What is Actinic Keratosis?
Actinic keratoses, also known as senile keratoses or solar keratoses, are harmless growths of the upper layer of skin that dermatologists often examine. People usually get them because they have been in the sun a lot over time. They appear as irregular, red, rough patches or growths on parts of the body that are often exposed to the sun. It’s really important to spot and treat these growths early, because they could turn into a type of skin cancer called squamous cell carcinoma. In this section, we’ll look at different ways to manage actinic keratosis.
What Causes Actinic Keratosis?
Actinic keratoses mainly occur as a result of continuous exposure to ultraviolet (UV) rays from the sun over a person’s lifetime.
Risk Factors and Frequency for Actinic Keratosis
Actinic keratoses are common skin issues that often appear on parts of the body that are frequently exposed to the sun. This condition is most common in older people who have been exposed to the sun over many years. Typical areas where actinic keratoses appear include the face, scalp, back of the arms, and the back of the hands.
Several factors can influence the likelihood of someone developing actinic keratoses. These factors include:
- Age: Actinic keratoses are found more often in older individuals because of their prolonged exposure to the sun over their lifetime.
- Gender: Actinic keratoses tend to be more common in men than women.
- Skin Type: People with fair or light skin, red or blond hair, and blue or light-colored eyes are more prone to this condition because their skin has less melanin to protect them from the sun.
- Geographic location: Countries near the equator have higher rates of actinic keratoses. Australia, for example, has almost 60% prevalence rate due to its location and its significant white population. Meanwhile, in a not-so-close-to-equator country like the United States, the prevalence rate is around 20%.
- Immunosuppression: People with weakened immune systems, such as those taking certain medications, people with immune disorders like AIDS, or individuals who have undergone chemotherapy, are more susceptible to these skin issues.
- Previous skin conditions: If someone has had actinic keratoses or other skin cancers before, they may be more likely to develop them again.
- Sun Exposure: People who spend a lot of time outside, whether for work or leisure activities, have a higher risk of developing actinic keratoses.
Signs and Symptoms of Actinic Keratosis
When looking at someone who might have actinic keratosis, there are a few important things to consider. Crucial information can be gathered from:
- Their current symptoms: It’s important to ask about any symptoms related to their skin lesions, like itching, pain, or bleeding with small injuries. These symptoms could suggest a higher risk of the lesions developing into invasive squamous cell carcinoma.
- Their medical history and medications: It’s a good idea to thoroughly review their medical conditions and any medications they’re taking. Certain health problems and medicines, like those that suppress the immune system, can increase the risk of getting actinic keratosis.
- Prior treatments or operations for skin cancer: Check if the patient has been treated for skin cancer before or has undergone any related surgeries. This information can help assess the patient’s overall risk levels and whether more proactive treatment may be necessary.
In addition, it’s important to carefully assess all potential risk factors connected with actinic keratosis. This includes looking at how long and how often they’ve been exposed to the sun, past sunburn events, their routine use of sunscreen, sun protection habits, and their job – particularly if it involves spending a long time outdoors.
The physical examination should involve a thorough check of the entire body’s skin, paying particular attention to the number, size, distribution, and characteristics of any suspicious skin lesions. Particular focus should be given to the areas of the body where the skin is exposed to sun, such as the head, face, scalp, neck, forearms, and hands. Ulceration and bleeding should also be taken note of.
Actinic keratosis can take on many forms, including scaly patches, red spots, raised areas or cutaneous horns. The surrounding skin may show signs of sun damage, including wrinkles, uneven pigmentation, or tiny, dilated blood vessels. When touched, these areas often feel rough due to excessive skin cell production.
Testing for Actinic Keratosis
The diagnosis of actinic keratosis, a type of skin condition, mainly depends on what the doctor observes during the physical check-up. However, in some cases, additional methods like dermoscopy or biopsy could be useful in providing more in-depth information.
Dermoscopy, a tool that is used to examine skin lesions, can show specific signs. For example, nonpigmented facial actinic keratoses might display a “strawberry pattern.” This includes red skin overlaid by a pseudo network of blood vessels, noticeable openings around hair follicles, and a white ring around the lesion.
A biopsy, a procedure where a small piece of skin is removed for testing, might be necessary in certain situations to confirm the diagnosis of actinic keratosis. It is generally only used for people whose skin doesn’t improve with treatment or when the doctor needs to check if actinic keratosis has advanced to a type of skin cancer called squamous cell carcinoma.
