Actinic keratosis is most effectively treated

Actinic keratosis—Overview

Actinic keratosis (AK), also called solar keratosis, is a precancerous skin condition caused by prolonged sun exposure. Untreated, rough, scaly patches on sun-exposed areas such as the face, head, ears, lips, forearms, and hands can develop into squamous cell carcinoma. The patches may appear pink, crimson, brown, or flesh-colored. Due to sun exposure, it usually develops in individuals over 40. AK is not contagious.

Actinic keratosis face, head

Possible Risks

• Possible risks include outdoor work, tanning beds, and chronic sun exposure.
• Light hair, eyes, and skin minimise melanin protection.
• Over 40.
• HIV and organ transplant recipients are immunosuppressed.

Location: 

• This condition is more common in sunny climates, such as in South Indian states like Tamil Nadu, where UV exposure is intense.

Possible Issues

• If left untreated, 5–10% of AKs develop Squamous Cell Carcinoma (SCC)
• Cosmetic issues: Face/scalp patches might impact appearance.
• Field cancerization: Multiple AKs imply broad solar exposure.

Diagnosis

• Clinical exam: Dermatologists examine patients visually and tactilely.
• If the lesion suggests invasive cancer, biopsy.

Ways to prevent

• For sun protection, use broad-spectrum sunscreen (SPF ≥30), protective clothes, and helmets.
• Stay away from tanning beds.
• Patients with AK who are at high risk or have multiple cases should have regular skin checks.
• Early treatment can prevent skin cancer.

What causes actinic keratosis?

Main Actinic Keratosis Causes

Long-term UV exposure

• Sunlight: The main reason. UV radiation damages keratinocyte DNA through the skin.
• Tanning beds and lights emit UV.

Long-term damage

• The cumulative effects of daily outdoor activities mount up over decades.
• Years of exposure cause lesions, not one sunburn.

Increased Susceptibility Risks

• Fair skin, light hair, and light eyes have less melanin.
• Over-40s are the most common.
• They typically reside in bright or high-UV areas such as South India and Australia.
• Job: Outdoor workers (farmers, builders, fishers).
• Chronic immunosuppression: Organ transplant recipients or immunosuppressive medication users.
• UV exposure causes DNA mutations in skin cells.
• Damaged epidermal cells provide rough, scaly areas.
• Untreated lesions can become squamous cell cancer.

Can actinic keratosis become cancerous?

• AK is a precancerous lesion that, in some cases, can progress to cancer.

Cancer Progression Risk

• AKs can lead to Squamous Cell Carcinoma (SCC), a prevalent skin disease.
• Studies predict that 5–10% of untreated AKs may develop SCC.
• Multiple AKs (field cancerization), lip lesions (actinic cheilitis), or immunosuppression (transplant patients) increase risk.

BCC/Melanoma:

• Although AKs don't cause these malignancies, their existence indicates significant UV damage, which raises skin cancer risk.

Malignant Transformation Warning Signs

• A thicker, sensitive, or painful lesion is a warning sign of malignant transformation.
• Rapid expansion or ulceration.
• Unhealing bleeding or crusting.
• The condition is compared to the firmness of the adjacent skin.

Monitoring & Prevention

• Early AK therapy greatly decreases cancer risk.
• If you have several lesions, see a dermatologist regularly.
• Protection from the sun (SPF ≥30, hats, clothing) is the best strategy to avoid new AKs and lower progression risk.

Also, read https://dermnetnz.org/topics/actinic-keratosis.

Who is most at risk for actinic keratosis?

High-risk Actinic Keratosis groups

1. Genetics, Skin Type

• Fair complexion, light hair, and light eyes result in reduced UV protection due to melanin.
• Skin cancer risk increases with family history and genetic predisposition.

2. Age

• Risk increases with accumulated sun exposure for individuals over 40.
• AKs are rare in youngsters but widespread in middle-aged and elderly individuals.

3. Solar exposure

• Outdoor workers such as farmers, builders, fishers, and athletes are susceptible to solar exposure.
• Solar exposure also affects people who live in bright climates or near the equator, such as in South India or Australia.
• People may have a history of sunburn or exposure to tanning beds.

4. Immune State

• Individuals who are on immunosuppressants following an organ transplant are a prime example.
• HIV-positive or immunocompromised people.
• Reduced immune surveillance lets aberrant cells proliferate unrestrained.

