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Actinic keratosis

Definition

Actinic keratosis is a small, rough, raised area found on skin that has been in the sun for a long period of time.

Some actinic keratoses may develop into a type of skin cancer.

Alternative Names

Solar keratosis; Sun-induced skin changes - keratosis; Keratosis - actinic (solar)

Causes, incidence, and risk factors

Actinic keratosis is caused by being in sunlight.

You are more likely to develop this if you:

  • Have fair skin, blue or green eyes, or blond or red hair
  • Had a kidney or other transplant
  • Take medicines that suppress the immune system
  • Spend a lot of time each day in the sun (for example, if you work outdoors)
  • Had many, severe sunburns early in life
  • Are older

Symptoms

Actinic keratosis is usually found on the face, scalp, back of the hands, chest, or other sun-exposed areas.

  • They begin as flat and scaly areas.
  • The color may be gray, pink, red, or the same color as the skin.
  • Often, it has a white or yellow crusty "scale" on top.
  • Later it develops a hard and wart-like or gritty, rough, surface.
  • It may be easier to feel than see.

Signs and tests

Your doctor or nurse can diagnose this condition by looking at your skin. A skin biopsy may be sometimes be done to see if it is cancer.

Treatment

Some actinic keratoses becomeo squamous cell skin cancer. That's why you should have all skin growths looked at by a doctor as soon as you find them. Your doctor will tell you how to treat it.

Growths may be removed by:

  • Burning (electrical cautery)
  • Scraping away the lesion and using electricity to kill any remaining cells (caled curettage and electrodesiccation)
  • Cutting the tumor out and using stitches to place the skin back together (called excision)
  • Freezing (cryotherapy, which freezes and kills the cells)

If you have many, your doctor may recommend:

  • A laser treatment called photodynamic therapy
  • Chemical peels
  • Skin creams such as 5-fluorouracil (5-FU) and imiquimod

Expectations (prognosis)

A small number of these skin growths turn into skin cancer.

Complications

  • Irritation and discomfort of the skin growth
  • Scarring from the treatment
  • Squamous cell carcinoma

Calling your health care provider

Call your health care provider if you see or feel a rough or scaly spot on your skin, or if you notice any other skin changes.

Prevention

You can prevent this condition by protecting your skin from sunlight. 

  • Wear protective clothing such as hats, long-sleeved shirts, long skirts, or pants.
  • Try to avoid being in the sun during midday, when ultraviolet light is most intense.
  • Use high-quality sunscreens, preferably with a sun protection factor (SPF) rating of at least 15. Pick a sunscreen that blocks both UVA and UVB light.
  • Apply sunscreen before going out into the sun, and reapply often.
  • Use sunscreen year-round, including in the winter.
  • Avoid sun lamps, tanning beds, and tanning salons.

Other important sun safety facts:

  • Sun exposure is stronger in or near surfaces that reflect light, such as water, sand, concrete, and areas painted white.
  • Sun exposure is more intense at the beginning of the summer.
  • Skin burns faster at higher altitudes.

References

Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2009:pp 812-818.

Ibrahim SF, Brown MD. Actinic keratoses. In: Lebwohl M, ed. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009.


Review Date: 11/22/2011
Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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