Actinic Keratosis
Fun in the sun may be the basis of many great memories, but it is also most likely the cause of most of your skin’s damage. When we are young, our bodies are able to repair some of the damage to our skin caused by UV rays. Over time, as the damage accumulates, the body is not able to manage the damage and repair itself. Sun-damaged skin becomes more apparent, and pre-cancerous growths called “actinic keratoses” can form.
What is an actinic keratosis (AK)?
An actinic keratosis, also called a “sunspot” or a “solar keratosis” is a rough-textured, sometimes thick, dry, scaly bump on the skin caused by excessive exposure to ultraviolet light (UV) such as sunlight or artificial UV lighting in indoor tanning beds. They occur most often on sun-exposed areas such as the face, scalp or ears, and can range in color from skin-toned to reddish-brown. Actinic keratoses are considered pre-cancerous — if left untreated, they have a significant chance of developing into squamous cell carcinoma. As such, treatment by a board-certified dermatologist is recommended. Treatment of AKs helps prevent skin cancer.
What are the signs and symptoms of actinic keratoses (AKs)?
- Actinic keratoses most often present as thick, scaly, crusty papules (bumps) or plaques (plateaus). Color varies – Aks can be the same color as surrounding skin or maybe white to brown or pink to red.
- AKs are generally between 2-6mm in size but may grow larger. By the time a growth exceeds 10mm (about half an inch), there is an increased chance that the growth has already turned the corner and become a skin cancer (typically SCCIS or invasive SCC).
- AKs often appear on sun-exposed skin such as the face, ears, lips, scalp, neck, chest, hands, back of arms, or forearms.
- AKs often appear as multiple growths – several rough spots are common in a sun-exposed area.
- AKs often feel rough or gritty, like sandpaper.
- They may itch or burn
- Actinic keratosis on the lips presents as constant dry lips, possibly with a white scale that resembles peeling lips. TIP: Lips that frequently crack or bleed may not just be dry. If a lip is heavily sun-damaged then the cracking or bleeding may be a sign of AK or skin cancer.
Since there are many clinical variants of AKs, it is best to consult a board-certified dermatologist if you suspect a lesion.
The incredible disappearing actinic keratosis: actinic keratosis can be present for days or weeks or even longer then flake off, leaving no sign of the previously damaged skin. The skin could feel smooth, with even color and texture. Often, the AKs will reappear randomly or when the person goes back into the sun. Despite the fact that the previously noticeable AKs have seemingly disappeared, a person should still seek a board-certified dermatologist for evaluations. AKs are a sign of badly sun damaged skin and are considered warning signs for future skin cancer development and the need for surveillance and skin exams.
What are the risk factors for developing AKs?
Your risk for developing actinic keratosis increases if you have one or more of the following risk factors:
- Cumulative sun exposure – A history of sun exposure including a history of chronic sun exposure or sunburns is the main cause of actinic keratosis.
- Skin pigmentation – AKs are seen primarily in Caucasians with pale skin living in sunny climates. Also at risk are individuals prone to freckling and those with a propensity to sunburn. Certain occupations such as welders are predisposed to develop AKs.
- Hair & eye color – Individuals with naturally red or blonde hair, especially when combined with blue, green, or hazel eye color.
- Balding – AKs are common on the scalps of balding men. Moreover, men with complete baldness of the upper scalp are 7 times more likely to have 10 or more lesions than those with minimal baldness.
- Age – AKs generally appear after the age of 40.
- Immunosuppression – Organ transplant recipients, patients who take immunosuppressants or those with a weakened immune system are 250 times more likely to develop AKs.
- HPV – Research has shown that certain strains of Human Papillomavirus (HPV) may be associated with an increased risk for AKs.
- Geography – People who live in climates that receive intense sunlight all year, such as Florida, Nevada, Texas, Arizona, and Southern California.
How can I prevent the development of actinic keratoses?
The steps for the prevention of actinic keratosis treatment are the same as those for the prevention of all skin cancers. Limit sun exposure by limiting outdoor activities during the hours of 10 am-4 pm. When you are outside, wear protective clothing including wide-brimmed hats, long sleeve shirts, and long pants, and, if possible, clothing with an SPF factor. Also, frequently apply sunscreen with a sun protection factor (SPF) of 30 or higher that protects against UVA and UVB rays.
How is actinic keratosis diagnosed?
Actinic keratosis is diagnosed during a skin exam. Sometimes a specialized magnifying glass called a dermatoscopy is used. If the dermatologist is concerned that growth may be skin cancer, then a biopsy may be performed.
