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Actinic keratosis

Definition


Disease: Actinic keratosis Actinic keratosis
Category: Dermatological diseases
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Disease Definition:

Also known as solar keratosis, actinic Keratosis is caused by frequent or intense exposure to UV (ultraviolet) rays, usually from the sun. It is a lesion that appears as a rough, scaly patch on the ears, lips, face, forearms, scalp, neck and back of the hands. Other than causing a patch or small spots on the skin, it has no additional signs or symptoms. Usually, first appearing in older adults, it takes years to develop and enlarges slowly. It can be considered precancerous because it can end up developing into skin cancer.

By protecting the skin from UV rays, and minimizing sun exposure, the risk of actinic keratosis can be reduced.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of its signs and symptoms may be:
 

  • A flesh-colored, red, pink or brown lesion.
  • A lesion that may develop a hard, wart-like surface.
  • Burning or itching in the affected area.
  • Dry, rough or scaly patch of skin, usually less than 2.5 cm in diameter (1 inch).


As mentioned before, an actinic keratosis can be found in areas that are exposed to the sun, such as the ears, lips, face, forearms, back of the hands, scalp and neck. A person may develop a single lesion or several lesions.

Although the lesion sometimes resolves on its own, but it usually returns again after additional sun exposure. It will also recur if the lesion is simply scratched or picked off.
With new skin changes, or when a spot or lesion grows, persists or bleeds, it's best to see a doctor. The person should be referred to a dermatologist in case:
 

  • The lesion oozes or bleeds
  • It changes in size, shape, color or elevation
  • It itches or burns
  • Becomes scaly or crusty
  • Is painful
     

Causes:

Usually, intense or frequent exposure to UV rays causes an actinic keratosis. It begins in the epidermis, which is as thin as a pencil line, and provides a protective layer of skin cells that the body sheds continually.

In the epidermis, skin cells develop in a controlled and orderly way, and normally, healthy new cells push older cells toward the skin's surface where they die and eventually are sloughed off. Changes occur in the skin's texture and color, when the skin cells are damaged through UV radiation, causing blotchiness and bumps or lesions.

Exposure to UV radiation from sunlight and commercial tanning lamps and beds can cause cumulative damage to the skin cells, so the more time spent under the sun or in a tanning booth, the greater the chance of developing skin cancer. If a person's outdoor exposure occurs mostly at times of the day or in locations where the sunlight is most intense, the risks of actinic keratosis will increase.
 

Complications

Complications:

If left untreated, the spots or patches may develop to a serious form of skin cancer known as squamous cell carcinoma. However, if treated early, almost all actinic keratoses can be eliminated before developing into skin cancer.

Although an actinic keratosis may be the earliest form of squamous cell carcinoma, this type of cancer isn't life-threatening when detected and treated early. However, it can grow in size, invade surrounding tissues and even spread to other parts of the body.

Treatments:

Actinic Keratoses are usually removed as a precaution, because it is impossible to tell exactly which patches or lesions will develop into skin cancer. A doctor should discuss with his/her patient which type of treatment is most appropriate. These treatments include:

Creams or ointments:
Some topical medications contain imiquimod , which modifies the skin's immune system to stimulate the body's own rejection of precancerous cells. There is another option, a chemotherapy drug called fluorouracil, which destroys actinic keratosis cells by blocking essential cellular functions within them.

Cryotherapy (freezing):
Cryotherapy can be performed in the doctor's office. It takes only a few minutes, and is the most common treatment, during which an extremely cold substance is applied to skin lesions, such as liquid nitrogen, freezing the skin surface and causing it to blister or peel. As the skin heals, the lesions slough off, allowing new skin to appear.

Scraping (curettage):
During this procedure, a device called a curet is used to scrape off damaged cells, which may be followed by electrosurgery, in which a pencil-shaped instrument cuts and destroys the affected tissue with an electric current.

Chemical peeling:
This procedure involves applying one or more chemical solutions to the lesions, such as trichloroacetic acid (TCA) that causes the skin to blister and eventually peel, allowing new skin to form.

Laser therapy:
Local anesthesia is often used to make this procedure more comfortable. During it, a special laser is used to precisely remove the actinic keratoses and the affected skin underneath. Laser therapy may cause some scarring or pigment loss.

Photodynamic therapy:
During this procedure, a photosensitizing agent is either injected or applied topically, making the damaged skin cells sensitive to light. Afterwards, to destroy the damaged skin cells, they are exposed to intense laser light.

Dermabrasion:
Local anesthetic is used to make this procedure more tolerable, during which a rapidly moving brush is used to remove the affected skin.

Actinic keratoses are usually very responsive to treatment. But because these procedures have various advantages as well as disadvantages, including side effects and risk of scarring, a doctor should be consulted so that he can determine which is the best treatment option. Later, to check for new patches or lesions, follow-up visits are required.

Prognosis:

Not available

Expert's opinion

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