5. Other Risks

• Men are more harmed owing to outdoor work and less sunscreen application.
• Bald or thinning hair: Increases UV exposure.
• Unprotected sunbathing, gardening, sports, and leisure activities increase UV exposure.

Common Actinic Keratosis Symptoms • Texture:

The affected areas may be rough, dry, or scaly, exhibiting a harsh texture. • These regions may exhibit a crusty texture or feature a prominent bulge resembling horns. • Color: red, pink, tan, brown, silvery, or skin-colored. • The color can manifest as discoloured patches or blend in with the surrounding skin. • Size: • The size can vary from a small spot to a diameter of 1 inch (2.5 cm). • Shape and Surface: • Flat or slightly elevated. • Over time, the surface may harden and develop a wart-like appearance. • Location: • Chronic sun exposure areas: face, scalp, ears, lips, neck, shoulders, forearms, and backs of hands. • Progress: • Lesions develop gradually over months to years. • Progressing squamous cell carcinoma may cause thickening, tenderness, or bleeding.

Warning Signs of Medical Concern · 

• The tumour may grow quickly or undergo a rapid size shift. • Pain, soreness, or itching. • Ongoing bleeding or ulceration. • The skin appears firmer in comparison to the surrounding skin.

Is the actinic keratosis resolved?

Untreated actinic keratosis (AK) often persists, recurs, or worsens.

• Natural Actinic Keratosis Course
• Persistence: AK lesions typically stay on the skin without treatment.
• Spontaneous Regression: AKs may temporarily fade or disappear when sun exposure is minimised.
• The sun damage keeps them from disappearing, so they regularly return.
• Untreated AKs can progress to squamous cell carcinoma (SCC) at a rate of 5-10%.
• No one can anticipate which lesions will become malignant.

Reasons to Treat

• Dermatologists proactively treat precancerous AKs.
• Removing them minimises SCC risk and enhances attractiveness.
• Cold therapy, topical creams (5-FU, imiquimod, and diclofenac), photodynamic therapy, and laser therapy are used.

Long-term care and prevention

• Provide consistent sun protection (SPF ≥30, caps, clothes).
• Check skin for new lesions regularly.
• Lifestyle changes: Stop using tanning beds and limit noon sun.

How to treat toddler keratosis?

• Bathe warmly, not hotly. Use a gentle, soap-free body and face wash. Apply a light moisturizer multiple times a day.

Treating actinic keratosis

The Main Treatments

1. Freezing therapy

• Liquid nitrogen is used to freeze and destroy abnormal cells.
• Ideal for: Few lesions.
• Quick, effective, and low-downtime.
• Cons: Possible redness, blistering, or hypopigmentation.
• Recurrence: 24% within 12 months if sun exposure continues.

2. Topically applied drugs

• 5-Fluorouracil (5-FU) cream destroys aberrant cells.
• Imiquimod: Boosts the immune system attack on damaged cells.
• Diclofenac gel: Milder, slower anti-inflammatory.
• Ingenol mebutate: Fast but rarely used.
• Best for: Multiple lesions or “field cancerization” (widespread UV damage).
• Cons: Treatment may cause redness, inflammation, and peeling.

3. Photodynamic Therapy

• A light-activated medication is applied to skin and exposed to specific light.
• This treatment is specifically designed for larger areas that have multiple AKs.
• Pros: Cosmetically effective, cures visible and unseen lesions.
• Cons: Clinic visits, transient pain/redness.

4. Surgery Choices

• Curettage and electrocautery: Lesion removal.
• Abnormal cells vaporise under laser therapy.
• This treatment is particularly effective for thick, resistant lesions.

5. Self-Care, Prevention

• Use sunscreen (SPF ≥30) daily on exposed skin.
• Protective gear, caps, and sunglasses.
• Avoid tanning beds and the noon sun.
• Regular dermatology exams should be conducted at least annually following therapy.

Brief Summary

Precancerous actinic keratosis demands active treatment. The most common first-line treatment is cryotherapy, whereas topical creams and photodynamic therapy treat extensive lesions. Sun protection is crucial to preventing recurrence.

Conclusion

Long-term sun exposure causes actinic keratosis (AK), a common precancerous skin disease. Sun-exposed areas develop rough, scaly patches that indicate skin injury. AKs can develop squamous cell carcinoma, so early identification and treatment are crucial.

Prevent, treat, and control actinic keratosis. Consistent sun protection and early medical care work best. AKs are a symptom of cumulative sun exposure, so patients may protect their skin and lower cancer risk.