Treatment Options for Actinic Keratosis
Dermatologists might suggest various treatments, continuous monitoring, and preventive methods to reduce cases of actinic keratosis. These measures help to avoid the risk of these cases advancing to squamous cell carcinoma, a type of skin cancer. The chance of actinic keratosis turning malignant varies for different people, with the average risk being 8%.
There are two categories of treatment for actinic keratosis: first, therapies that focus on individual actinic keratoses, known as lesion-directed therapies. These involve methods like cryotherapy (cold therapy), curettage (scraping off), or surgical removal of the lesions.
Secondly, we have field-directed therapies that help in treating multiple, unseen actinic keratoses that might exist within an area greatly exposed to the sun. This type of therapy benefits from creams (chemotherapy or immunomodulators), light-based therapies, or laser resurfacing. They serve to treat all visible actinic keratoses and the ones that can’t be identified by the naked eye.
Treatment plans should consider the lesion characteristics, patient preferences, treatment availability, the patient’s ability to follow through with treatments, adverse effects tolerance, and cost. Quick intervention is required under circumstances such as when there are many lesions, bleeding, severe pain, or rapid lesion growth.
Patients should be informed about potential adverse effects of treatments such as blisters, discomfort, or swelling, as well as how to take care of their skin during recovery. It is important to acknowledge that there’s no completely risk-free treatment for actinic keratosis, as each has its potential adverse effects, which may include pain, inflammation, healing issues, or scarring.
Actinic keratosis can reoccur, potentially requiring multiple treatments. When treatments don’t result in the intended outcomes, further investigation is necessary. Non-compliance with the treatment regimen, misdiagnoses, or transformation to squamous cell carcinoma could be the reasons for therapy failure.
People diagnosed with actinic keratosis should get regular skin cancer screenings and learn sun protection strategies. Also, taking 500 mg of vitamin B3 twice daily can potentially reduce actinic keratoses.
There are various treatment options for actinic keratoses, such as cryotherapy, surgical removal, dermatologist-guided skin abrasion, laser treatment, chemical peels, and photodynamic therapy. The therapies used for a patient should be tailored to their specific needs and circumstances.
Finally, there are several approved topical medications for treating actinic keratosis that patients can apply at home. A review of possible side effects like blistering, discomfort, or swelling should be carried out, and the patient educated on skin care during the healing process.
What else can Actinic Keratosis be?
Actinic keratosis, a skin condition, can present in different forms such as hyperkeratotic actinic keratosis, atrophic actinic keratosis, actinic cheilitis, pigmented actinic keratosis, lichenoid AK, and cutaneous horn.
Diagnosing actinic keratosis primarily involves a physical examination by a medical professional, who would typically look for distinctive skin lesions and their location. Other skin issues that may be considered due to their similar appearance include solar lentigo, seborrheic keratosis, common warts (verruca vulgaris), flat warts (verruca plana), discoid lupus erythematosus, and squamous cell carcinoma.
What to expect with Actinic Keratosis
Actinic keratosis, a type of skin condition, can behave unpredictably over time. Some may naturally go away on their own, although researchers are still trying to understand why this happens.
Conversely, some actinic keratoses may stay the same, with little change in size or appearance for a long period. It’s important to note, however, that they can potentially develop into a type of skin cancer known as invasive squamous cell carcinoma. Most cases of this particular skin cancer originate from existing actinic keratoses or areas that have them.
Possible Complications When Diagnosed with Actinic Keratosis
There are different ways to treat actinic keratoses, but all of them carry some risks. The treatments can potentially lead to certain side effects like pain, inflammation, difficulty in healing, changes in skin color, and scarring. There’s also a chance that the actinic keratosis could come back, or even transform into a type of skin cancer known as squamous cell carcinoma.
Potential side effects of actinic keratosis treatments include:
- Pain
- Inflammation
- Problems with healing
- Changes in skin pigment
- Scarring
- Recurrence of actinic keratosis
- Transformation into squamous cell carcinoma
Preventing Actinic Keratosis
It’s crucial that patients understand the various ways they can prevent actinic keratosis, a skin condition, from developing and progressing. This includes strategies like limiting or avoiding sunlight exposure, particularly during the most intense daylight hours. Additionally, wearing sun-safe clothing and wide-brimmed hats, as well as applying sunscreen diligently on all skin exposed to the sun, including the face, can greatly help in reducing the risk.
