patches on the skin or itchy areas, make sure you have your doctor take a look at them—if only to give you the all-clear from a disease point of view.

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Actinic keratosis treatment

Treatment may be done if the affected area starts causing discomfort or turns precancerous. In some cases, treatment may also be initiated if the patches seem unsightly to the patient. Creams or topical ointments may be prescribed by the doctor. These are most effective on facial skin. Other treatments include:

  • Surgical removal: Ensures complete excision of the affected patch 

  • Cryotherapy: The spots are removed using liquid nitrogen; healing takes one to four weeks

  • Shave and electrocautery: This method includes shaving with a sharp instrument and burning and sealing with heat (cauterize), to lighten the spots.

Prevention of actinic keratosis

You can take the following precautions if you want to actively prevent actinic keratosis:

  • Wear a sunscreen and lip balm before going out, to protect them from harmful radiation (read more: How to use sunscreen properly
  • Limit your sun exposure, especially between 10am and 2pm to avoid the harshest rays (read more: How to treat sunburn at home)
  • Cover up with clothes that protect your arms and legs


References

  1. Lober BA, Lober CW. Actinic keratosis is squamous cell carcinoma. South Med J. 2000 Jul;93(7):650-5. PMID: 10923948.
  2. Ackerman AB, Mones JM. Solar (actinic) keratosis is squamous cell carcinoma. Br J Dermatol. 2006. Erratum in: Br J Dermatol. 2006 Aug;155(2
  3. J. Roewert‐Huber E. Stockfleth H. Kerl Pathology and pathobiology of actinic (solar) keratosis – an update British Journal of Dermatology, Volume157, Issues2 December 2007 Pages 18-20
  4. Maud H.E. Jansen, M.D., Janneke P.H.M. Kessels, M.D., Ph.D., Patty J. Nelemans, M.D., Ph.D., Nina Kouloubis, M.D., Aimee H.M.M. Arits, M.D., Ph.D., Han P.A. van Pelt, M.D., Ph.D., Patricia J.F. Quaedvlieg, M.D., Ph.D., Brigitte A.B. Essers, Ph.D., Peter M