What Is an Actinic Keratosis?
An actinic keratosis is a rough, scaly patch on your skin caused by too much exposure to the ultraviolet rays of the sun or tanning devices. Actinic keratoses (the plural form) can also be called solar keratoses. It's important to know about them because they can turn into skin cancers called squamous cell carcinomas.
It's estimated that more than 40 million Americans develop actinic keratoses each year. This condition is more common at high altitudes and in sunny countries closer to the equator. While most people who get actinic keratoses are over age 40, they can happen in younger adults who spend a lot of time outside in the sun or inside at tanning facilities.
Actinic Keratosis Causes
An actinic keratosis can develop when your skin is damaged by frequent or intense exposure to ultraviolet light from:
- The sun
- Tanning devices, such as tanning beds and sunlamps
This kind of damage builds up over time. That's why actinic keratoses become more common with age. The damage affects cells in the outer layer of your skin called keratinocytes, leading to inflammation and other changes that cause abnormal cell growth.
Actinic Keratosis Risk Factors
While anyone can get actinic keratoses, you are more likely to develop them if you::
- Have fair skin
- Have blond or red hair
- Have blue or green eyes
- Tend to freckle or burn in the sun
- Have a history of sunburns
- Have spent a lot of time in the sun – including working outside
- Have a suppressed immune system
- Are over age 40
Actinic Keratosis Symptoms
Actinic keratoses usually show up on areas of skin that get lots of sun exposure. That might include your:
- Face
- Ears
- Scalp
- Hands
- Legs
- Arms
The first sign of an actinic keratosis is usually a raised, rough bump. The bump may be gray, pink, red, or the same color as your skin. It's often covered by a yellow or brown crust. Sometimes it's easier to feel than to see. It tends to feel like sandpaper.
Symptoms might also include:
- Bleeding
- Burning
- Itching
- Dry, scaly lips
- Hornlike growths that stick out
- Lost color in the lips
- Pain or tenderness
Whether it looks like a actinic keratosis or not, if you have any skin spot that's new, tender, bleeding, or that changes in appearance, see a doctor.
Actinic Keratosis Diagnosis
Your primary doctor or a dermatologist (skin doctor) can often diagnose actinic keratoses by looking closely at your skin and examining it with a magnifying tool. In some cases, they might confirm the diagnosis by doing a biopsy, which means taking off a piece of skin and sending it to a lab for closer examination under a microscope.
If you have had past actinic keratoses or are at risk of other sun-related skin changes, your doctor might recommend regular full-body skin exams to look for any concerning spots and diagnose them promptly.
Actinic Keratosis Treatment
The aim of actinic keratosis treatment is to remove the spot so it doesn't turn into a skin cancer. They can be removed in several ways, with procedures or medications. Here are the common procedures.
Cryosurgery. In this quick office procedure, the doctor uses liquid nitrogen to freeze the surface skin. This can cause some skin redness and blistering until the area is replaced with new skin. This is the most commonly used treatment for an actinic keratosis.
Surgical removal and biopsy. If you have the spot removed to confirm the diagnosis, no further treatment may be needed.
Photodynamic therapy. A chemical is put on the skin. Then the skin is exposed to a light that activates the chemical to destroy the abnormal skin cells. There can be burning, stinging, and changes in skin pigment.
Chemical peel. A chemical solution is put on the skin to cause blistering and peeling away of the actinic keratoses. You'll likely have temporary redness and swelling.
Dermabrasion. This uses a handheld device to "sand" the skin and improve its appearance. It can be used to treat large lesions that are often too big to treat with topical treatments. It leaves the skin red and raw and can hurt. A topical numbing ointment, nerve blocks, or other pain medications are often used.
Topical medications
Another way to clear up actinic keratoses is to apply medication to the spots. This can be especially useful when you have a lot of them on your face, scalp, or elsewhere. These medications, all of which are approved by the FDA, include:
5-fluorouracil. This is a cream applied to the spot or the entire sun-damaged area once or twice a day for several weeks. Usually, the skin turns red and blisters before new skin appears. It's considered one of the most effective treatments. But it can harm an unborn baby, so it's not safe if you are pregnant.
