Actinic Keratosis (Solar Keratosis)

Actinic Keratosis

What is actinic keratosis? — Actinic keratosis (AK) is a skin condition caused by sun damage. It causes scaly, rough, or bumpy spots on the skin. If an area of skin has more than one spot, the spots are called "actinic keratoses."
AK is most common in people who:
Spend a lot of time outside, or did when they were young – People who work outside, such as farmers and lifeguards, have a higher risk of AK.
Have fair (light) skin and hair
Have freckles
Sunburn easily
Cannot get a tan easily
AK is more common in older people. This is because sun damage builds up over time. Both men and women get AK, but it is more common in men. AK is not common in people with olive-colored or dark skin.
Having one or more painful sunburns in your life raises your risk of getting AK.
Common places for AK include the:
Scalp, in people who are bald or losing their hair
Face
Side of the neck
Backs of the hands and forearms
Legs or feet, especially in women
What are the symptoms of actinic keratosis? — AK looks like an abnormal area of skin. The area of skin can be:
Red and swollen
Thick, crusty, or scaly
Smooth and red
Sticking up, pointed, and hard like a finger nail
One kind of AK can happen on the lip. It can cause a rough, dry, or scaly spot. The lip might also crack or get a sore on it.
Should I see a doctor or nurse? — Yes. Show your doctor or nurse any changes in your skin. AK can turn into a form of skin cancer called "squamous cell carcinoma."
Is there a test for actinic keratosis? — No, there is no one test. The doctor or nurse will do an exam and check your skin. He or she can usually tell if you have AK by looking at any skin changes and touching them.
If the doctor is not sure whether AK is causing the skin changes, you will have a test called a biopsy. You might also have a biopsy if a spot is hard, bleeding, growing quickly, or larger than a certain size.
During a biopsy, a doctor takes a small sample from the abnormal area of skin. Or he or she takes out the whole area. Then another doctor looks at the skin under a microscope to check for skin cancer.
The doctor can also do a different test. In this test, he or she looks at the skin with a small microscope that has a light on it. The doctor holds this over the area with skin changes. The microscope and light help the doctor see under the skin. It can help show if a spot is an AK or something else.
How is actinic keratosis treated? — A few people have AK that goes away on its own. This usually only happens in younger people. Most AK needs treatment. The spots can grow, spread, and turn into skin cancer.
The right treatment depends on the size of the AK, where it is on the body, and whether there are one or more spots.
Doctors can:
Freeze the AK off with a special cold liquid (called liquid nitrogen)
Do a procedure to remove the AK – This involves using special tools to scrape and cauterize (burn) it off.
Give a strong cream or gel to put on the AK – The medicine in the cream or gel can get rid of the AK. If you have an area of skin with several AKs, the doctor might tell you to put cream or gel on that whole area.
Remove the AK with a strong chemical
Do therapy with lights – In this treatment, a doctor puts cream on the skin. This makes it sensitive to a special kind of light. Then, he or she shines the special light on the skin. This reacts with the cream to get rid of AKs.
What happens after treatment? — After treatment, you need to be checked to see if the AK comes back or you get more AKs. The doctor will do an exam and check your skin for changes. You should also keep checking your skin for any new changes. Show any changes you find to your doctor or nurse.
Can actinic keratosis be prevented? — Yes. You can help prevent AK by protecting your skin from the sun. To lower the chance of getting AK, you can:
Stay out of the sun in the middle of the day (from 10 a.m. to 4 p.m.)
Wear sunscreen – An SPF of at least 30 is best. The SPF number is on the sunscreen bottle or tube.
Wear a wide-brimmed hat, long-sleeved shirt, long pants, or long skirt outside.
Not use tanning beds
Even if you already had treatment for AK, protecting your skin can help keep you from getting more.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 82940 Version 5.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.