What is an actinic keratosis?
Actinic keratosis (AK), also referred to as solar keratosis, is a small, rough spot occurring on sun-exposed skin. These small superficial spots are superficial skin cancers that have not invaded the deeper layers of the skin. Actinic keratoses characteristically appear on photo-damaged skin.
Specialized forms of actinic keratoses include cutaneous horns, in which the skin protrudes in a thick, hornlike manner, and actinic cheilitis, scaling and roughness of the lower lip and blurring of the border of the lip and adjacent skin. There are other causes of cutaneous horns, including warts and age spots (seborrheic keratoses).
What causes actinic keratoses?
Actinic keratoses (AK) develop on the skin due to chronic sun exposure. It most commonly occurs in fair-skinned people after years of sun exposure.
Who is at risk for actinic keratoses?
Those who develop actinic keratoses tend to be fair-skinned people who have spent years outdoors at work or play or who have exposed their skin to indoor tanning radiation. Their skin often becomes wrinkled, mottled, and thinned from sun exposure.
Others at risk include immunosuppressed organ transplant patients and patients treated with PUVA therapy (long-wave ultraviolet light plus an oral drug called psoralen) for psoriasis.
What are symptoms and signs of actinic keratosis?
Actinic keratoses generally range in size between 2-6 mm in diameter (between the size of a pencil point and that of an eraser). They are usually reddish in color, with a rough texture, and often have a white or yellowish scale on top. There is often a prickling pain felt when it is touched.
Where on the body do actinic keratoses typically occur?
Common locations for actinic keratoses include the following:
- Cheeks
- Bridge of the nose
- Rim of the ears
- Scalp
- Back of the neck
- Upper chest
- Tops of the hands and forearms
Men are more likely to develop AKs on top of the ears or a bald pate, whereas long hair is often protective.
What is the significance of an actinic keratosis?
Actinic keratoses are localized superficial tumors with the biological potential to develop into invasive skin cancer. Although the chance of an individual actinic keratosis progressing into an invasive squamous cell carcinoma is less than 1%, patients with many of these lesions (very common) who continue to expose their skin to carcinogenic ultraviolet sunlight are likely to develop invasive skin cancers. Squamous cell skin cancers are locally destructive and have a small but real potential for metastasis (spreading to other areas). Treating actinic keratoses at an early stage will help prevent invasive skin cancer.
When patients are diagnosed with this condition, they often say, "But I never go out in the sun!" The explanation for this is that there can be a long delay, even decades, for these keratoses to develop. Short periods of sun exposure do not generally either produce actinic keratoses or transform them into skin cancers.
![](https://images.medicinenet.com//images/slideshow/common-adult-skin-problems-s1-photo-of-freckled-young-woman.jpg)
SLIDESHOW
Rosacea, Acne, Shingles, Covid-19 Rashes: Common Adult Skin Diseases See SlideshowWhat specialists diagnose actinic keratoses?
Generally, primary care physicians or dermatologists can diagnose and care for actinic keratosis. If the lesion is especially large or thick, a biopsy may be advisable to make sure that the spot in question has not become skin cancer.
There are other spots, called seborrheic keratoses, which are not caused by sun exposure and have no relationship to skin cancers. These are raised brown lesions that may appear on any area of the skin. They also often run in families.
What is the treatment for actinic keratosis?
The best treatment for an AK is prevention. For light-skinned individuals, this means minimizing their sun exposure. By the time actinic keratoses develop, however, the relevant ultraviolet radiation is often so far in the past that prudent preventive measures play a relatively small role.
Fortunately, treatment methods are usually straightforward and may include:
- Cryosurgery: Freezing with liquid nitrogen
- Other forms of surgery: Doctors sometimes scrape away or burn off AKs.
- Laser resurfacing: Using either carbon dioxide (CO) or erbium:yttrium aluminum garnet (Er:YAG) lasers
- 5-fluorouracil (5-FU): Creams containing this medication cause AKs to become red and inflamed before they fall off. Although effective, this method often produces unsightly and uncomfortable skin for weeks, thus making it impractical for many patients. This method is best for patients who have a great deal of sun damage and many AKs. Once the skin heals, it often looks much smoother and even-toned.
- Imiquimod (Aldara): This immune stimulator is similar in its indications and effects to 5-FU.