Imiquimod cream. This medication works with your immune system to clear actinic keratoses. You might apply it just once or twice a week for a few months or use it daily for a couple of weeks at a time. There may be redness, itching, swelling, crusting, and peeling. It's usually used on limited areas of your face or scalp.
Diclofenac sodium. This nonsteroidal anti-inflammatory gel can be applied twice a day for 2 to 3 months to clear up actinic keratoses. It can have milder side effects than alternative skin treatments.
Tirbanibulin ointment: This may be an option for spots on your face and scalp. You use it for just 5 days in a row.
Note: a previously available fast-acting gel called ingenol mebutate has been pulled from the U.S. market because of safety concerns.
Oral medications
Oral medications – pills – aren't commonly used for actinic keratoses. But studies have shown that daily doses of vitamin B3 may help limit actinic keratoses in some people. Retinoids, which are natural and synthetic forms of vitamin A, have shown some promise for preventing and treating actinic keratoses, particularly in transplant recipients – whose impaired immune systems put them at high risk of skin cancers.
Actinic Keratosis Home Remedies
The main treatments to use at home for actinic keratoses are FDA-approved creams, gels, or ointments prescribed by your doctor.
One topical medication, diclofenac skin gel (sold under the brand name Voltaren) is available without a prescription. But you shouldn't use it to treat actinic keratosis without a doctor's recommendation.
Note: You should apply any product evenly and carefully, avoiding sensitive areas such as the eyes and lips.
Post-treatment at-home care: If you've had actinic keratoses removed, through cutting, freezing, or other methods, be sure to ask your doctor how to care for the skin at home. Typically, you'll be asked to keep the area clean and to put petroleum jelly and bandages on any wound until it heals. Do not put hydrocortisone or other corticosteroid products on your treated skin because the corticosteroids might stop your treatments from working.
Natural remedies for actinic keratosis: There's no natural home remedy for actinic keratosis. Doctors have reported a single case in which an actinic keratosis may have been successfully treated with kanuka honey, which may have anti-inflammatory and immune system effects. But there's been no follow-up study to find out whether that really works.
Actinic Keratosis Complications
The most common complications of actinic keratoses are from treatment: You may have pain, inflammation, healing issues, skin color changes, or scarring.
But not treating these spots could have more serious consequences.
Most actinic keratoses, about 90%, never turn into skin cancers. But almost all squamous cell carcinomas of the skin start out as actinic keratoses. That's why it's important to recognize and treat them.
Squamous cell skin cancer is the second most common form of skin cancer. Unlike melanoma, the most serious form, squamous cell skin cancers rarely spread elsewhere in your body or threaten your life. But it can happen if the cancer is left untreated for a long time or you have a damaged immune system.
Treatment of squamous cell cancers can leave scars as well.
Actinic Keratosis Prevention
The best way to prevent actinic keratoses is to protect your skin from UV exposure.
To do that:
- Avoid the sun during peak hours, about 10 a.m. to 2 p .m.
- Seek the shade outdoors.
- Wear clothing that covers your arms and legs, along with sunglasses and a broad-brimmed hat.
- Use sunscreen with a sun protection factor (SPF) of 30 or higher, applying it at least 15 to 30 minutes before going outside.
- Choose a sunscreen that's labeled “broad-spectrum,” with UVA and UVB protection.
- Reapply sunscreen every 2 hours when outdoors, even on cloudy days, and more often if you're sweating or swimming.
- Avoid tanning salons, sunlamps, and tanning beds.
Remember that it's light from the sun that can be dangerous, so you can be at risk even when the temperature is mild.
Takeaways
Actinic keratoses are a common result of spending too much time in the sun or using tanning devices. They can sometimes develop into a form of skin cancer. So it's important to watch for these rough, scaly spots and to get them treated. Once you've had one or more actinic keratoses, you are at risk of having more – but protecting yourself from the sun can reduce your risk.
Actinic Keratosis FAQs
What is actinic cheilitis?
An actinic cheilitis is the same as an actinic keratosis, except that it's on your lip, not elsewhere on your skin. Like any such spot, it can turn into a squamous cell cancer if it's not removed.
How long does it take for actinic keratoses to become cancerous?
Most of these lesions – about 90% – will never become skin cancer. But the few that do typically take about 2 years to change into squamous cell skin cancer, research suggests.
