ACTINIC KERATOSIS

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.

Also known as solar keratosis, an actinic keratosis enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on your skin. These lesions take years to develop, usually first appearing in older adults.

A small percentage of actinic keratosis lesions can eventually become skin cancer. You can reduce your risk of actinic keratosis by minimizing your sun exposure and protecting your skin from ultraviolet (UV) rays.

Signs and Symptoms

The signs and symptoms of an actinic keratosis include:

• Rough, dry or scaly patch of skin, usually less than 1 inch (2.5 centimeters) in diameter
• Flat to slightly raised patch or bump on the top layer of skin
• In some cases, a hard, wart-like surface
• Color as varied as pink, red or brown, or flesh-colored
• Itching or burning in the affected area

Actinic keratoses are found primarily on areas exposed to the sun, including your face, lips, ears, back of your hands, forearms, scalp and neck.

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.

Causes

Actinic keratosis is caused by frequent or intense exposure to UV rays, from the sun or from tanning beds.

Risk factors

Although anyone can develop actinic keratoses, you may be more likely to develop the condition if you:

• Are older than 40
• Live in a sunny climate
• Have a history of frequent or intense sun exposure or sunburn
• Have pale skin, red or blond hair, and blue or light-colored eyes
• Tend to freckle or burn when exposed to sunlight
• Have a personal history of an actinic keratosis or skin cancer
• Have a weak immune system as a result of chemotherapy, chronic leukemia, AIDS or organ transplant medications

Complications

If treated early, almost all actinic keratoses can be eliminated before developing into skin cancer. However, if left untreated some of these spots or patches may progress to squamous cell carcinoma — a type of cancer that usually isn't life-threatening if detected and treated early.

Preparing for your appointment

You're likely to start by seeing your family doctor or primary care doctor. However, in some cases when you call to set up an appointment, you may be referred directly to a specialist in skin diseases (dermatologist).

What you can do

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your appointment. List your questions from most important to least important in case time runs out.

For actinic keratoses, some basic questions to ask your doctor include:

• Are tests needed to confirm the diagnosis?
• What are my treatment options and the pros and cons for each?
• What will the treatments cost? Does medical insurance cover these costs?
• What suspicious changes in my skin should I look for?
• What kind of follow-up should I expect?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask follow-up questions during your appointment.

What to expect from your doctor

Questions your doctor may ask you include:

• When did you first notice the lesions?
• Have you noticed multiple lesions?
• Have you noticed any changes in the appearance of the lesions?
• Is the condition bothersome?
• Have you experienced frequent or severe sunburns?
• How often are you exposed to sun or UV radiation?
• Do you regularly protect your skin from UV radiation?

Tests and diagnosis

Your doctor can usually diagnose actinic keratosis simply by looking at it. If there's any doubt, your doctor may do other tests, such as a skin biopsy. During a skin biopsy, your doctor takes a small sample of your skin for analysis in a lab. A biopsy can usually be done in a doctor's office after a numbing injection.

Treatments and drugs

An actinic keratosis sometimes resolves on its own, but typically returns again after additional sun exposure. Because it's impossible to tell exactly which patches or lesions will develop into skin cancer, actinic keratoses are usually removed as a precaution.

Medications

If you have several actinic keratoses, you may be better served by treating the entire affected area. Prescription products that can be applied to your skin for this purpose include:

• Fluorouracil cream (Carac, Fluoroplex, Efudex)
• Imiquimod cream (Aldara, Zyclara)
• Ingenol mebutate gel (Picato)
• Diclofenac gel (Voltaren, Solaraze)

Therapy

In photodynamic therapy, a medicine that makes your damaged skin cells sensitive to light (photosensitizing agent) is applied to the affected skin. 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.

Surgical and other procedures

If you have only a few actinic keratoses, your doctor may recommend individual removal. The most common methods 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. Cryotherapy is the most common treatment; it 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.

Prevention

Prevention of actinic keratoses is important because the condition can precede cancer or be an early form of skin cancer. Sun safety is necessary to help prevent development and recurrence of patches and lesions caused by an actinic keratosis.

Take these steps to protect your skin from the sun:

• Limit your time in the sun. Avoid staying in the sun so long that you get a sunburn or a suntan. Both result in skin damage that can increase your risk of developing actinic keratoses and skin cancer. Sun exposure accumulated over time may also cause an actinic keratosis.
• Use sunscreen. Regular use of sunscreen reduces the development of actinic keratoses. Before spending time outdoors, apply a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15. Use sunscreen on all exposed skin, including your lips. Apply sunscreen 20 minutes before sun exposure and reapply it every two hours or more often if you swim or sweat.
• Cover up. For extra protection from the sun, wear tightly woven clothing that covers your arms and legs. Also wear a broad-brimmed hat, which provides more protection than does a baseball cap or golf visor. You might also consider wearing clothing or outdoor gear specially designed to provide sun protection.
• Avoid tanning beds and tan-accelerating agents. Tanning beds emit ultraviolet A (UVA) rays, which are often touted as less dangerous than are ultraviolet B (UVB) rays. But UVA light penetrates deeper into your skin, causes actinic keratoses and increases your risk of skin cancer. Sunless tanning lotions or bronzing lotions that produce a tanned look without sun exposure are a safe choice, if you continue to use sunscreen when outdoors.
• 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.

Reference:  MayoClinic. http://www.mayoclinic.org/diseases-conditions/actinic-keratosis/basics/definition/con-20030382