Actinic Keratosis Causes, Symptoms, Diagnosis, Treatment, Prevention

Actinic Keratosis Causes, Symptoms, Diagnosis, Treatment, Prevention

What Is Actinic Keratosis? What does it look like?

An actinic keratosis is a rough, scaly patch on your skin that develops from years of exposure to the sun. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck — areas of skin typically exposed to the sun.

An actinic keratosis, also known as solar keratosis, enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on your skin. An actinic keratosis takes years to develop, usually first appearing in older adults. Many doctors consider an actinic keratosis to be precancerous because it can develop into skin cancer.

Actinic keratosis is a very common skin condition. It occurs when skin cells called keratinocytes start to grow abnormally, forming scaly discolored spots. The skin patches may be brown, tan, grey, or pink. They tend to appear on the parts of the body that get the most sun exposure such as the hands, arms, face, scalp, and neck.

Actinic keratosis may actually be in situ stage squamous cell carcinoma (SCC) lesions. “In situ” means the lesions are confined to one location and not invading other tissue. In most cases, Actinic keratosis lesions are relatively benign. However, each lesion has about a 10 percent chance of progressing into an invasive form of SCC. Because of this risk, the spots should be monitored regularly for any suspicious changes.

You can reduce your risk of actinic keratosis by minimizing your sun exposure and protecting your skin from ultraviolet (UV) rays.

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Who is affected?

Actinic keratoses are most commonly seen in fair-skinned people, especially those with blue eyes, red hair, freckles and a tendency to burn in the sun. Men are more affected than women.

People who have lived or worked abroad in a sunny place or who have worked outdoors or enjoy outdoor hobbies are most at risk.

It may take many years before actinic keratoses develop – they don't usually appear before the age of 40.

What Causes Actinic Keratosis?

The major cause of actinic keratosis is excessive sunlight (natural light such as the sun or artificial light such as a tanning bed). Long-term exposure to the ultraviolet rays in sunlight causes chemical changes in skin cells known as keratinocytes, which make up 90 percent of the epidermis (the outermost layer of the skin). These keratinocytes then undergo changes in their size, shape, and organization.

Most of the damage to skin cells results from exposure to UV radiation from sunlight and commercial tanning lamps and beds. The damage adds up over time, so the more time you spend in the sun or in a tanning booth, the greater your chance of developing skin cancer. Your risk increases even more if most of your outdoor exposure occurs at times of the day or in locations where the sunlight is most intense.

What Are the Symptoms of Actinic Keratosis?

Actinic keratoses start out as thick, scaly, crusty skin patches. These patches are generally about the diameter of a pencil eraser. Over time, the lesions may disappear, remain the same, or develop into SCC. There is no way of predicting which lesions may turn cancerous. If you notice any of the following changes in an age spot, you should have it examined by a dermatologist:
  • hardening of the lesion
  • inflammation
  • rapid enlargement
  • bleeding
  • redness
  • ulceration

Actinic keratoses are more likely to develop on parts of the body that get the most exposure to the sun, such as the face, ears, neck, hands, and forearms. Peeling or cracking lips, especially the lower lip, after sun exposure might also be a sign of actinic keratosis.

If there are cancerous changes, don’t panic. This type of skin cancer is relatively easy to diagnose and treat in its early stages. Squamous cell skin cancer is the second most common type of human cancer. Over 250,000 new cases are diagnosed each year in the United States.

When to see a doctor

Because it can be difficult to distinguish between noncancerous spots and cancerous ones, it's best to have new skin changes evaluated by a doctor, especially if a spot or lesion persists, grows or bleeds. See your doctor or ask for a referral to a dermatologist if a skin lesion:

  • Is painful
  • Itches or burns
  • Oozes or bleeds
  • Becomes scaly or crusty
  • Changes in size, shape, color or elevation

How is actinic keratosis diagnosed?

People who are at risk for any kind of skin disorder should check their skin on a regular basis. If you notice any persistent bumps or spots with an unusual color, texture, shape, or size, contact your health care provider or a dermatologist. Other concerning signs are pimples that don't heal and anything that bleeds easily. Your doctor might perform a skin biopsy by removing part or all of the growth to determine if cancer cells are present.

What Kinds of Treatment are Available for Actinic Keratosis?

