Doctor explains Actinic Solar Keratosis | Sun damaged skin - causes, symptoms and treatment

Actinic keratoses (AKs) are a common skin condition that arises from prolonged sun exposure, and understanding them is crucial for maintaining skin health. In this article, I will delve into the nature of actinic keratoses, their causes, symptoms, diagnosis, treatment options, and preventive measures.

What Are Actinic Keratoses?

Actinic keratoses, also known as solar keratoses, are rough, scaly patches that develop on sun-exposed areas of the skin. They typically appear on the face, ears, scalp, back of the hands, and forearms.

• The term "actinic" refers to damage caused by sunlight.
• "Keratosis" indicates a thickening of the skin.

These lesions can vary in color, often appearing pink, red, or skin-colored, and they may feel rough or scaly to the touch.

Causes of Actinic Keratoses

The primary cause of actinic keratoses is cumulative sun exposure over the years. Risk factors include:

• Sunbathing and outdoor exposure without UV protection.
• Tanning beds, which emit harmful UV rays.
• Fair skin, light-colored eyes, and red or blonde hair, which make individuals more susceptible to sun damage.
• Prolonged outdoor work or activities without adequate protection.

Importantly, actinic keratoses are not contagious and cannot spread from person to person.

Symptoms and Appearance

Actinic keratoses may:

• Feel rough or scaly, resembling dry skin.
• Vary in size from a few millimeters to 1–2 cm in diameter.
• Appear in clusters in the same sun-exposed areas.
• Be accompanied by sun damage signs such as freckling, blotchiness, and wrinkles.

While AKs are usually asymptomatic, some individuals may experience:

• Itching or tenderness.
• Changes in the lesions (growth, thickening, or bleeding), which could indicate progression to squamous cell carcinoma (SCC), a type of skin cancer.

If an actinic keratosis becomes raised, tender, bleeds, or ulcerates, seek medical advice immediately.

Diagnosis of Actinic Keratoses

Diagnosis is typically straightforward and based on the lesion’s appearance. However, a biopsy may be performed in cases where:

• There is uncertainty about the diagnosis.
• The lesion shows signs of skin cancer.
• The lesion does not respond to treatment.

Treatment Options

While actinic keratoses can be treated, they often recur due to ongoing sun damage. Treatment depends on the number, location, and severity of the lesions.

1. Topical Treatments

• 5-Fluorouracil (Efudex) – A chemotherapy cream that destroys abnormal skin cells.
• Imiquimod – Stimulates the immune system to attack AK cells.
• Diclofenac gel – A non-steroidal anti-inflammatory drug (NSAID) used for mild cases.

Side effects: Redness, inflammation, and peeling during treatment.

2. Cryotherapy (Freezing Treatment)

• Liquid nitrogen is applied to freeze and destroy the actinic keratosis.
• Effective for isolated lesions.
• May lighten skin in the treated area.

3. Surgical Removal

• For larger or concerning lesions, a dermatologist may remove them surgically.
• Can be done via excision, curettage, or electrosurgery.
• Allows for histological examination to rule out cancerous changes.

4. Photodynamic Therapy (PDT)

• Uses a light-activated cream to target abnormal cells.
• Often performed in specialized dermatology clinics.
• Effective for larger affected areas.

5. Laser Therapy

• Targets damaged skin and removes AKs with minimal scarring.
• Less commonly used but effective in certain cases.

Prevention Strategies

Preventing actinic keratoses is key to reducing the risk of skin cancer. Here are five essential strategies:

1. Wear Protective Clothing – Use wide-brimmed hats, long sleeves, and UV-protective sunglasses.
2. Limit Sun Exposure – Avoid the sun between 11 AM and 3 PM, when UV rays are strongest.
3. Use Sunscreen – Apply a broad-spectrum sunscreen with at least SPF 30.
4. Perform Regular Skin Checks – Monitor your skin for changes, and consult a dermatologist if anything unusual appears.
5. Avoid Tanning Beds – Artificial tanning increases the risk of skin cancer.

Conclusion

Understanding actinic keratoses is essential for early detection and treatment. By recognizing their causes, symptoms, and treatment options, you can take proactive steps to maintain healthy skin.

If you notice any changes in your skin or have concerns about actinic keratoses, consult a dermatologist. Staying informed and protected is the first step in preventing serious skin conditions.