Symptoms, Diagnosis, and Treatment for Actinic Keratosis
As you age, you might notice that your skin changes.
New wrinkles and lines are to be expected, but you may also notice the development of new moles, freckles, or spots. Some changes are a normal part of aging, and some are a sign of more serious conditions.
It is important to monitor and check new spots of aging to rule out the possibility of cancerous or precancerous growths like actinic keratosis.
In this article, we will discuss the symptoms, causes, diagnosis, and treatment for actinic keratosis.
Table of Contents
- What Is Actinic Keratosis?
- What Causes Actinic Keratosis?
- What Are the Symptoms of Actinic Keratosis?
- How Is Actinic Keratosis Diagnosed?
- How Is Actinic Keratosis Treated?
- What Happens If You Don’t Treat Actinic Keratosis?
- Goodskin Dermatology Provides High-Quality, Patient-Based Care for Actinic Keratosis
What Is Actinic Keratosis?
Actinic keratosis (AK), also known as solar keratosis, is a form of abnormal skin cell growth that causes scaly, dry patches on the skin.
Actinic keratosis is a common precancerous skin condition. Data predicts that at least 58 million Americans will have at least one patch of actinic keratosis. Unfortunately, many cases of actinic keratosis are undiagnosed. Only 40 million Americans are diagnosed with this condition each year.
What Causes Actinic Keratosis?
Long-term, frequent, and intense exposure to UV rays is the cause of almost all actinic keratosis cases. UV ray exposure can cause damage to the skin which can compound over time. Even regular short-term exposure can build up over a lifetime.
To decrease the risk of developing actinic keratosis or other conditions caused by UV radiation, experts recommend:
- Staying in the shade during midday hours.
- Dressing to protect sensitive areas from the sun.
- Wearing sunscreen with an SPF of 15 or higher.
- Avoiding the use of tanning beds.
Risk Factors for Actinic Keratosis
Since cumulative UV exposure is the most likely cause of actinic keratosis, age is the most common risk factor. According to one Baltimore study, the prevalence of AK in patients of different age groups is estimated as:
- .01% for individuals ages 30-39
- .45% for individuals ages 40-49
- 1.77% for individuals ages 50-59
- 4.61% for individuals ages 60-69
- 9.38% for individuals ages 70-79; and
- 14.57% for individuals ages 80-89
Other risk factors can be predisposed or a consequence of lifestyle choices such as:
- Skin type
- Weakened immune system
- Geographical proximity to the equator
- Amount of sun exposure due to hobbies or occupations
- Sex — men (26.5%) are more likely to develop AK than women (10.2%)
What Are the Symptoms of Actinic Keratosis?
Actinic keratosis most often appears as a lesion on the top layer of the skin. This lesion may have a rough, scaly, or even wart-like appearance. Spots of AK are typically less than an inch in diameter and can be flat or slightly raised.
Where Does Actinic Keratosis Appear?
Actinic keratosis can appear on any part of the body that has been subject to long-term sun exposure. Generally, AK is most likely to appear on the face, lips, ears, scalp, forearms, neck, or back of the ears. In extremely rare instances, actinic keratosis may appear in the form of a cutaneous horn.
What Color Is Actinic Keratosis?
Actinic keratosis lesions are commonly brown or yellow but can appear as other colors or mixtures including:
- Red
- Tan
- Pink
- Skin-toned
- Silvery
Does Actinic Keratosis Hurt?
AK can make the skin feel dry and tight. In some cases, actinic keratosis may feel tender, raw, or sore.
In rarer cases, it can cause bleeding or sores called ulcerations.
How Is Actinic Keratosis Diagnosed?
During diagnosis, a dermatologist may ask you a series of health-related questions like sun exposure, sunscreen use, and medical history followed by an inspection of your skin. Samples of lesions that are suspected to be precancerous or cancerous may be extracted for biopsy.
The Journal of the American Academy of Dermatology (JAAD) recommends a full-body skin evaluation (FBSE) every two to three years, if not annually. This is especially important for individuals who are at high risk for developing skin cancer or actinic keratosis.
At Goodskin Dermatology, we encourage our patients to take changes in their skin seriously. Self-examination is your first line of defense against skin cancer, but expert inspection and evaluation can catch conditions that might have otherwise gone unnoticed.
How Is Actinic Keratosis Treated?
Actinic keratosis treatment may vary depending on the individual. If you have or suspect that you have AK, it is recommended that you consult your healthcare provider when considering treatment options.
Several factors may influence your treatment options. These factors include:
- The number of AK lesions present
- Location
- Size and appearance
- Whether you have a history of skin cancer
- Other current medical conditions
Treatment for actinic keratosis may range from topical, at-home treatments to ablative procedures. Treatments may be individual legion-based (treating one isolated area) or field-based (treating a larger area).
Topical Treatments
Topical treatments are field-based and generally prescribed to patients with numerous or widespread AKs.
A healthcare provider may prescribe you an ointment or gel to apply as recommended. The goal of this actinic keratosis treatment is to decrease the presence of actinic keratosis over time and with minimal scarring and downtime.
Symptoms may include:
- Burning, itching, and irritation
- Redness
- Crusting
Typically, the presence of these side effects means that the medication is working. If these side effects worsen while using or persist after use, contact your doctor.
Fluorouracil
Fluorouracil is a class of medications called antimetabolites. This medication works by killing the fast-growing cells in AK and other skin conditions.
