WHAT IS ACTINIC KERATOSIS?
Actinic keratosis are precancerous growths that are typically found on sun-exposed surfaces of the skin. These are typically caused by UV exposure from the sun but may also arise from tanning bed use and other environmental exposures.

They are important to diagnose early as these pre-cancerous lesions can eventually develop into squamous cell carcinoma, a type of skin cancer. Early treatment significantly decreases the likelihood of cancer development and prevents the need for a more invasive and extensive cancer treatment later on.

WHAT CAUSES ACTINIC KERATOSIS?
UV exposure damages the outermost layer of skin, causing it to change from its normal texture and growth patterns. People who get sunburnt easily and rarely tan or have naturally red or blond hair with light colored eyes have an increased risk of developing skin conditions like actinic keratosis. These people don’t produce as much melanin, which is a protective pigment our skin produces, thus increasing their risk of UV damage.

However, people with darker skin tones can still develop actinic keratosis. Older age, high UV exposure both from the sun and artificial sources, like tanning beds, are also at higher risk from a greater accumulation of UV-induced damage over time. People with weakened immune systems and those with xeroderma pigmentosum are more likely to develop actinic keratosis as they don’t have the normal mechanisms that our body has to fight off abnormal cell growth.

HOW DO I KNOW IF IT IS ACTINIC KERATOSIS?
Actinic keratosis can vary in color from flesh-colored, pink, red, yellow, brown, gray, and white. They can also appear differently from rough patches, scaly bumps, or rash-like raised, scaly spots. On your lips, they may look like perpetually dry and scaly or scaly white patches.

Determining whether your skin growths are actinic keratoses or any other potential skin concern can be very difficult, so it’s highly recommended to have a full skin exam from a board-certified dermatologist once a year. If you develop new or changing growths that you are concerned about, it is reasonable to seek care from a dermatologist to examine the growth.

HOW DO YOU TREAT ACTINIC KERATOSIS?
Once your board-certified dermatologist has diagnosed you with actinic keratosis. The treatment can vary depending on how many and how big the affected areas are, where they are on your body, the physical appearance of the actinic keratoses and your past medical history, such as a history of skin cancer or if you are immunocompromised.

In-clinic treatment includes cryosurgery, photodynamic therapy, medical-grade chemical peels, and curettage.

  • Cryosurgery – freezes the site of the actinic keratosis, which will cause it to fall off a few days to a few weeks after treatment
  • Photodynamic therapy (PDT) – a solution is applied to the affected area that makes it highly sensitive to light; red or blue light is then used to activate the solution, destroying the actinic keratosis
  • Medical-grade chemical peels – highly concentrated peel that should only be done by a physician; it peels the top layer of sun-damaged skin to allow new skin to grow back underneath
  • Curettage – surgically scraping off the actinic keratosis; usually done if it’s very thick and is sometimes followed by photodynamic therapy or cryotherapy if needed

Based on studies done, evidence supports cryosurgery as one of the most common treatments due to its availability, short treatment time, efficacy, and relatively low discomfort and risks compared to other treatments. However, every patient is different and the choice of treatment is best selected after an evaluation by a dermatologist.

At-home treatments that involve topical creams like Efudex (fluorouracil) and Aldara (imiquimod) have been shown to be efficacious and safe to use for the treatment of actinic keratosis. Other topical creams have insufficient evidence presently. Topical creams or gels are favored for treatment when there are a multitude of affected areas, have high densities within an area, difficult to see, or have indistinct borders.

WHAT CAN I DO TO PREVENT ACTINIC KERATOSIS?
Sun safety is paramount! Apply broad-spectrum sunscreen everyday and remember to reapply every two hours. Even in a cloudy or overcast day, just because you can’t see the sun, doesn’t mean those UV rays aren’t there. Protect your skin by using clothing and accessories, like a hat and sunglasses. Avoid the sun and seek the shade when outdoors. Do a self-exam on your skin every so often and see a dermatologist for a full skin exam once a year.

A history of actinic keratosis increases your risk of developing more actinic keratoses and skin cancer, even after successful treatment. Prevention by following the sun safety habits above is the best way to keep your skin healthy!

References:
Eisen DB, Asgari MM, Bennett DD, et al. Guidelines of care for the management of actinic keratosis. Journal of the American Academy of Dermatology. 2021;85(4). https://www.jaad.org/article/S0190-9622(21)00502-8/fulltext#secsectitle0095
Callen JP, Bickers DR, Moy RL. Actinic Keratoses. Journal of the American Academy of Dermatology. 1997: 36(4). https://www.jaad.org/article/S0190-9622(97)70265-2/fulltext
Actinic Keratosis. American Academy of Dermatology Association. n.d. https://www.aad.org/public/diseases/skin-cancer/actinic-keratosis-facts-about-precancerous-skin-growths