It's impossible to tell exactly which patches or lesions will develop into skin cancer. Therefore, actinic keratoses are usually removed as a precaution. Your doctor can discuss with you which treatment is appropriate for you. With most of these procedures, the treated area takes a few days to several weeks to heal.

Actinic keratosis treatment options may include:

Freezing (cryotherapy)

An extremely cold substance, such as liquid nitrogen, is applied to skin lesions. The substance freezes the skin surface, causing blistering or peeling. As your skin heals, the lesions slough off, allowing new skin to appear. This is the most common treatment, takes only a few minutes and can be performed in your doctor's office. Side effects may include blisters, scarring, changes to skin texture, infection and darkening of the skin at the site of treatment.

Scraping (curettage)

In this procedure, your surgeon uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which a pencil-shaped instrument is used to cut and destroy the affected tissue with an electric current. This procedure requires a local anesthetic. Side effects may include infection, scarring and changes in skin coloration at the site of treatment.

Creams or ointments

Some topical medications contain fluorouracil (Carac, Fluoroplex, Efudex), a chemotherapy drug. The medication destroys actinic keratosis cells by blocking essential cellular functions within them. Another treatment option is imiquimod (Aldara), a topical cream that modifies the skin's immune system to stimulate your body's own rejection of precancerous cells. Diclofenac gel (Voltaren, Solaraze), a nonsteroidal anti-inflammatory topical drug, may help, too. Side effects may include skin irritation such as pain, itching, stinging or burning sensation, crusting, and sensitivity to sun exposure at the site of treatment.

Chemical peeling

This involves applying one or more chemical solutions — trichloroacetic acid (Tri-Chlor), for example — to the lesions. The chemicals cause your skin to blister and eventually peel, allowing new skin to form. Skin peeling usually lasts for five to seven days. Other side effects may include stinging or burning sensation, redness, crusting, changes in skin coloration, infections and, rarely, scarring. This procedure may not be covered by insurance, as it's often considered cosmetic.

Photodynamic therapy

With this procedure, an agent that makes your damaged skin cells sensitive to light (photosensitizing agent) is either injected or applied topically. Your skin is then exposed to intense laser light to destroy the damaged skin cells. Side effects may include redness, swelling and a burning sensation during therapy.

Laser therapy

A special laser is used to precisely remove the actinic keratoses and the affected skin underneath. Local anesthesia is often used to make the procedure more comfortable. Some pigment loss and scarring may result from laser therapy.


In this procedure, the affected skin is removed using a rapidly moving brush. Local anesthetic is used to make the procedure more tolerable. The procedure leaves skin red and raw-looking. It takes several months for the skin to heal, but the new skin generally appears smoother.

Talk to your doctor about your treatment options. The procedures have various advantages and disadvantages, including side effects, risk of scarring, and the number of treatment sessions required. Afterward you'll likely have regular follow-up visits to check for new patches or lesions.

What happens after an actinic keratosis is treated?

Patients who develop actinic keratoses are usually well advised to have a doctor examine them annually. The purpose of these regular checks is to be sure that new lesions have not developed and that old ones are not becoming thicker and more suspicious looking (for cancer). Furthermore, continual avoidance of excessive sun exposure can decrease the risk of recurrences.

How can you prevent actinic keratosis?

The best way to prevent actinic keratosis is to reduce your exposure to the sun, especially during peak hours when sunlight is most intense. Here are some methods:

  • Wear long-sleeved shirts, pants, and a hat to protect areas of skin that might be exposed to the sun.
  • Apply a sunscreen with a sun protection factor (SPF) of 30 or higher at least 30 minutes before going outdoors. A broad-spectrum sunscreen is recommended to protect the skin from both ultraviolet A and B rays.
  • Avoid trying to get a tan by staying out in the sun or using tanning beds; use self-tanning products instead.
  • Check your skin regularly and report changes to your doctor. Examine your skin regularly, looking for the development of new skin growths or changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears and scalp. Examine the tops and undersides of your arms and hands.
  • If you have Actinic keratosis, you should see a dermatologist regularly. They can monitor your skin for signs of SSC. When caught early, SSC is very treatable. So don’t put off seeing your dermatologist if you have any worrisome spots!