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What Is Actinic Keratosis And How To Treat Them?

What Is Actinic Keratosis And How To Treat Them

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    Every day we are exposed to sun and there is no real escape from it. And this sun exposure may be damaging our skin more than we are able to see or understand. Excess of exposure to harsh UV rays from sun, may cause actinic keratosis. So, if you notice any change in your skin, such as patchiness, redness, or itchiness, you need to examine it thoroughly before it develops into something more serious.

    What Is Actinic Keratosis?

    Actinic Keratosis is also known as solar keratosis which. It is known for its crusty, scaly growth on the skin, which is caused by over exposure to ultraviolet rays and also due to indoor tanning. These are precancerous growths on skin, and if left untreated, they may become cancerous. Actinic Keratosis typically affects your face, lips, ears, back of your hands, forearms, scalp or neck. People with this condition tend to have melanoma as well.
    It is hard to detect during the early stages, as it grows slowly and gradually without causing any signs or symptoms other than a patch or a small spot, which takes years to develop.

    Also Read: Chemical Peel Treatment For Actinic Keratosis

    What Are Actinic Keratosis Lesions?

    The lesions caused by actinic keratosis are small and rough spots, and although you cannot really see them at first, but they can be felt, as your skin tends to have a sandpaper-like texture because of their existence. As time goes by, these lesions grow into large, red, scaly and rough patches, usually ranging from 3-10mm to 1-3 cm.
    Around 10-15% of active lesions, proceed further into squamous cell carcinomas, which need dermatologist treatment, without which they develop into infectious ulcers damaging surrounding tissues and spreading eventually to internal organs.

    What Is Hypertrophic Actinic Keratosis?

    Hypertrophic actinic keratosis is a variant of actinic keratosis, with the same source affecting it – chronic ultraviolet exposure. They are induced by the trauma caused due to chronic rubbing of skin. This condition is very common in areas that tend to have heavy sun exposure, hence causing solar-damaged skin. It is proved clinically, that in comparison, the lesions caused by hypertrophic actinic keratosis tend to be slightly tender, rough, scaly, and poorly demarcated.
    The most aggressive form of actinic keratosis is actinic cheilitis which appears on lips and may grow in squamous cell carcinoma.

    What Are The Causes Of Actinic Keratosis?

    Actinic keratosis is mainly caused by chronic sun exposure, and hence is common with people who are overly exposed to sun. It is caused because of abnormal skin cell development, which is a result of the DNA damage that is caused by short wavelength UVB.
    And, it is seen that the appearances of actinic keratosis is more common in the people with poor immune systems or because of ageing, heavy sun exposure, predisposing disease or certain drugs.
    Immunosuppressed people who are undergoing chemotherapy, AIDS transplant, or any other organ transplant; are all at higher risk of developing this condition on skin.
    keratosis is more common in old age as then the body may not be able to keep check on lesions on skin, but this may even develop in people under 20 years.

    Also Read: How To Protect Skin From The Sun?

    What Are The Signs & Symptoms Of Actinic Keratosis?

    • Dry and rough skin with white scaly plaque, that are typically about 1 inch.
    • They are generally surrounded with redness.
    • Flat or a little protruded patch or bump on the epidermis.
    • Surrounding areas often appear sun damaged like pigmentation, wrinkles and dryness.
    • Hard wart-like surface and often itch and bleed.
    • The colour of the patches are vary from being pink, red, or brown, depending on the gravity of the patches
    • Itching or burning sensation in the affected area
    • There are typically 3 grades of Actinic keratosis based on their appearance; grade 1 (less visible), grade 2 and grade 3 (more prominent).
    Actinic keratosis typically affects those areas of the body that are more prone to the damage caused due to sun exposure – face, lips, ears, hands, forearms, scalp and neck.

    Also Read: Signs And Symptoms Of Keratosis Pilaris

    How To Treat Actinic Keratosis Effectively?

    There is a probability of Actinic Keratosis being cancerous if not treated in the early stages. If it suspected to be cancer, then the doctor may take a sample of the tissue for biopsy, by scraping the lesion with a curette.
    Depending on the patient’s health and age, there are various treatment options available for actinic keratosis:
    1- Topical Treatment –
    In cases where actinic keratosis is widely spread on the body, the doctor usually recommends a cream, gel, or solution. These topical solutions do not have any risk of scarring and are known to treat the visible and invisible lesions with minimal risk. It is often suggested to combine these tropical treatments with field therapy.
    • Chemical peel – Chemical peeling is best known for reversing signs of photoaging. In this procedure, the superficial actinic keratosis is removed using plant extracts, such as trichloroacetic acid and/or similar chemicals, causing the top skin layers to peel off.

