Actinic keratosis

What is actinic keratosis?

It is a dermatological (or skin) disease. The word actinic keratosis itself describes what has happened to the skin. The Greek words ‘actinic’ stands for ray and ‘keratosis’ means hardening of the skin. Actinic keratosis is the outgrowth of a scaly and crusty outgrowth on the skin due to damage from the exposure of the ultraviolet (UV) rays of the sun. It is also known as solar keratosis. In most of the cases, several scaly outgrowths are found in case of actinic keratosis. It is considered precancerous as if untreated it gives rise to skin cancer or the second most common type of cancer- squamous cell carcinoma. Actinic keratosis is the most common form of precancerous skin lesions. Actinic keratosis affects people who are exposed to sunlight for long hours or those who are excessively exposed to artificial UV rays like indoor tanners. The lesions may occur on bald scalp, nose, face, ears, neck, legs or any other exposed part of the body.

What are the symptoms of actinic keratosis?

Although actinic keratosis may occur in solitary, the lesions found are always in a plural number. The general appearance of the patches varies. The following are the most common symptoms of this skin disease –

• The patches on average have a diameter of 12.5 cm to 25 cm. Although the large ones can spread over a diameter of 2.5 m (or, 1 inch).
• It may both be flat or may occur with a small elevation on the top layer of skin.
• The lesion is dry, rough and scaly which will feel like a sandpaper when brushing fingers over it.
• Most of the actinic keratosis lesions turn red but they may also be pink, skin-colored, white or dark tan in color.
• Tender or asymptomatic.
• Some of them have wart-like texture.
• In the case of squamous cell carcinoma (SCC) cutaneous horn may arise from actinic keratosis.
• Skin near the lesion always shows some evidence of sun damage like hyperpigmentation, deep wrinkles etc.

Actinic keratosis Types

Actinic keratosis can be divided into three distinguishable grades which are as follows-

• 1st Grade: Not easily visible and slightly palpable (can be felt better than seen)
• 2nd Grade: Easily visible and palpable (can be felt both by touching and seeing)
• 3rd Grade: Visible frankly and hyperkeratotic (clinically obvious)

Actinic keratosis can be divided into a number of varieties according to its appearance.

• Hyperkeratotic Actinic keratosis or the formation of a cutaneous horn-like structure from the underlying SCC cells.
• Pigmented Actinic Keratosis or spreading Actinic Keratosis may be of different colors varying from yellow to brown. They are much smoother than other actinic keratoses.
• Lichenoid actinic keratosis generally occurs in the upper torso and is not diagnostically distinguishable from another type of lesions of the same disease.
• Atrophic actinic keratosis is devoid of epidermal proliferation found in the hypertrophic ones.

These subtypes actinic keratosis as mentioned above does not always have some independent existence they may coexist or overlap with another subtype.

What are the causes of actinic keratosis?

Actinic keratosis may occur due to any of the following reasons.

• Excessive exposure to the sun due to work or recreation.
• It is common for organ transplant patient as the immune system gets weak and the WBC are busy fighting with the foreign bodies putting stress on the immune system.
• With aging getting easily affected by this skin disease.
• White skinned people are more vulnerable to this pigmentation disorder.
• Many scholars connect actinic keratosis with viral infection caused by Human Papilloma Virus (HPV).

How can actinic keratosis be diagnosed?

A trained dermatologist can easily recognize an actinic keratosis even when the lesion (s) is/ are at the 1st Grade stage by closely examining the skin. Generally, the actinic keratosis is much thicker and rough than any other skin disease and a dermatologist can determine whether the scaly patch has any precancerous characteristics.

A skin biopsy will assure whether the keratosis is associated with actinic keratosis. While actinic keratosis can easily be diagnosed, it is a rare disease and is often misdiagnosed as basal cell carcinoma (BCC), seborrheic keratosis (associated with sebaceous glands) and malignant skin cancer. Often suspecting skin cancer dermatologists go for immediate operation and cut off the patch, but in actinic keratosis, the lesions will again appear at some other place. Unexperienced medicine practitioners often go for fungal infection at first which delay the starting of the actual treatment. In children, actinic keratosis is often conceptualized as psoriasis, which is another more common skin disease in newborns and children.

Actinic keratosis Treatment

The treatment for actinic keratosis depends largely on the number of lesions appeared since the probity of becoming a squamous cell carcinoma (SCC) is directly proportional to the number of lesions. The treatment may be both medicinal and operational. Medical therapy includes treatment with 5-fluorouracil, ingenol mebutate, etc. Surgical therapy aims at complete eradication of the actinic keratosis lesions.

Actinic keratosis Preventions

Keeping in mind that prevention is the best cure here are some measures that can be undertaken to avoid the disease.

• An individual shall not expose to sun rays, especially from 10 am to 3 pm.
• Should wear proper anti-sun gears and clothing and use adequate sunscreens of SPF30 or more.
• Follow a low-fat diet.

Those who have a family history of skin cancer and those who have whitish or fair skin tone must be more precautious about the preventive measures.

Actinic keratosis Pictures

Actinic keratosis FAQs

Does all actinic keratosis necessarily turn to be cancerous?

Chances of a single lesion to become cancerous is quite low (<10%). The number of lesions dictates the chances of skin cancer. However, proper treatment from the beginning can nullify the chances of malignancy completely.

When do the symbols appear?

The symbols appear within an hour of exposure and become easily recognizable after a day.

When to consult a professional?

Call a professional when you have a dry, scaly or warty patch with red or any other mentioned colors and the lesion is unresponsive to non-prescribed medicines.