Actinic Keratoses

Actinic keratoses (AK) are small, rough, raised areas found on skin that has been exposed to the sun over a long period of time. They are also commonly referred to as solar keratoses. They are common in older adults, particularly in those with fair skin, and are considered precancerous as they can lead to squamous cell carcinoma. Understanding AK is crucial for early intervention and prevention of skin cancer.

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Key Points

What is actinic keratoses?

Actinic keratoses are small, rough patches on the skin, often felt before they are seen. They result from long-term exposure to sunlight and are a warning sign of skin damage that could potentially lead to skin cancer.

Who gets actinic keratoses?

Actinic keratoses are more common in older adults, especially those with fair skin, a history of sunburns, or a high level of sun exposure. They are less common in younger people and those with darker skin tones.

Clinical features

Actinic keratoses typically appear on sun-exposed areas such as the face, ears, neck, scalp, and arms. They are characterised by rough, scaly patches that can be pink, red, or flesh-coloured.

Diagnosis and differential diagnosis

Diagnosis is primarily based on the clinical appearance of the skin. A biopsy may be performed to rule out Bowen’s disease or squamous cell carcinoma. Differential diagnosis includes Bowen’s disease, seborrheic keratosis, basal cell carcinoma, and psoriasis.

Impact and complications

If untreated, actinic keratoses have to potential to progress to squamous cell carcinoma. They can also cause cosmetic concerns and may be symptomatic, with itching or tenderness.

Subtypes and variants

The main subtypes of actinic keratoses include – 

  • Hyperkeratotic –  Thick and wart-like.
  • Atrophic –  Thin and appear eroded.
  • Pigmented –  Resemble lentigo maligna.
  • Actinic cheilitis –  Affects the lips.

Causes and triggers of actinic keratoses

  • Cumulative Sun Exposure –  The primary cause. 
  • Age –  More common in older adults.
  • Skin Type –  Fair skin types are more susceptible.
  • Geographical Location –  Higher incidence in areas with high UV.
  • Immune Status –  Immunosuppressed individuals are at higher risk.

Treatment options for actinic keratoses

The treatment of actinic keratoses (AK) involves a variety of options that depend on the number, size, and location of the AK lesions, incorporating both medical and procedural approaches. Lifestyle measures are crucial, with sun protection playing a key role; this includes the use of sunscreen and protective clothing to minimise further sun damage. Topical treatments, such as chemotherapeutic creams, immune stimulator creams and others are commonly employed to address these lesions. Photodynamic therapy remains a popular option due to the quicker recovery time and in-clinic nature of treatments.  While oral treatments are uncommonly used, Vitamin-A derived prescribed tablets may be prescribed in specific cases. Physical treatments like cryotherapy and curettage are also effective in managing AK lesions. It’s important to avoid further sun exposure to prevent new lesions from developing. Regular monitoring and adjustments to treatment are common practices to effectively manage actinic keratoses and prevent progression.

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