Actinic Keratosis, Solar Keratosis

What is it?
Actinic keratosis (AK) is the most common skin condition caused by long term skin damage by exposure to the sun. It presents itself in localized areas where it is characterised by crusting of the skin surface. There are usually multiple areas which can be discreet and flat or elevated, with the lesions being pink, grey, scaly or warty. Surface of the lesions can sometimes be smooth and shiny and to touch the surface is rough like sand paper. For patients the lesions are sometimes more easily felt than seen. Patients may complain of tenderness when a lesion is rubbed or shaved over with a razor. The lesions are usually relatively small measuring from 3mm - 1cm in diameter.

These keratoses are mainly found on the frequently sun exposed surfaces of the face, ears, bald scalp, dorsal hands and forearms. The lesions are normally harmless however they could in some instances become cancerous.

Who is affected?
Lesions typically appear in persons over 50 years of age however, the disease may occur in younger people who are in their 20s or 30s who live in areas of high solar irradiation and are fair skinned.

What is the cause?
AK is caused by years of long term damage to exposed areas of the skin by the sun, specifically UV rays. Hence it affects older individuals.

How it is diagnosed?
A doctor will diagnose AK by a clinical examination. If in any doubt a consultant dermatologist will examine the lesions more closely.

What is the treatment?
No treatment is an option if there are minimal lesions as a quarter of lesions tend to disappear within a year. Emollients can be used to soften crusty areas on the lesions however, AK can be prevented by the regular application of a high factor sun screen and by a diet low in fats. Freezing with liquid nitrogen (cryotherapy) is the most effective and practical course of treatment when there are limited number of lesions.

Patients with significant diffuse photo damage or multiple and recurrent lesions present difficult treatment problems. Standard topical non-surgical treatment Topical 5-Fluorouracil cream or Imiquimod 5% cream (an immune response modifier) has been shown to effectively treat multiple AK. Photodynamic therapy is another option for treating more extensive AK and allows the physician to treat a large surface area.

Electro desiccation and curettage are also effective and maybe necessary for thick lesions.

Are you suffering from Actinic Keratosis? Here are some links to help you:

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