All to Know about Actinic keratoses


Actinic Keratosis is a lumpy, rough spot on the skin as the result of long exposure to the sun. It is mostly found on the face, ears, lips, back of the hands, forearms, scalp and neck.


It is also known as a solar keratosis. An actinic keratosis gets bigger slowly. It usually origins no signs or symptoms except for a spot or small patch on the skin. It takes years for the patches to develop. It, typically, appears in people with more than 40 years of age.

A trivial fraction of actinic keratosis lesions could gradually turn into skin cancer. The risk of actinic keratoses could easily be reduced by decreasing your sun exposure and through protecting the skin from ultraviolet (UV) waves of the sun.


Actinic keratoses begins as dense, rough, hard skin patches. These patches are typically as large as a small pencil eraser. There may also be itching or burning in the area that has been affected.

Over the course of time, the lesions can fade out, expand, remain still, or grow into SCC. There’s no way to know which lesions might turn out to be cancerous. However, if one notices any of the following changes one should want his physician to examine the spots as soon as possible:

  • toughening of the lesion
  • irritation
  • quick expansion
  • bleeding
  • blush
  • ulceration

Stay calm if you experience any cancerous alterations. SCC is relatively easy to diagnose and treat in its early stages.


Long-lasting exposure to the sun is the main cause of nearly all actinic keratoses. Sun harm to the skin is cumulative. Therefore, even a brief period of sun exposure increases the lifetime total. Since 70-80 percent of the sun’s ultraviolet (UV) beams can go through clouds, cloudy days also are not safe. These harmful beams can also be reflected from sand, snow and other reflective surfaces, these surfaces give you extra exposure.


The more time you spend under the sun rays over the time, the likelier you are in danger of developing one or more Actinic Keratoses. Therefore, the elderly and those working in open-air are at bigger risk. The occurrence is a little higher among men, because they are inclined to spend more time under sun rays and use less sun protection than women do.

Although some people as young as in their 20s are affected by the condition, Actinic Keratoses are way more common in individuals aged 50 or over. Some specialists believe that nearly everybody over 80 has AKs.

Location matters: The nearer you live to the equator, the more likely you are to have actinic keratoses. 

Other Causes

The ultraviolet radiation send off by the lamps in a tanning beauty salons could be more dangerous than the sun itself, that’s why dermatologists warn against indoor tanning. If you do tanning, you should know that your odds of developing AKs are high.

Sometimes, actinic keratoses can be triggered by long exposure to X-rays or some other of chemicals used in industry.

Those at Risk

Individuals with light skin, freckles, red or blonde color of hair and blue, green or gray eyes are most at risk of sun damages. These people, if spend time in the sun and live a long life, will have a high tendency to develop AKs. Hispanics, Arabs, African Americans, Asians and others with darker skin are not as vulnerable as Caucasians, thought, anybody could grow skin cancers. Actually, partly due to late detection, skin cancers in Hispanics and African Americans are more expected to be detected at advanced phases than those found in Caucasians.

Individuals with immune defenses get weakened by performing cancer chemotherapy, AIDS, organ transplantation or other factors are less able to resist the effects of ultraviolet radiation and therefore are more likely to grow actinic keratoses. It is worth mentioning that too much UV exposure suppresses the immune system of the person and whereby reduces the body’s ability to heal UV damages.


A diagnosis of actinic keratosis is generally made with simple observation techniques. However, further examining with a skin biopsy might be required to ratify the diagnosis. Additional tests, like blood tests or imaging tests, are not typically needed.


It is essential to know that actinic keratosis should be diagnosed as early as possible. Because it can grow to squamous cell carcinoma without treatment. However, with suitable timely intervention, most cases of skin cancer could be cured.

Skin Appearance

A simple check of the characteristic skin patches is most of the time sufficient to identify actinic keratosis. The appearance of the skin and texture of the skin on the patches often suffice.

Typical signs that may be indicative of actinic keratosis include:

Skin Biopsy

In some cases, a skin biopsy could be required to ratify the diagnosis. This method is usually used to exclude a diagnosis of squamous cell carcinoma if the lesion is more progressive or if the patient has a record of skin cancer.

