Actinic Keratosis

Actinic keratosis, or solar keratosis, is a dry, scaly patch of skin often found in sun exposed areas like the scalp, face, neck, and shoulders. It enlarges gradually and is often found in older adults. It can often range in size from a tiny spot to as much as an inch in diameter. Actinic keratosis mostly appears as small, crusty or, at times, scaly bumps or horns. The base is most often dark or light-colored and can also have additional colors to it, such as pink, red, or tan.

The condition develops due to skin damage caused by exposure to UV rays from the sun.

Actinic keratosis can remain without any other symptoms or signs for several years. In some cases, it may develop into skin cancer.

Minimizing sun exposure and protecting the skin from UV rays are ideal ways to prevent the formation of these precancerous skin patches.

The main symptom of actinic keratosis is a dry, scaly skin lesion, often measuring an inch in diameter. The patch may be solitary or found in groups. 

The appearance of these patches varies; they may be:

• Skin-colored or reddish in appearance
• Wart-like with a bumpy surface
• Flat and thickened in the form of a papule
• Tender and without any specific symptoms

It is often found in sun exposed areas of the skin like the hands, face, and scalp.

In people with chronic exposure to the sun, keratosis may be found in the upper body, lower limbs, and on the feet.

Frequent exposure to UV rays causes abnormal development of skin cells, which results in actinic keratosis.

UV ray exposure in tanning salons may also result in these dry, scaly patches. The damage caused by UV rays accumulates over time, resulting in skin damage. Thus, actinic keratosis is more common among older adults than in younger people. It is also common among people who have poor immunity that may result from age, certain conditions, or certain drugs.

In some cases, keratosis may result from exposure to X-rays and certain industrial chemicals.

Those who have pale skin and/or blonde hair also have an increased chance of developing this skin condition.

A physical examination is the best way to diagnose actinic keratosis.

A doctor may suggest additional tests, such as a biopsy to rule out the chances of squamous cell carcinoma.

A biopsy is generally recommended only if the person is not responding to treatment, is on an immunosuppressant medication, or has a high risk of developing skin cancer.

If the skin patches are not worrisome, doctors may not recommend any specific treatment for actinic keratosis. However, any changes in the color or structure of the patch requires attention.

Patches may be removed if the risk of developing cancer is high, or for cosmetic reasons.

About 10% of actinic keratosis cases develop into skin cancer, hence, in most cases, removal is suggested.

Surgical Treatment

Cryosurgery is one of the most common treatment methods for solar keratosis, particularly when there is a limited number of patches on the skin. The growth of the lesions stops when liquid nitrogen is applied to the area.

Damaged cells in the affected area are also removed using a curette. This is often followed by electrosurgery, in which the affected tissue is removed using an electric current.

• Desiccation or curettage: The doctor would mostly scrape or shave off part or, in certain cases, all of the lesion. They would then apply heat or a chemical agent to stop the bleeding as well as kill off any remaining actinic keratosis cells.
• Laser surgery: In the case of laser surgery, as the name suggests, the doctor would use intense light for vaporizing the tissues of actinic keratosis.

If there are numerous forms of actinic keratosis found in the individual, the doctor may prescribe certain solutions or creams. These would help treat the visible as well as invisible lesions with very little risk of scarring on the skin. In certain cases, the doctors would refer to this therapy as field therapy, since the topical method of treatment can cover the entire area of the skin as opposed to just targeting certain isolated lesions.

• Chemical peel: This method is best known for reversing the signs of photoaging. It is also used to remove any superficial actinic keratosis present on the face, especially in cases where other techniques have been unsuccessful. The doctor would apply the trichloroacetic acid or some other similar chemical to the face, thus causing the top of the skin to slough off.
• 5-fluroouracil: Available in the brand names Fluoroplex and Carac, this is a form of topical chemotherapy treatment.
• Ingenol mebutate: This is a rapidly effective topical treatment that is said to be derived from plants. It is an immunologic mechanism of action.
• Imiquimod: Available in the brand names Zyclara or Aldara, this is a form of topical immunotherapy known to stimulate the immune system to produce interferon, which is a chemical that attacks any cancerous or precancerous cells present in the body.
• Diclofenac: This is available under the brand name Solaraze. Diclofenac along with hyaluronic acid is known to be a combination topical treatment.

Non-Surgical Treatment

When the lesions are multiple and scattered, topical applications like gels, creams, and solutions are preferred. These are used either alone or in combination with other methods.

