Actinic Keratosis

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty bump that arises on the skin surface. The base may be light or dark, tan, pink, red, or a combination of these ... or the same color as your skin. The scale or crust is dry and rough. Occasionally it itches or produces a pricking or tender sensation. An actinic keratosis can appear anywhere but is most likely to appear on sun exposed areas such as the face, ears, bald scalp, neck, backs of hands and forearms, and lips.

Why are actinic keratosis important?

Actinic Keratosis are considered pre-cancerous because they can be the first step in the development of a type of skin cancer, called squamous cell carcinoma. While all actinic keratosis have the potential to turn into squamous cell carcinoma, some are riskier than other. A dermatologist can diagnose the lesion and assess the risk.

What is the Cause?

Sun exposure is the cause of almost all actinic keratosis. Sun damage to the skin accumulates over time, so that even a brief exposure adds to the lifetime total. The likelihood of developing keratosis is highest in regions close to the equator. However, regardless of climate, everyone is exposed to the sun. Ultraviolet rays reflect off sand, snow, and other surfaces. About 80 percent of ultraviolet rays can pass through clouds.

Who is at Risk?

People who have fair skin, blonde or red hair, blue, green, or gray eyes are at the greatest risk. Because their skin has less protective pigment, they are the most susceptible to sunburn. Even those who are darker-skinned can develop keratosis if they expose themselves to the sun without protection. African-Americans, however, rarely have these lesions.

Individuals, who are immunosuppressed as a result of cancer, chemotherapy, AIDS, or organ transplantation, are also at higher risk.

How Common is It?

One in six people will develop an actinic keratosis in the course of a lifetime, according to the best estimates. Older people are more likely than younger ones to have actinic keratosis, because cumulative sun exposure increases with the years.

A survey of older Americans found keratosis in more than half of the men and more than a third of the women aged 65 to 74 who had a high degree of lifetime sun exposure. Some experts believe the majority of people who live to the age of 80 have keratosis. Because more than half of an average person's lifetime sun exposure occurs before the age of 20, keratosis appear even in people in their early twenties who have spent too much time in the sun with little or no protection.

How is It Prevented?

The best way to prevent actinic keratosis is to protect yourself from the sun.

    • Limit the amount of time spent in the sun.
    • Avoid the peak hours from 10 a. m. to 4 p.m.
    • Cover up with protective clothing, including a broad-brimmed hat.
    • Wear a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 or greater.
    • Avoid tanning parlors and artificial tanning devices.
    • Keep newborns out of the sun. Sunscreens can be used on babies over the age of six months.
    • Teach your children good sun-protection practices.
    • Perform regular skin self-examination and consult a dermatologist if you find a suspicious area.
    • Actinic keratosis is skin cancer's warning signal. Heed that signal.

How is It Treated?

There are a number of effective treatments for actinic keratosis. The right treatment for you will depend on the size and site and aggressiveness of the lesion, as well as the health and wishes of the patient. Your dermatologist can help you choose among the following possible treatments:

Cryosurgery– This is the most commonly used procedure. It involves freezing off the lesions through application of liquid nitrogen with a special spray device or cotton-tipped applicator. It does not require anesthesia and produces no bleeding. There is a slight risk of scaring and hypopigmentation.

Topical Medications – Multiple topical medications can be used at home to treat these lesions, especially when the lesions are large or numerous. Those medications include fluorouracil, imiquimod, Picato, Soloraze.

Shave removal, Curettage and Electrodessication, or surgical removal

Photodynamic therapy

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