This process normally includes the gathering of a skin sample from the affected part, which could be taken by a general physician through the use of a local anesthetic injection. The sample, afterward, is sent to a laboratory to be fully examined by the use of microscopes.


Several cases of actinic keratosis could be entirely coped with by a general practitioner without need for the participation of a dermatologist. However, referral to a dermatologist for further assessment may be required in some cases, for instance if:

  • The diagnosis is unclear
  • The skin patches are serious or extensive
  • The symptoms are not responsive to healing process
  • The patient is taking immunosuppressant medicines
  • There is a high risk of associated malignancy

A dermatologist might also use some other approaches in the diagnosis of actinic keratosis, like fluorescence with a photosensitizing medicine.

When a suitable management action for actinic keratosis is planned, the ongoing follow-up appointments are often performed by the patient’s general practitioner.


Timely treatment can remove nearly all actinic keratoses before they grow into skin cancers. If an AK is suspected to be an early cancer, the physician may take tissue for biopsy by shaving off a portion of the AK with a scalpel or scraping the lesion with a curette (an instrument with a sharp ring-shaped tip). The curette may also be used to scrape off the base of the lesion. Bleeding is stopped with an electrocautery needle, or by applying trichloroacetic acid (TCA). Local anesthesia is necessary.


Depending on the nature of the growth and the patient’s age and health, various treatment options are available for actinic keratosis, including the following:

Surgical Procedures

These are most commonly used for treating AKs.

  • Cryosurgery: The doctor puts on liquid nitrogen to the AK to make the tissue freeze. Then, the wound and surrounding frozen skin might sore or get crusted and go down.
  • Curettage and desiccation: The doctor shaves portion or all of the lesion, then puts on heat or a chemical agent to stop the bleeding and possibly destroy any residual AK cells.
  • Laser surgery: The doctor employs extreme light to disappear AK tissue.

Topical Treatments

If one has frequent or extensive actinic keratoses, the doctor might recommend a topical ointment, cream or gel. These can treat observable and unobservable lesions with a slight danger of scarring. Physicians from time to time consider this type of therapy as “field therapy,” because the topical treatments could cover a wide field of skin as opposed to targeting secluded lesions.

  • 5-fluorouracil (Carac®, Efudex®, Fluoroplex®): a method of topical chemotherapy.
  • Chemical peel: Best recognized for reversing the symptoms of photoaging, this technique is also employed to eliminate some superficial actinic keratoses on the face, particularly when other methods have not succeeded. The doctor applies trichloroacetic acid and/or alike substances to the face, making the top skin layers to fall off.
  • Diclofenac (Solaraze®) and hyaluronic acid: a mixture of topical therapy.
  • Imiquimod (Aldara®, Zyclara®): A kind of topical immunotherapy which stimulates the immune system to create interferon, a substance that attacks cancerous and precancerous cells.
  • Ingenol mebutate (Picato®): A fast and effective topical therapy resulting from plants. An immunologic mechanism of action is suggested.

Photodynamic Therapy

Photodynamic therapy (PDT) is exclusively suitable for extensive lesions on the face and scalp. The doctor uses a light-sensitizing topical mediator to the cuts, then uses an intense light to trigger the topical agent, abolishing the AKs while sparing healthy tissues. (In some places like Europe, some doctors keep applying the light-sensitizing agent with exposure to sunbeams in place of non-natural light; this is well-known as daylight PDT, and regarded as a tender treatment than normal PDT.)

Combination Therapy

Medical experts might mix therapies for a course of time to perform the treatment for AKs. Usually, treatment regimens mix cryosurgery with PDT or a topical mediator similar to imiquimod, diclofenac, ingenol mebutate, or 5-fluorouracil (5-FU). The topical medicines and PDT might as well be used interchangeably every three months, six months or year, as decided by the doctor at follow-up skin inspections.

Keep in mind that some of the aforementioned strategies upsurge sensitivity to sun. Therefore consult with your physician, and be particularly industrious on using sun protection in the time of the treatment.

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