Actinic keratosis

Actinic keratosis (also called solar keratoses) are scaly, crusty patches of skin that are caused by sun damage (UV light).

They most commonly develop on areas of skin that get a lot of sunlight, such as on your face, neck, backs of hands, ears, lower legs, scalp (if you have a bald patch) or forearms. In rare circumstances, they may also appear on your lip.

Actinic keratosis are uncommon in people under the age of 40, as they usually only appear after years of sun exposure, and the condition will often cause no other symptoms.

Although rare, a small percentage of these patches of skin may eventually lead to a form of skin cancer, so it is always best to get it checked out by a doctor as soon as possible.

Things to look out for include:

  • Scaly, crusty or dry patch of skin, that’s sometimes raised
  • Patches can be pin-head sized, or have a diameter of 1 to 3cm
  • A pink, red or brown colouring around the affected area
  • Burning, itching or soreness in the affected area

You should not try to diagnose actinic keratosis yourself, due to the small chance it could be cancerous, or lead to cancer.

A doctor will usually be able to diagnose the condition just by looking at the affected area. If they can’t diagnose it this way, they may refer you for a skin biopsy where a small sample of your skin will be taken for analysis and further testing.

It is particularly important to see a GP if a skin patch:

  • Grows quickly
  • Bleeds or becomes painful
  • Does not clear up on its own
  • Has a hard skin growing out of it that looks like a horn (cutaneous horn)

If you have had actinic keratosis before, and you think that a new patch has developed, you should also see a GP.

Actinic keratosis appears on skin that has been exposed to the sun or to UV rays from tanning beds. Anyone can have it, but because they usually develop after many years of sun exposure; they mainly occur on people aged 40 or over.

You are also more at risk of developing actinic keratosis if you:

  • Live or have lived in a sunny country
  • Burn easily or get freckles when in the sun
  • Have had a lot of sunburn in the past or intense sun exposure
  • Have already had actinic keratosis or skin cancer
  • Are blonde or a red head
  • Have blue or light-coloured eyes
  • Have a weakened immune system

If it is caught early, actinic keratosis can be successfully treated before it gets more serious, which is why it is important not to delay seeing a doctor.

If left untreated, the condition can sometimes lead to a cancer called squamous cell carcinoma (SCC), which although not life threatening usually needs surgery, again showing the importance of seeing a GP as soon as you can.

Signs that it may have developed into cancer include it becoming ulcerated, bleeding or getting bigger in size quickly.

A doctor may recommend just keeping an eye on the skin patches, and to seek medical help if you notice any changes. You may find that they disappear on their own, but this is usually temporary and they may reappear when your skin is exposed to the sun again.

Sometimes actinic keratosis are removed as a precaution because it is difficult to know which ones may develop into cancer.

Treatments may include:

  • Topical treatments – creams, gels and ointments may be prescribed to help clear them up.
  • Freezing – this is the most common treatment and it is pretty simple to carry out. The patches are frozen (cryotherapy) with liquid nitrogen so that they blister and then fall off.
  • Scraping - a surgeon scrapes off (curettage) the damaged skin cells under local anaesthetic.
  • Photodynamic therapy (PDT) - a chemical solution is applied to the skin to make it sensitive to light. An artificial light is then used to destroy the damaged skin cells.

You can help to protect your skin from the sun by:

  • Protect yourself from UV rays - if you work or spend a lot of time outside, are on holiday or live in a sunny climate then you should use a sunscreen with a sun protect factor of at least SPF 30. Remember, if you go into water, or sweat a lot in the sun, you need to top up once you get out, as although some sunscreen is water resistant, it is not waterproof.
  • Stay out of or limit your time in the sun - sun exposure over time increases the risk of actinic keratosis, so you should look to limit the amount of time you spend in the sun and avoid being out when it is at its strongest, which is usually from 11am – 3pm, but this varies in different countries.
  • Cover yourself up - you can protect your skin by wearing clothing that covers your arms and legs, and any other area that is exposed. Also wear a hat – a large brimmed one will help protect your face, neck, ears and shoulders.
  • Check your skin regularly - keep an eye out for new skin growths, as well as for changes in existing moles, bumps and freckles.
  • Avoid tanning – if you are a fan of sitting in the sun, or of tanning beds, you are exposing yourself to harmful UV rays in a short amount of time, which can lead to actinic keratosis.

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