Actinic Keratoses

Overview

Actinic keratoses (also called solar keratoses) are rough, scaly patches on the skin that develop after many years of sun exposure. They are a sign of sun damage and are sometimes called 'pre-cancerous' because, in rare cases, they can turn into a type of skin cancer. However, most actinic keratoses stay harmless.

Very common. They affect about one in four adults at some point in their lifetime.

They most often affect people with fair skin, light hair, or light eyes — especially after age 40. People who have spent a lot of time in the sun or used tanning beds are also more likely to develop them.

Symptoms

Common symptoms

• Rough, scaly patches that feel like sandpaper
• Flat or slightly raised areas of skin
• Colours ranging from pink, red, brown, or skin-toned
• Itching, burning, or tenderness in the affected patches
• Patches commonly appearing on the face, ears, scalp (if balding), backs of hands, forearms, and lips

Causes

Main causes

• Ultraviolet (UV) radiation from the sun or tanning beds damages the top layer of skin over time. The skin responds by forming rough, scaly areas.

Risk factors

• Fair skin, light hair, or light eyes
• History of sunburns, especially in childhood
• Many years of outdoor work or leisure activities
• Living in sunny climates
• A weakened immune system from medication or illness
• Older age
• Male sex

When to see a doctor

See a doctor urgently if:

• Seek same-day medical care if a patch becomes very painful, rapidly changes shape or colour, starts bleeding, or turns into a non-healing sore.

Book a routine appointment if:

• Make a routine appointment if you notice a new rough, scaly patch that feels like sandpaper and does not go away after a few weeks.

Diagnosis

A doctor can usually diagnose actinic keratoses by looking at your skin and feeling the patches. They may use a magnifying tool called a dermatoscope to see the skin more closely.

Tests that may be done

• A skin examination with a dermatoscope
• A skin biopsy (removing a small piece of skin to be tested in a laboratory)

What to expect at your appointment

The doctor will look at the affected skin and ask about your sun exposure history. If a biopsy is needed, it is quick and done with local numbing medicine. You may feel a small pinch. The sample is sent to a lab, and results usually come back within one to two weeks.

Treatment

The aim of treatment is to remove the damaged skin cells and lower the risk of skin cancer. The best option depends on how many patches you have, where they are, and what they look like. Not all actinic keratoses need treatment, but it is usually recommended to treat them.

Self-care at home

• Protect your skin from the sun: use sunscreen, wear a wide-brimmed hat, and cover your arms and legs.
• Avoid sunbeds and tanning lamps.
• Check your skin regularly and tell your doctor about any new or changing patches.

Medical treatments

Various treatment approaches are available. These may include prescription creams or gels applied to the skin over several weeks, cryotherapy (freezing the patch with very cold liquid), photodynamic therapy (a light treatment activated after applying a cream), or curettage (scraping the patch away after numbing the skin). Your doctor will explain the most suitable option for you. Do not use over-the-counter treatments without a doctor's advice.

When is surgery considered?

Surgery is rarely needed. It may be considered if a patch looks suspicious, does not respond to other treatments, or if a biopsy suggests early skin cancer.

Living with this condition

Treat actinic keratoses as a sign to be extra careful about sun protection. Use sunscreen every day, even on cloudy days, and reapply it often. Check your skin monthly, and see your doctor for regular skin examinations.

Lifestyle tips

• Wear protective clothing, including long sleeves and a wide-brimmed hat.
• Avoid going outside during peak sun hours, usually mid-morning to late afternoon.
• Use broad-spectrum sunscreen with a high SPF.
• Do not use tanning beds.
• Avoid smoking, as it can harm your skin.
• Keep a simple skin diary of new patches or changes.

Diet and exercise

There is no specific diet for actinic keratoses, but eating a healthy diet with plenty of fruits and vegetables, and drinking enough water, helps maintain healthy skin. Regular exercise is good for your overall health.

Mental health and emotional wellbeing

Having several skin patches can sometimes cause worry or self-consciousness. It is normal to feel concerned about the risk of skin cancer. Talking to your doctor and having a clear treatment plan can help reduce anxiety.

Prevention

Yes, most actinic keratoses can be prevented by protecting your skin from ultraviolet (UV) radiation from an early age and continuing throughout life.

Screening programmes

There is no routine national screening for actinic keratoses, but regular skin checks by a doctor are important if you have risk factors. You can also do monthly skin self-exams.

Complications

If left untreated

• If left untreated, a small number of actinic keratoses may become a type of skin cancer called squamous cell carcinoma.
• Squamous cell carcinoma is generally treatable if found early, but it can spread to other parts of the body if ignored.

Long-term outlook

The outlook is excellent with proper care. Most actinic keratoses do not turn into cancer, and treatment is usually very effective. If one patch does develop into cancer, it is most often caught early and cured.

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