Actinic keratosis (also called solar keratosis, or AK) is a pre-malignant condition of thick, scaly, or crusty patches of skin. It is more common in fair-skinned people, especially those who are repeatedly exposed to the sun, as it is usually accompanied by sun damage. Spots usually begin appearing after the age of 50, though may develop earlier in sunny climates. Since some of these pre-cancers progress to squamous cell carcinoma (skin cancer), they should be evaluated and treated.

What causes Actinic Keratosis?

Actinic keratoses are caused by sun exposure over long periods of time. The genetic structure of the skin is changed by UV exposure, allowing for abnormal skin growths to occur. These skin growths start out as flat scaly areas that feel rough, similar to sandpaper in texture, and later evolve into a tough, wart-like area.

An actinic keratosis growth commonly ranges between 2 and 6 millimeters in size, and can be dark or light, tan, pink, red, a combination of all these, or have the same coloring as surrounding skin. It may appear on any sun-exposed area, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips.

You will sometimes feel the presence of an AK lesion before you see it.

How do I know if it is Actinic Keratosis or something else?

Doctors can usually identify AK by doing a thorough examination. A biopsy may be necessary when the keratosis is large and/or thick, to make sure that the bump is a keratosis and not a skin cancer. Seborrheic keratoses are other bumps that appear in groups like the actinic keratosis but are not caused by sun exposure, and are not related to skin cancers. Seborrheic keratoses may be mistaken for an actinic keratosis. Dr. Mann recommends that you not take chances with any unusual or abnormal skin growth. Delayed evaluation can result in prolonged treatment or the diagnosis of potential skin cancer.

How is Actinic Keratosis treated?

  • Liquid nitrogen, or “freezing off” the AKs.
  • 5-fluorouracil (efudex, carac) to activate chemical peeling
  • Photodynamic therapy: Light activated therapy involves applying a solution which makes AKs more sensitive to any form of light.
  • Laser resurfacing with Fraxel is often used with diffuse AKs.
  • Immunotherapy: topical treatment with imiquimod (Aldara, Zyclara), an immune enhancing agent.

How can I prevent Actinic Keratosis?

Prevention is very important. Sun protection can reduce the number of new areas occurring and may help small lesions go away on their own. If you are being treated for AK’s it is extra important to adhere to your doctor’s precautions.

  • Avoid direct sun in the middle of the day (10 AM to 3 PM). Remember: snow and water reflect light to the skin, and clouds still let a lot of light through, so you may still be exposed to ultraviolet light even on cloudy days.
  • Use a hat with a wide brim. A baseball hat does not give much protection.
  • Cover up with tightly woven clothing. Some manufacturers make specialty clothing with a high sun protection
  • factor (SPF) rating, or you can purchase a special ingredient to be added to your washer that can “wash” SPF into your
  • clothing.
  • Use sunscreen on all exposed skin areas, including the lips, before going outside. A broad spectrum (blocks both UVB and UVA light), with an SPF of at least 30, is best. Apply generously 30 minutes before going outdoors and reapply every 2 hours or after swimming or sweating a lot.
  • Do not use tanning beds!

If you have any questions, please contact us at (615) 266-3376 (DERM).