Actinic Keratosis

What are actinic keratoses?

What causes actinic keratoses?

They are caused by repeated sun damage over many years - from sun-bathing and sun-beds as well as from working or playing out of doors- and are therefore commoner in older people. Fair-skinned people, blue-eyed, red or blond haired individuals, who burn easily in the sun but tan poorly are at particular risk.    Actinic keratoses are not contagious.

Are actinic keratoses hereditary?

No, they are not; but some of the factors that increase the risk of getting actinic keratoses, such as fair skin, a tendency to burn rather than tan, and freckling, do run in families.

What are the symptoms of actinic keratoses?

They often cause little trouble. Many affected individuals are not aware of them at all. The involved skin feels rough and dry, and frequently it becomes pink, red or brown, giving a blotchy appearance if there are a lot of them.

However, if an actinic keratosis starts to grow into a lump, becomes itchy or tender, or bleeds, medical advice should be sought as these changes could indicate the development of a skin cancer.

What do actinic keratoses look like?

Actinic keratoses can be variable in appearance, even differing from one another within a single individual. At first they can be hard to see, and are more easily felt, being rough, like sandpaper. They may grow up to a centimetre or two in diameter.  Some are skin coloured, others are pink, red or brown. They can become raised, hard and warty, and may even develop a small horny outgrowth. The surrounding skin often looks sun-damaged - blotchy, freckled and wrinkled.

How are actinic keratoses diagnosed?

Usually, the appearance of an actinic keratosis is sufficient to enable the diagnosis to be made, but in cases of doubt, for example if an early skin cancer is suspected, a sample (or the whole lesion) may be removed under a local anaesthetic for laboratory examination.. 

Can actinic keratoses be cured?

Yes - but others may develop in the future from the surrounding sun-damaged skin.

How can actinic keratoses be treated?

Some small actinic keratoses may go away spontaneously, so a few, small lesions may not require treatment, but it is important to protect the skin from the sun eg by wearing a hat, long sleeves and a high factor sun-block. It is advisable to treat more extensive and larger actinic keratoses as there is a small risk of some of them transforming into a skin cancer.  

Treatments used for actinic keratoses

Freezing with liquid nitrogen (cryotherapy).  This is an effective treatment when there are only a few, smallish actinic keratosis.   It can be painful, but often the actinic keratoses go away without leaving a scar though occasionally there may be a pale mark.

Surgical removal. This requires local anaesthetic, after which the actinic keratosis can be scraped off with a sharp spoon-like instrument (a curette), or it can be cut out and the wound closed with stitches. Surgical removal leaves a scar but provides a specimen that can be analysed in the laboratory to confirm the diagnosis.

Creams. A cream containing a drug called 5-fluorouracil is a useful treatment for actinic keratoses, especially if there are a lot of them. This preparation appears to selectively destroy the abnormal cells in sun-damaged skin. However, it often causes a good deal of inflammation of the treated areas.  Diclofenac, retinoic acid and imiquimod are other drugs in cream or ointment form that that are helpful when applied to actinic keratoses.

Photodynamic therapy.  A chemical is applied to the affected area and then treating with the correct wavelength of visible light. This treatment is available in certain centres.

What can I do?

Even though your skin is already damaged, protecting it from the sun from now on will reduce the number of new actinic keratoses you get, and also reduce the risk of getting a sun-induced skin cancer. You should be extra cautious in the sun by following these recommendations:

Protect yourself from the sun at its height, from 10.00 a.m. to 3.00 p.m.

Wear protective clothing- hats, long sleeves, long skirts or trousers.

Apply a sunscreen regularly of sun protection factor 15 or above (and able to block both UVA and UVB light) to exposed skin before going into the sun, and again every two hours when you are out in the sun.

Protect your children from the sun in the same way.

Avoid sunbeds.

Examine your own skin every few months and see your doctor if an actinic keratosis starts to itch, bleed, or thicken, in case it has changed into a skin cancer.

Where can I get more information about actinic keratoses?

Links to other Internet sites:

www.skincarephysicians.com/actinickeratosesnet
www.emedicine.com/derm/topic9.htm
http://www.aad.org/public/publications/pamphlets/sun_actinic.html

While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Your own doctor will be able to advise in greater detail.