Brand names for this type of medication are:
- Carac
- Efudex
- Fluoroplex
This medication is generally prescribed to be applied twice a day for 2-4 weeks. If you are prescribed fluorouracil, use as directed by your doctor.
Imiquimod
Imiquimod is a type of medication that treats AKs by stimulating the body’s immune system and destroying affected cells. It is generally recommended that imiquimod is applied before bedtime, as it must sit on the skin for several hours.
For actinic keratosis, you may be instructed to use this medication twice a week for 16 weeks. As always, use prescribed medication as directed by your doctor.
Diclofenac
Diclofenac is a topical treatment that comes as a gel and is generally paired with hyaluronic acid. The active ingredient of this medication is diclofenac sodium which is a non-steroidal anti-inflammatory drug (NSAID).
How diclofenac treats AKs is not fully understood. Research has revealed that diclofenac is a potent inhibitor of cyclo-oxygenase, which can cause the reduction of prostaglandin synthesis. Sun damage and actinic keratosis are linked to raised levels of prostaglandin production.
If you are prescribed diclofenac, you may be instructed to apply the gel twice a day for 30-60 days.
Photodynamic Light Therapy
The goal of this actinic keratosis treatment is to destroy the cells in the AK so that new unaffected skin can grow.
Photodynamic light therapy is successful at eliminating actinic keratosis growths but may require multiple treatments. This type of treatment may be field-based or individual legion-based.
Photodynamic therapy (PDT) is a medical procedure that incorporates the use of blue fluorescent light to activate an applied topical medication (aminolevulinic acid).
When the aminolevulinic acid (ALA) is exposed to the blue fluorescent light, it is converted to a naturally occurring substance called protoporphyrin IX. The protoporphyrin IX then absorbs the energy emitted by the blue light and produces oxygen free radicals which then kill the abnormal cells.
The ALA must sit on the skin and incubate for some time before blue light exposure begins.
For mild cases of AK, incubation may take about 90 minutes. For more intense cases, your physician may increase the incubation time to 2-4 hours.
The blue light exposure time is much shorter. You can expect to sit under the blue light for roughly 15 minutes. You might experience mild discomfort with this treatment, but any burning or tingling should cease as soon as the light is turned off.
This procedure is generally safe, with few risks and downtime is minimal. PDT can increase photosensitivity (sensitivity to light) so it may be recommended that you avoid light for at least 40 hours following treatment.
Any lasting irritation like burning or stinging may last for up to 24 hours. Any redness/swelling or scaling/crusting may last up to 4 weeks following treatment.
Surgical Procedures
Surgery as an actinic keratosis treatment is typically used for cases that present as one or more isolated lesions (individual legion-based). Typically, these procedures may on need to be performed once on a single AK.
Cryosurgery
Cryosurgery is the most common treatment for actinic keratosis presenting as single lesions. High-grade, medical liquid nitrogen is applied to the affected areas, instantly freezing and killing the abnormal skin cells causing them to eventually slough off.
The liquid nitrogen can be applied with a:
- Cotton swab
- Dipstick
- Cryospray/cryoprobe
This procedure only takes minutes and can be done in the office with little need for preparation. You may feel pain as the liquid nitrogen is applied but the pain greatly diminishes after an hour or so. While the lesion sheds, it and the surrounding skin may feel irritated for about a week.
Curettage and Desiccation
Curettage is performed by a physician using a curette to scrape the actinic keratosis off. Generally, local anesthesia is administered to diminish pain. This method is generally used to treat thicker patches of actinic keratosis.
After the AK lesion is removed, the area is usually desiccated. This involves using a small burst of electric current to cauterize the wound. It may take up to six weeks for the treated patch to heal.
Excision
For actinic keratosis that may be more advanced and likely cancerous, excision will be implemented. During this procedure, your healthcare provider will administer local anesthesia and excise the lesion with a scalpel. To close the wound, stitches will be applied.
There may be a little downtime associated with this procedure to ensure that your stitches remain intact.
What Happens If You Don’t Treat Actinic Keratosis?
If left untreated, actinic keratosis has the propensity to develop into squamous cell carcinoma (SCC). Research suggests that 10% of actinic keratosis cases may develop in SCC if allowed to progress if untreated for approximately two years.
It is nearly impossible to predict which AK lesions will progress into skin cancer. For this reason, all actinic keratosis cases are treated as precancerous and suggested for removal.
Sun damage is common, especially in individuals who do not use sunscreen. To preserve your health, it is important that you monitor changes in your skin and have a dermatologist address any concerns.
Goodskin Dermatology specializes in the diagnosis and treatment of skin ailments like actinic keratosis and other skin cancers. AK often presents itself in more than one lesion, a full-body skin evaluation will help our team uncover any other issues. If our providers find anything, a small sample will be taken for biopsy. After 7-10 days the biopsy will return with your results and our team will consult you on how to proceed.
Goodskin Dermatology Provides High-Quality, Patient-Based Care for Actinic Keratosis Treatment
Despite actinic keratosis being a common ailment, 85% of individuals in the U.S. are unaware of its existence. AK is more than just a cosmetic blemish — it is a health risk.
At Goodskin Dermatology, it is our mission to not only treat the public for these conditions but to educate them as well. We aim to make all of our patients feel understood and respected, no matter their condition.
We will walk you through diagnosis and treatment while providing high-quality, patient-centered care compounded with state-of-the-art technology and treatment methods.
Your skin is one of your largest and most important organs so you should take care of it. Schedule an appointment at Goodskin Dermatology to protect your skin’s health.