What are the management and treatment options for actinic keratoses?
Actinic keratosis can be treated a variety of ways, both in-office and at home. At Premier Dermatology, we offer the following treatment options for AKs:
In office procedures
- Photodynamic Light Therapy (PDL) – a non-invasive, effective treatment for AKs during which a photosensitizing topical pharmaceutical called Aminolevulinic Acid (ALA) / Levulan is applied directly to the lesions and surrounding areas by a nurse. The medicine is left on the area for one to three hours, after which the treatment area is exposed to a narrow band of blue light while the patient sits or lies on the examination chair. The light activates the pharmaceutical solution and destroys the pre-cancerous cells, leaving the healthy tissue remaining. This procedure is a highly effective treatment for large treatment areas or areas that are cosmetically sensitive such as the face, neck, scalp, hands and chest. Premier Dermatology and Mohs Surgery of Atlanta is proud to offer BLU-U photodynamic light therapy for the treatment of actinic keratosis. BLU-U helps you “manage your damage.”
- Cryotherapy – liquid nitrogen is used to treat the pre-cancerous cells by freezing them. Blisters generally form then fall off within a few days to weeks. Often a hypopigmented (lighter skin) spot remains. As this is a less expensive option than PDL, it is often chosen for a single, small area spot on a non-cosmetically sensitive area such as the arms.
- Electrodesiccation and Curettage (ED&C) – ED&C’s are quick procedures performed for larger AKs or AKs that have failed to resolve with cryotherapy or PDL. The area to be treated is numbed with local anesthetic. The AK is scraped with a curette and then cauterized (burned) to remove more damaged tissue. Typically, this process is repeated a second time. The area is dressed with a bandage. No stitches are required.
At-home treatment options
Actinic keratosis can be treated topically, as can squamous cell carcinoma in situ that may develop from untreated AKs. Topical treatment options widely vary on treatment time and intensity. Your dermatologist may prescribe one of the following to you for treatment:
- 5-fluorouracil (5-FU) cream: 5-FU is a form of topical chemotherapy. It works by causing fast-growing cells to die. Since pre-cancers grow more quickly than healthy background cells, 5-FU selectively damages the bad cells while leaving healthy cells intact. 5-FU causes temporary redness and crusting. Patients typically apply 5-FU twice daily for 2 to 4 weeks. A person who has extensively damaged skin may need to use 5-FU longer. 5-FU causes sun-damaged areas to become raw and irritated. As the skin heals, healthy skin grows in where AKs used to be present.
- Diclofenac sodium gel: Diclofenac is a gel chemically related to ibuprofen and “NSAIDs” or non-steroidal anti-inflammatory drugs. Patients apply the medicine twice per day for 2 to 3 months. This treatment is gentler but often less effective than more aggressive options and is suitable for patients with AKs scattered across a broad area.
- Imiquimod cream: This cream helps boost the immune system so that one’s own immune system can get rid of precancerous or cancerous cells. For actinic keratosis, imiquimod is applied twice per week for sixteen weeks. If imiquimod is effective, then areas with AK or precancer will typically redden, swell or peel. The skin heals within one to three weeks after treatment is complete. Because imiquimod works by stimulating the immune system, it is not recommended in patients with autoimmune diseases.
- Ingenol mebutate gel: This gel is made from the sap of the milkweed plant. It works in two ways. It boosts the body’s immune system. It also has a directly damaging effect on precancerous cells. Ingenol mebutate comes in two strengths. For AKs on the face and scalp, the 0.015% strength is applied once daily for 3 days in a row. For AKs of the arms, legs, and torso, the 0.05% strength is applied once daily for 2 days. Both formulas can cause rapid redness and swelling. As the skin heals, the redness and swelling and AKs clear, and healing typically takes place over 1-3 weeks.
Why should I choose Premier Dermatology for my AK treatment?
At Premier Dermatology and Mohs Surgery of Atlanta, we treat the entire patient first. AKs vary tremendously, and, as seen above, many treatments are available. Proper care requires a customized approach. Dr. Brent Taylor is a board-certified dermatologist and fellowship trained Mohs surgeon. Patients benefit from his extensive training in skin cancer detection and treatment. He will help you choose the treatment that is right for you. At Premier Dermatology, we operate under the motto of promoting high standards of patient education, individualized patient counseling and considerate and superior care. If you are concerned about a possible AK, contact Premier Dermatology and Mohs Surgery in Alpharetta, GA today.