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Actinic Keratosis of Skin

Last updated March 25, 2018

Approved by: Krish Tangella MD, MBA, FCAP

DoveMed found a great video by the Dr. Bob Show discussing actinic keratosis. Dr. Meredith Overholt, Board Certified Dermatologist, in the show shows several pictures of actinic keratosis and explains how this condition is treated.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Actinic (Solar) Keratosis of Skin
  • Atrophic Keratosis
  • Sun-Induced Skin Changes - Keratosis

What is Actinic Keratosis of Skin? (Definition/Background Information)

  • Prolonged exposure to the sun’s ultraviolet rays, results in damage of skin DNA, causing patches of rough, scaly, and thickened skin. This is called Actinic Keratosis (AK) of Skin
  • The affected regions typically include, body areas exposed to the sun, such as the face, neck, bald portion of the scalp, hands, and even the chest
  • Actinic Keratosis of Skin is considered precancerous, since it has the potential to progress into skin cancer, called squamous cell carcinoma of skin

Who gets Actinic Keratosis of Skin? (Age and Sex Distribution)

  • Actinic Keratosis of Skin form over many years. Hence, they are mostly observed in adults, over 50 years of age, or more. They can also occur in individuals, upwards from the 20-30 age groups, especially if there is significant sun exposure, early in their lives
  • No gender inequality has been observed; both men and women are equally prone to the condition. Nevertheless this factor varies across geographical regions and is based on the kind of occupation they hold (especially those related to outdoor activities)
  • Dark-skinned people are hardly affected. It is the fair-skinned individuals (and particularly those with blue eyes) who are affected the most
  • Among nations, Australia has a very high prevalence of AK (1 in 2 adults, over 40 years of age)

What are the Risk Factors for Actinic Keratosis of Skin? (Predisposing Factors)

The risk factors for Actinic Keratosis of Skin include:

  • Exposure to intense sun for long periods during the course of work, or due to outdoor sports activities
  • People living in geographical regions where hot-dry, desert-like climatic conditions prevail 
  • Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant
  • Those with sensitive skin, who get easily sunburned

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Actinic Keratosis of Skin? (Etiology)

  • Actinic Keratosis of Skin is caused when skin cells (the keratinocytes that form the epidermis) are burnt or damaged from prolonged (frequently severe) exposure to the ultraviolet component of the sun, over many decades
  • The source of UV may be from lamps and other such devices, apart from the sun, and their effect on the skin may cumulatively add-up
  • Sometimes, individuals working in certain industries may be exposed to chemicals or x-rays for a long duration. This may also contribute to the formation of this skin disorder
  • Scientific research has indicated that the human papillomavirus along with other risk factors, such as sun-exposure, skin color, and an advancing age, seem to greatly multiply the chance of a person being affected by AK. Nevertheless, the reason behind how the virus is responsible for influencing the condition’s development, is unclear

What are the Signs and Symptoms of Actinic Keratosis of Skin?

The main indication of Actinic Keratosis of Skin is a visible change in the skin condition and appearance. The signs and symptoms include:

  • Initial formation of light skin lesions that appear as sunspots, which later turn to dry, red, scaly, with raised patches
  • Gradually the skin condition gets rough, inflamed, and thickening occurs. The size of the patches grow bigger and multiple lesions are observed
  • Itching or burning sensations may be experienced. When the condition is acute, there may be pain, bleeding/oozing from the sores
  • Typical body regions affected include: The face and lips, hairless portion of the scalp, neck, arms (hand, forearm), and chest

How is Actinic Keratosis of Skin Diagnosed?

A diagnosis of Actinic Keratosis of Skin is made by:

  • Physical examination of  the skin
  • Skin biopsy, to essentially evaluate for any cancerous transformation. The skin biopsy is analyzed by a pathologist under a microscope, for a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Actinic Keratosis of Skin?

The possible complications due to Actinic Keratosis of Skin could be:

  • Discomfort, irritability of the affected skin
  • Permanent scarring might occur with Actinic Keratosis and cosmetic surgery may be required to restore the skin condition
  • The main complication that may arise from AK is that it could develop to form squamous cell carcinoma (a common skin cancer). This normally takes place if the treatment is delayed, or the condition left untreated

How is Actinic Keratosis of Skin Treated?

Commencing early treatment can help prevent a progressive deterioration of Actinic Keratosis of Skin, and avoid complications. Several management measures are available and these include:

  • Use of topical ointments, lotions, and creams. These may be antiseptic and anti-inflammatory applications
  • Chemical peeling, in which strong chemicals applied on the skin, cause it to peel and shed, giving way to formation of new skin
  • Use of photodynamic light or laser therapy: Light destroys the damaged cells after they are treated with a special medical application
  • Scraping and dermabrasion: Removal of skin lesions by scraping them, or using abrasion techniques (rapid brushing)
  • Cryotherapy: Controlled use of liquid nitrogen, to force spontaneous peeling, and removal of skin
  • Removal of the entire affected skin layer, by cosmetic resurfacing procedure (called moh's procedure)
  • Complete removal of the affected skin by a biopsy, is also curative

How can Actinic Keratosis of Skin be Prevented?

A few methods to prevent Actinic Keratosis of Skin include:

  • Avoid prolonged and chronic exposure to the sun. If this is unavoidable (like due to an occupational requirement), then take safety steps to reduce exposure to the UV rays, by using sunscreens with high sun-protection factor, using wide-brimmed hats, and protective clothing
  • Be aware of the hazards of prolonged sun exposure and take steps to protect yourself. Modify your profession to stay out of the sun during the period, when it is the most intense
  • Avoid excessive sunbathing (particularly if you are fair-skinned), use of tanning beds, sun lamps, and chemical agents, that accelerate sun tanning
  • Individuals who are regularly exposed to the sun, or work under the sun should get their skin periodically examined by a physician. This is crucial if they suspect, or if there are any noticeable skin changes

What is the Prognosis of Actinic Keratosis of Skin? (Outcomes/Resolutions)

  • Early diagnosis, followed by a prolonged, continuous  treatment of Actinic Keratosis of Skin, results in an excellent prognosis
  • Severe cases of AK may cause permanent facial (or body) marks and pigmented scars, especially if proper treatment is not administered, or is delayed. In such cases, cosmetic surgery may be required to restore facial skin
  • There is also a chance that some of the lesions may develop to form invasive skin cancers, when chronic sun exposure and other risk factors are high

Additional and Relevant Useful Information for Actinic Keratosis of Skin:

Even though dark-skinned individuals are at a very low risk of suffering from Actinic Keratosis of Skin, it has been observed that skin malignancies that form in them (if any), are known to be particularly aggressive. The cause for this finding is unknown.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 8, 2015
Last updated: March 25, 2018