Introduction:
Actinic keratosis is also known as solar keratosis is a slow-growing skin lesion that is irregular and scaly skin patches commonly affecting people over 40 years. Minimizing sun exposure and protecting the skin from UV (ultraviolet) rays reduces the risk of actinic keratosis. When left untreated, for about 5 % to 10 % of individuals, actinic keratosis may turn into a skin cancer called squamous cell carcinoma.
What Are the Causes of Actinic Keratosis?
The common cause of actinic keratosis is repeated and extreme exposure to UV (ultraviolet) light. The source of UV light can be from the sun or tanning equipment, like tanning beds. UV light damages the cell present on the outer layer of skin, called keratinocytes.
What Are the Risk Factors of Actinic Keratosis?
Actinic keratosis can affect anyone who does not protect the skin from sun exposure.
The following features increase the risk of actinic keratosis:
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People with blue, green, or light-colored eyes, red or blond hair, and fair or light skin tone.
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History of sun exposure or sunburn.
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Individuals older than 40 years.
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Live in a hot climate.
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One who works more outdoors.
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The weak immune system as in any illness or immunotherapy for cancer.
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People with rare skin conditions have skin sensitivity to UV rays, like albinism or xeroderma pigmentosum (XP).
What Are the Symptoms of Actinic Keratosis?
Common symptoms of actinic keratosis are:
- Actinic keratosis may vary in appearance.
- Usually they present as coarse, dry, scaly skin patches that are less than 1 inch in diameter. They may be flat to somewhat elevated patches, or sometimes as hard, wart-like on the superficial skin surface.
- The color may vary from yellow, pink, red, gray, or brown.
- They may be an itchy, painful, tender, burning sensation, bleeding, or crust.
- New patches occur on sun-exposed areas of the scalp, head, neck, lips, hands, and forearms.
- Loss of color in the lips may also be seen.
How to Diagnose Actinic Keratosis?
A simple complete physical examination by a dermatologist using a dermascope can reveal actinic keratosis. In case of any doubt, a skin biopsy can be suggested.
How to Treat Actinic Keratosis?
At-home therapy for actinic keratosis involves the application of medicated creams and ointments onto the skin surface with multiple skin lesions.
Some of these creams are:
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Diclofenac skin gel.
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Fluorouracil skin cream.
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Imiquimod skin cream.
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Ingenol mebutate topical gel.
In-office treatment for actinic keratosis is aimed at removing the skin patches.
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Chemical Peels: In this procedure, a chemical is used to safely destroy the patches in the top surface of the skin. In the first few days, the area that is treated will appear red and itchy. As the skin heals, a new healthy skin layer replaces the damaged skin.
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Cryotherapy: If there are only a few patches, cryotherapy may be suggested. Here, liquid nitrogen is used to freeze abnormal skin patches or growths. In a few days, these skin patches and growths slough and peel off producing new skin cells. Side effects include blister and scar formation, change in skin texture, infection, and discoloration of the affected area.
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Curettage and Excision: This involves scraping away (curettage) or cutting out (excision) the lesion using an electric current called electro surgery. When excision is done using a scalpel the treated area has to be sutured. Usually, the wound heals in two to three weeks. Side effects include scarring, infection, and discoloration of the affected area.
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Photodynamic Therapy: If there are multiple skin spots that relapse after treatment, photodynamic therapy can be suggested. This therapy uses light-sensitive chemical creams and specific light to terminate precancerous skin cells. Avoid sun exposure for a few days after the treatment. Phototherapy may cause redness, burning sensation, and swelling during the therapy.
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Laser Therapy: Lasers are commonly used to treat actinic keratosis. It involves using an ablative laser device that destroys the skin patch, producing new skin cells to appear. Side effects of laser therapy are scar formation and discoloration of the affected skin.
What Are the Complications of Actinic Keratosis?
Actinic keratosis clears up or fades when treated during the early stage.
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Actinic cheilitis.
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Basal cell carcinoma (BCC, is more common than SCC).
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Melanoma.
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Merkel cell carcinoma.
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Cutaneous horn.
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When left untreated, some spots of actinic keratosis may progress to a type of skin cancer called squamous cell carcinoma (SCC).
How to Prevent Actinic Keratosis?
Sun protection is essential to prevent the progress and relapse of actinic keratosis spots and patches.
Some skin protection steps from the sun are:
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Limit sun exposure time. Particularly avoid sun exposure between 10 AM to 2 PM and avoid staying in the sun for a longer time as it may cause sunburn or a suntan.
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Use sunscreen before moving outdoors, apply a water-resistant broad-spectrum sunscreen with a minimum of 30 sun protection factors (SPF). Apply sunscreen on all areas exposed to sunlight, and use lip balm with sunscreen for lips at least 15 minutes before moving outdoors and reapply every two hours.
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Sunscreen is not suggested for babies below six months. Hence, keep them out of the sun as much as possible, protect them in shade or wear hats and clothing to cover them.
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For extra sun protection, wear tightly woven clothing that covers the arms and legs, and a broad hat.
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Avoid tanning beds, tanning salons, and sun lamps. Tanning beds produce artificial UV light that can cause skin damage similar to sun exposure.
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The amount of the spot and severity of actinic keratosis can be reduced by oral vitamin B complex supplements.
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Check for changes in the skin regularly.
What Is the Prognosis of Actinic Keratosis?
The overall prognosis of actinic keratosis is excellent. Most actinic keratosis fades away from treatment. Only 10 % of people with actinic keratosis develop skin cancer. Yet, most people diagnosed with squamous cell carcinoma started with an actinic keratosis lesion. Hence, diagnosing and treating actinic keratosis in its early stage is very important to prevent progress into cancer.
Conclusion:
Actinic keratosis or solar keratosis is a skin lesion that occurs due to overexposure to the sun's ultraviolet light. It is a precancerous skin lesion with scaly spots on sun-damaged skin. Early diagnosis and intervention can heal the lesion without causing any complications.