    Also Read: Is Chemical Peel Good For Skin?

    • Combination topical therapy – Diclofenac and hyaluronic acid is a commonly used is combination topical therapy for treating actinic keratosis.
    • Imiquimod – It is form of topical immunotherapy, that is known for stimulating the immune system, such that the body produces interferon (a chemical that attacks cancerous and precancerous cells).
    • Ingenol mebutate – This a topical therapy that is derived from plants and is known to be rapidly effective on the affected tissue.
    • 5-fluorouracil is a type of topical chemotherapy.

    2- Photodynamic Treatment –
    Photodynamic therapy (PDT) is a treatment that is mostly used on the lesions that are on the face and scalp. In this treatment, a light sensitizing topical agent is used on the lesions, in combination with a strong light that activates this topical agent and destroys the affected AK tissues, with no damage caused to the surrounding healthy tissues.

    3- Combination Treatment –
    In many cases, a combination of therapies is suggested for treating Actinic keratosis. For example, treatment regimens typically use cryosurgery in combination with PDT or a topical agent, for treating the affected tissues. Sometimes the topical medications and are used alternatively for every three months, six months or year, depending on the skin examinations conducted by the specialists.

    4- Surgical Treatment
    • Cryosurgery – In this procedure, the dermatologist liquidifies the lesions using liquid nitrogen, so as to freeze the tissue. The lesions that surround the frozen skin forms blisters/crust and falls of the skin after a certain period of time.
    • Curettage and desiccation – In this procedure, the affected part of the tissue is scraped or shaved off, and then heat or a chemical agent is applied to stop the bleeding and to kill any AK (actinic keratosis) cells that might be remaining.
    • Laser surgery – Intense light is used in this method to effectively vaporize the affected part of the tissue.

    How To Prevent Actinic Keratosis?

    The most optimal way of preventing actinic keratosis is to either reduce the exposure to sunlight or to ensure proper protection while being exposed to the sun. This also helps in reducing the risk of skin cancer. The following are a few pointers to keep in mind:
    • Ensure that you cover yourself up by wearing hats and long-sleeved shirts when you are being exposed to bright sunlight.
    • Avoid going out during midday when the heat is at its peak, and the sun is the brightest.
    • Avoid tanning beds.
    • Always use sunscreen when you are heading out, irrespective of it being a sunny or a cloudy day. The sunscreen used should at least be of SPF 30 or more. Check with your dermatologist for more details on sunscreens for your skin type.


    Is actinic keratosis cancerous?
    Although Actinic keratosis is not a cancer, but this condition is surely made up of precancerous lesions and have the ability to develop into skin cancer called Squamous Cell Carcinoma, which potentially is capable of spreading into internal organs.

    Is actinic keratosis benign or malignant?
    Actinic keratosis, in majority of cases, remains benign, and studies have reported that on constant su damage, these could develop into any kind of skin cancer.

    Who is at the risk of developing actinic keratosis?
    Anyone with chronic sun exposure is a probable candidate of developing actinic keratosis. It is typically seen in the elderly population who usually spend several hours outdoors. Also, fair-skinned people are known to be more vulnerable to this condition, as are people with supressed immune systems.

    On which areas of the body, AK typically occurs?
    Actinic Keratosis typically affects the most sun-exposed areas of the body – face, lips, ears, back of your hands, forearms, scalp or neck.

    What is a lichenoid actinic keratosis?
    Lichenoid keratosis is also caused by sun exposure and appears to be small, solitary, inflamed macule or thin pigmented plaque on the epidermis. The lesions of lichenoid actinic keratosis are also benign.

    What is pigmented actinic keratosis?
    Pigmented actinic keratosis is a combination of nonpigmented solar keratosis and a coexistent pigmented lesion.

    Chronic sun exposure can cause actinic keratosis, which are malignant cells. These are often not recognized during the early stages, as they are easier to feel than to see. But, it is always recommended to limit your sun exposure and use proper protection against the sun. And, it is suggested to consult a dermatologist if you happen to notice any kind of patchiness/redness on the skin, to treat them in time.

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    About The Author

    Kushneet Kukreja

    Kushneet Kukreja

    A postgraduate in Biotechnology from Kingston University and an ISSA Certified Specialist in Fitness & Nutrition, Kushneet Kukreja is a passionate writer who works in close association with the dermatologists at our head office to generate valuable and scientifically accurate content for our blog.

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