14148 Actinic Keratosis

Overview

Actinic keratosis, also called solar keratosis, is a rough, scaly patch on the skin. It forms after years of sun exposure. It is a very early sign of skin damage and can sometimes develop into a type of skin cancer, but most actinic keratoses do not. They are often harmless but should be checked by a doctor.

Yes, actinic keratosis is very common, especially in people over 40 who have had a lot of sun exposure. It is most often seen in people with fair skin.

Actinic keratosis mostly affects people with fair skin, light hair or light-coloured eyes. It is more common in men, in older adults, and in people who work outdoors or spend a lot of time in the sun.

Symptoms

Common symptoms

• Rough, dry, or scaly patches on the skin, often on the face, ears, scalp, lips, backs of hands, or forearms.
• Patches that feel like sandpaper or are crusty.
• Flat or slightly raised patches, often red, pink, or brown.
• Patches that can be itchy, tender, or sore.
• Sometimes the patches can come and go, but they often stay for months or years.

Symptoms in children

• Actinic keratosis is very rare in children.
• When it does happen, it usually appears in teenagers who have had intense sun exposure, especially those with fair skin.
• The patches look the same as in adults: rough, scaly areas on sun-exposed skin.

Symptoms in older adults

• In older adults, actinic keratoses are more common and can be larger.
• They may be thicker, crusty, and sometimes bleed easily.
• Older adults are more likely to have several patches at once.

Causes

Main causes

• Ultraviolet (UV) radiation from the sun over many years.
• Use of sunbeds or sunlamps.
• Some people inherit a lower ability to repair UV damage in skin cells.

Risk factors

• Fair skin that burns easily.
• Blond or red hair, or light-coloured eyes.
• Living in a sunny or high-altitude area.
• Outdoor work or hobbies that expose skin to the sun.
• Having had many sunburns, especially in childhood.
• Age over 40.
• A weakened immune system, for example after an organ transplant or with some medications.

When to see a doctor

See a doctor urgently if:

• See a doctor as soon as possible if a skin patch becomes painful, bleeds, or starts to grow very quickly.
• If you notice a new or changing skin spot on your face, lips, or hands, show it to your doctor.

Book a routine appointment if:

• If you have a rough, scaly patch that does not go away after a few weeks, book a routine appointment with your GP (family doctor).
• If you have several rough patches or a history of sun damage, ask for a full skin check during your routine visit.

Diagnosis

A doctor usually diagnoses actinic keratosis by looking at your skin closely. They may use a special magnifying tool called a dermatoscope to examine the patch better.

Tests that may be done

• Usually no tests are needed.
• If there is any doubt about the diagnosis, your doctor may take a small sample of the skin called a biopsy and send it to a laboratory for examination.

What to expect at your appointment

A skin check is quick and painless. The doctor will ask about your sun history and examine the affected areas. If a sample is needed, they will numb the skin first, so pain is minimal.

Treatment

Treatment for actinic keratosis aims to remove the damaged skin cells, reduce symptoms, and lower the risk of skin cancer. The right treatment depends on how many patches you have, where they are, and what they look like. Your doctor can explain all options.

Self-care at home

• Protect your skin from the sun every day: use a high-factor, broad-spectrum sunscreen, wear a hat, and seek shade in the middle of the day.
• Check your skin regularly for any new or changing patches and show them to your doctor.
• Keep the area moisturised to reduce any dryness or irritation, but remember this does not treat the keratosis.

Medical treatments

Medical treatments for actinic keratosis include creams or gels applied to the skin, freezing the patches with liquid nitrogen (cryotherapy), scraping them off under local anaesthetic, or light-based therapy called photodynamic therapy. These treatments are quick and are done by your doctor or a skin specialist (dermatologist).

When is surgery considered?

In rare cases, a doctor may recommend removing the patch with a small surgical procedure, especially if a biopsy shows abnormal cells that could become cancer.

Living with this condition

Day-to-day, it helps to keep a regular skin routine. Look at your skin in a mirror every month to watch for changes. Keep follow-up appointments with your doctor or specialist. Carry on with normal activities, but always use sun protection when outdoors.

Lifestyle tips

• Wear a wide-brimmed hat and sunglasses when you are outside.
• Use sunscreen on all exposed skin, even on cloudy days.
• Avoid the sun between 10am and 4pm when UV rays are strongest.
• Never use sunbeds or sunlamps.

Diet and exercise

There is no special diet for actinic keratosis, but eating a healthy, balanced diet and staying physically active supports your general health and your skin's repair. Vitamin D is also important, so talk to your doctor about safe sun exposure and supplementation.

Mental health and emotional wellbeing

Worrying about skin cancer is common after a diagnosis of actinic keratosis. These feelings are normal. Knowing that actinic keratoses are very treatable and that monitoring helps catch problems early can be reassuring. If worry affects your daily life, talk to your doctor or a counsellor.

Prevention

Yes, most actinic keratoses can be prevented by protecting your skin from the sun, avoiding sunburns, and never using sunbeds. Sun protection works best if you use it every day, starting in childhood.

Screening programmes

If you have risk factors, consider regular skin checks with your doctor. You can also check your own skin monthly and use a mirror to look at areas you cannot see easily.

Complications

If left untreated

• A small number of actinic keratoses may turn into a type of skin cancer called squamous cell carcinoma.
• If that happens, the cancer is usually very treatable when found early, but it can be more serious if it grows deeply.
• Some actinic keratoses can become large, painful, or even ulcerated.

Long-term outlook

The outlook is good. Actinic keratoses are easily treated, and the risk of progression to cancer is very low. Regular checks and prompt treatment keep the skin healthy and reduce any risk. With sun protection, new patches can also be prevented.

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