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Actinic Keratosis of Skin

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 the upper chest
  • Actinic Keratosis of Skin is considered precancerous, since it has the potential to progress into  the skin cancer 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 the 20 and over age group, if there is significant early sun exposure
  • No gender inequality has been observed; both men and women are equally prone to the condition. This factor varies across geographical regions and is based on the nature of one’s occupation and recreational activities
  • Dark-skinned people are less affected; fair-skinned individuals are affected the most
  • Australia has a very high prevalence of Actinic Keratosis of Skin (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 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 who easily sunburn because of light pigmentation

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's 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 damaged from prolonged (and frequently severe) exposure to the ultraviolet (UV) component of the sun over decades
  • The source of UV may be from recreational indoor tanning and medical phototherapy too
  • Welding, flying airplanes, and other occupations can expose workers to increased ultraviolet radiation
  • Research has indicated that the human papillomavirus (HPV) can multiply the risk for Actinic Keratosis. The mechanism by which  the virus contributes to the formation of Actinic Keratosis is presently unclear

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

The main diagnostic criterion for Actinic Keratosis of Skin is the visible change in the skin. The signs and symptoms generally include:

  • Initial formation of slightly rough skin lesions, which later turn to dry, pink, scaly patches
  • Gradually the lesions get thicker and inflamed. The patches grow in size
  • Multiple lesions are often seen within a region or in other sun-exposed areas
  • Itching or burning may be experienced
  • Pain, bleeding, and seeping results from minor trauma
  • Typical body regions affected include the face and lips, hairless portion of the scalp, neck, arms (hand, forearm), and upper chest

How is Actinic Keratosis of Skin Diagnosed?

A diagnosis of Actinic Keratosis of Skin is made by:

  • Physical examination of the skin
  • The history and visual inspection are usually adequate for a diagnosis of the condition
  • A skin biopsy is done when there is a diagnostic question in the mind of the practitioner. Most frequently the differential diagnosis lies between Actinic Keratosis and superficial squamous cell carcinoma of the skin or in situ basal cell carcinoma of the skin. 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 and irritability of the affected skin
  • The main complication that may arise from Actinic Keratosis of Skin is that it could develop to form squamous cell carcinoma (a common form of skin cancer). This normally takes place if the treatment is delayed, or the condition is 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. Most common are imiquimod, 5-flurouracil, diclofenac, and Ingenol topical
  • 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
  • Cryotherapy: Controlled use of liquid nitrogen to freeze intracellular water, killing the cells and causing them to slough-off
  • 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:

  • Avoiding prolonged and chronic exposure to the sun. If this is unavoidable ( due to an occupational requirement), then taking safety steps to reduce exposure to the UV rays, by using sunscreens with high sun-protection factor, wide-brimmed hats, and protective clothing
  • Being aware of the hazards of prolonged sun exposure and taking steps to protect oneself. Modifying one’s profession to stay out of the sun during the period when it is the most intense
  • Avoiding excessive sunbathing (particularly for fair-skinned individuals), usage 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 consistent follow-up, with timely treatment of Actinic Keratosis of Skin, and consistent sun protection can help result in an excellent prognosis
  • Severe cases of Actinic Keratosis 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 for Actinic Keratosis of Skin, it has been observed that skin malignancies that form in them, are known to be particularly aggressive. The cause for this finding is unknown.

What are some Useful Resources for Additional Information?

Skin Cancer Foundation
149 Madison Avenue Suite 901 New York, NY 10016
Phone: (212) 725-5176
Website: http://www.skincancer.org

American Cancer Society (ACS)
1599 Clifton Road, NE Atlanta, GA 30329-4251
Toll-Free: (800) 227-2345
TTY: (866) 228-4327
Website: http://www.cancer.org

National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322 Bethesda, MD 20892-2580
Phone: (301) 435-3848
Toll-Free: (800) 422-6237
TTY: (800) 332-8615
Email: cancergovstaff@mail.nih.gov
Website: http://www.cancer.gov

References and Information Sources used for the Article:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001830/ (accessed on 03/08/2013)

http://www.skincancer.org/skin-cancer-information/actinic-keratosis (accessed on 03/08/2013)

http://www.mayoclinic.com/health/actinic-keratosis/DS00568 (accessed on 03/08/2013)

Helpful Peer-Reviewed Medical Articles:

Englert, C., & Hughes, B. (2012). A review of actinic keratosis for the nurse practitioner: diagnosis, treatment, and clinical pearls. J Am Acad Nurse Pract, 24(5), 290-296. doi: 10.1111/j.1745-7599.2011.00686.x

Idezuki, T. (2013). [Field cancerization and field therapy - the therapy of actinic keratosis by imiquimod]. Gan To Kagaku Ryoho, 40(1), 1-5.

Schmitt, J. V., & Miot, H. A. (2012). Actinic keratosis: a clinical and epidemiological revision. An Bras Dermatol, 87(3), 425-434.

Stanciu, M., Aubut, N., Gagne, E., & Thibeault, M. M. (2012). Capecitabine-induced inflammation of actinic keratosis: case report and literature review. J Cutan Med Surg, 16(5), 298-299.

Uhlenhake, E. E. (2013). Optimal treatment of actinic keratoses. Clin Interv Aging, 8, 29-35. doi: 10.2147/CIA.S31930

Pomerantz, H., Hogan, D., Eilers, D., Swetter, S. M., Chen, S. C., Jacob, S. E., ... & Konnikov, N. (2015). Long-term efficacy of topical fluorouracil cream, 5%, for treating actinic keratosis: a randomized clinical trial. JAMA dermatology, 151(9), 952-960.

Sahebian, A., Morze, C., Grant, M., Hopkins, P., Yerkovich, S., Chambers, D., & Soyer, H. P. (2015). Prevalence of actinic keratosis and the risk factors for skin cancer in lung transplant recipients in Queensland, Australia.

Jacobs, L. C., Liu, F., Pardo, L. M., Hofman, A., Uitterlinden, A. G., Kayser, M., & Nijsten, T. (2015). IRF4, MC1R and TYR genes are risk factors for actinic keratosis independent of skin color. Human molecular genetics, 24(11), 3296-3303.