Actinic Keratosis or Solar Keratosis is a medical condition of the skin, characterized by rough, scaly patches on the skin, as a result of prolonged sun exposure. The common areas where these patches are found are face, ears, lips, back of the hands, forearms, neck or scalp. The primary symptom of actinic keratosis is a small patch or a spot which slowly grows; other than this, there are usually no additional symptoms. These lesions develop over many years and are first observed in older adults. A very minor percentage of the lesions of actinic keratosis can develop into skin cancer. This risk can be reduced by protecting your skin from the harsh UV (ultraviolet) rays and minimizing your exposure to the sun. Treatment comprises of topical medications and surgical procedures like cryotherapy and curetting.
Causes of Actinic Keratosis or Solar Keratosis
The cause of Actinic Keratosis is intense or prolonged exposure to the sun, its UV rays or from long term use of tanning beds which also emit UV rays.
Risk Factors for Actinic Keratosis or Solar Keratosis
- Individuals who live in sunny climates are at a higher risk for developing Actinic Keratosis.
- Individuals over the age of 40 are at an increased risk for developing Actinic Keratosis.
- Individuals who have red/ blond hair, blue/ light-colored eyes and pale skin are at an increased risk for developing Actinic Keratosis.
- Individuals who have a history of prolonged sun exposure/ sunburn are at an increased risk for developing Actinic Keratosis.
- Individuals who have a family history of skin cancer or actinic keratosis.
- Individuals with a tendency to develop freckles or get sunburn upon exposure to sun are at an increased risk for developing Actinic Keratosis.
- Individuals who have a weak immune system from AIDS, chemotherapy, chronic leukemia or medications given in organ transplantation are at an increased risk for developing Actinic Keratosis.
Signs and Symptoms of Actinic Keratosis or Solar Keratosis
- Development of patches or spots, which are dry, rough or scaly, on the skin.
- These patches are commonly less than 1 inch in width.
- Patient can also experience burning or itching in the affected region.
- These patches can be flat to slightly elevated and are present on the upper most layer of the skin.
- The color of the patches/lesions in Actinic Keratosis can be brown, pink, red or flesh-colored
- In some patients, these patches can also attain a hard surface resembling warts.
Investigations for Actinic Keratosis or Solar Keratosis
Physical examination is often sufficient to arrive at a diagnosis. Other tests, like skin biopsy, where a small skin sample is taken and sent to the lab for analysis helps in further confirmation of diagnosis.
Treatment for Actinic Keratosis or Solar Keratosis
- In some cases actinic keratosis doesn't require treatment and it goes away on its own; however, it tends to recur after more sun exposure.
- As the lesions of Actinic Keratosis can develop into skin cancer, they are often (and recommended) to remove, as a preventive measure.
- Medications used in Actinic Keratosis, especially if there are multiple patches or lesions, include creams, such as Fluorouracil and Imiquimod; gels like Ingenol Mebutate and Diclofenac. These topical ointments are applied to the entire affected region.
- In photodynamic therapy, photosensitizing agent, which is a medicine which makes the damaged cells on the skin more sensitive to light, is applied to the affected area after which the skin is exposed to intense laser light which destroys the damaged skin cells. Side effects of photodynamic therapy include swelling, redness and burning sensation.
Surgery for Actinic Keratosis or Solar Keratosis
- Cryotherapy is the commonest treatment done. This is a process where liquid nitrogen is applied to the lesions on the skin. Liquid nitrogen works by freezing the surface of the skin and cause peeling or blistering of the affected skin layer. When the skin heals and the lesions/damaged cells slough off, resulting in development of new cells and skin minus the lesions. Cryotherapy only takes few minutes to perform and can be done on an outpatient basis. Side effects of cryotherapy include: scarring, blisters, skin textural changes, skin darkening and infection at the region of treatment.
- Curettage is a procedure where the surgeon, with the help of a surgical instrument curette, scrapes off the damaged cells in the affected area. Electrosurgery can be done after curetting where the affected tissue is cut and destroyed using an electric current. Side effects include: scarring, infection, and skin color changes at the region of treatment.
Prevention of Actinic Keratosis or Solar Keratosis
- Limit your exposure to the sun.
- Be sure to always use a broad-spectrum sunscreen with a minimum SPF (sun protection factor) of 20 on all the exposed areas of the body including your lips. Always apply the sunscreen 20-25 minutes before stepping out into the sun and reapply it every couple of hours.
- Cover yourself with a scarf, broad-brimmed hat, baseball cap etc. for further sun protection.
- Always avoid tan-accelerating agents and tanning beds as they release ultraviolet-A rays which can cause actinic keratoses and also increase the risk of skin cancer. It's safer to use bronzing lotions or sunless tanning lotions if you desire a tanned look without the harmful sun exposure.
- Always examine your skin on a regular basis and visit your doctor if any changes or new growths are present.