Less scarring occurs with topical medications. Fluorouracil cream, ingenol mebutate gel, diclofenac gel, and imiquimod cream are commonly prescribed topical applications for controlling solar keratosis.

Superficial actinic keratosis can also be removed using chemical peels.

Photodynamic therapy is another solution suggested for widespread lesions on the skin. In this method, a photosensitizing agent is applied on the affected skin and then exposed to laser. It selectively removes the damaged cells and thus prevents damage to the surrounding tissue.

This therapy is often done in combination with cryosurgery, or with topical applications.

Doctors can also look to combine certain therapies for a certain period of time to treat actinic keratosis. Typically, the treatment would combine cryosurgery with PDT or another topical agent, such as imiquimod, ingenol mebutate, diclofenac or 5-FU. PDT and the other topical medications can also be used as alternatives for a period of three months, six months, or a year. 

Limiting one’s exposure to the sun is the best way to prevent skin damage. This can be done by wearing sunscreen or a hat, and covering the hands and legs while outside.

Avoiding tanning beds is another preventive measure, as they are also a source of UV rays.

There are several alternative and homeopathic remedies used for actinic keratosis.

Green tea and milk thistle are known to soothe skin damage and sunburn.

Organic virgin coconut oil is used to remove spots caused by sun exposure.

Cider vinegar is another alternative therapy used for the control of sunburns.

There are different ways to adapt your lifestyle to cope with actinic keratosis.

Self-help is the best method to control skin damage.

Using sunscreen, wearing a hat, and covering the arms and legs are the best ways to avoid sun damage.

Any changes in the structure and color of patches in the skin should be reported to a doctor immediately.

Protecting the skin from the sun is very important since it can help prevent new forms of actinic keratosis from arising. A dermatologist or skin expert would offer the following tips to patients who suffer from actinic keratosis:

• Avoid exposure to the sun during midday. This can be done by scheduling outdoor activities during the earlier part of the morning, such as before 10 a.m., and the later part of the afternoon, after 2 p.m.
• Apply sunscreen every day, even when it is not sunny or is in the winter. Be sure to apply sunscreen to all skin areas that are not able to be covered by clothing.
• Protect the lips by applying a lip balm that contains sunscreen. The lip balm you use should also offer an SPF protection of 30 or above as well as protection from UVA/UVB rays.
• Whenever possible, ensure you are completely covered before you step out into the sun. To determine how well the garment would protect you, hold it in front of a bright light; if you see light through the cloth, this means the harmful light would pass through the cloth into the skin, so you should try another garment. You can also apply sunscreen first and then wear the garment to avoid any risk.
• Reach out to a dermatologist if you notice any new growths on the skin, which may have traits such as itching or bleeding, changes in color, size, or shape, becoming noticeably thicker, or remaining after using certain treatments.

Skin cancer is the most dreaded complication associated with actinic keratosis. Early treatment can prevent the disease turning into cancer.

Why is actinic keratosis a cause of concern? The majority of actinic keratosis cases remain benign. They only reveal that the individual has sustained damage to the skin due to sun exposure and could possibly develop into skin cancer. This especially is said to cause the second most common form of disease known as SCC, or squamous cell carcinoma. If an individual has one actinic keratosis, there is a chance said individual can develop another. The longer these actinic keratosis patches remain untreated and the older these lesions appear, the greater the chances that one or more the patches turns into SCC. Some researchers have interpreted that actinic keratosis is the earliest form of SCC. In certain rare instances, these actinic keratosis patches can turn out to be basal cell carcinoma, which is the most common form of skin cancer. If the SCC is left untreated for long, it can become invasive and life-threatening or even fatal.

Actinic cheilitis is said to be a variant of actinic keratosis. It is often an aggressive type of pre-cancer that forms on the lower lips, which is at a heightened risk of developing into an invasive form of SCC. Once cancer arises from the actinic cheilitis, it starts to penetrate the outer layer of the lip’s skin, then starts to bleed, leading to the development of a sore that does not heal easily. It can become infected and also spread to other internal organs and damage them.

It has been observed that, at most, ten percent of actinic keratosis cases turn into cancer, and the majority of SCCs initially begin as actinic keratosis. Also, there is no way ahead of time to understand which one of them would be a precursor of squamous cell carcinoma. Thankfully, researchers have many effective treatments to eliminate actinic keratosis.