- Ingenol mebutate (Picato): Is derived from the sap of a plant of the genus Euphorbia, which is related to the poinsettia plants that are popular at Christmas time. It is helpful in the treatment of small areas but causes significant irritation.
- Photodynamic therapy (PDT): This therapy involves applying an agent (aminolevulinic acid [Levulan] or ALA) that sensitizes the skin to light, leaving it on for about one hour, and then exposing the skin to light that activates the chemical. This blue light is absorbed by the compound, releasing the energy as heat which is believed to destroy the actinic keratoses. Like 5-FU and imiquimod, photodynamic therapy works best for patients with many AKs. Patients need to avoid exposure to sun or intense fluorescent light for two days after treatment to prevent ongoing peeling.
- Diclofenac (Solaraze): This cream is a nonsteroidal anti-inflammatory drug (NSAID), an agent related to ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever), a popular medication for headaches. Diclofenac is gentler than 5-FU or imiquimod, causing less inflammation, but must be applied for a longer period of about two months to achieve only modest improvement.
- Superficial chemical peels using trichloracetic acid (TCA) can also be effective. This procedure is performed in the doctor's office.
Health News
- One Death, 10 Hospitalizations in Listeria Outbreak Tied to Peaches, Plums
- Charity Scams Get Active Over the Holidays: Expert Tips to Avoid Them
- Too Few Seniors Get Follow-up Care After a Serious Fall
- AI Could Predict a Nonsmoker's Risk for Lung Cancer
- Breast Cancer Rates Higher in Urban vs. Rural Areas
More Health News »
Are there home remedies for actinic keratoses?
There are no home remedies for actinic keratoses, but many will resolve spontaneously if sun exposure can be strictly limited. Those lesions that do not resolve need professional medical attention.
What is the prognosis of an actinic keratosis?
Patients who develop actinic keratoses should be examined at least once yearly. Actinic keratoses are an indicator that sufficient sun exposure has occurred to produce skin cancers such as basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. The purpose of these regular checks is to prevent and detect the development of invasive skin cancer. Furthermore, continual avoidance of excessive sun exposure can decrease the risk of recurrences.
Is it possible to prevent actinic keratoses?
Sun avoidance is the simplest way to avoid actinic keratoses. This would include applications of SPF 50 sunscreens to exposed skin, wearing sun-protective clothing, shade-seeking behavior, and avoiding tanning.
There is now some evidence that taking niacinamide (nicotinamide), not niacin, may have some preventative benefit. Niacinamide is available at many health food stores.
Concerns about vitamin D deficiency can be avoided by taking multivitamin supplements.
Health Solutions From Our Sponsors
Costa, Claudia, et al. "How to Treat Actinic Keratosis? An Update." J Dermatol Case Rep 9.2 (2015): 29-35.
Uhlenhake, E.E. "Optimal treatment of actinic keratoses." Clin Interv Aging 8 (2013): 29-35.
Top Actinic Keratosis Related Articles
Cutaneous Horns Picture
The cutaneous horn appears as a funnel-shaped growth that extends from a red base on the skin. See a picture of Cutaneous Horns and learn more about the health topic.Dermabrasion
Dermabrasion is a skin procedure that freezes and then sands the skin. Dermabrasion improves the appearance of acne scarring and other skin conditions, such as wrinkles and skin lesions. Possible dermabrasion side effects include darkening of the skin, scarring, infection, and uneven changes in skin color.diclofenac
Diclofenac (Voltaren, Cataflam, Voltaren-XR, Cambia) is a nonsteroidal anti-inflammatory medication prescribed to treat inflammation and pain caused by conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendinitis, bursitis, and menstrual cramps. Side effects, drug interactions, dosage, and pregnancy safety should be reviewed prior to taking this medication.fluorouracil (Efudex)
Topical fluorouracil (Carac, Efudex, Fluoroplex, Tolak) is a medication prescribed for the treatment of conditions of the skin such as skin cancer, psoriasis, and keratosis. Review side effects, drug interactions, warnings, and pregnancy and breastfeeding safety information prior to taking this drug.imiquimod
Imiquimod is a topical cream used in the treatment of certain skin disorders including external genital warts, scaly skin, and superficial basal cell carcinoma (sBCC), a type of skin cancer. Common side effects of imiquimod include redness (erythema), flaking/scaling/excoriation, dryness, scabbing and crusting, swelling (edema), erosion and ulceration, weeping and discharge (exudate), blisters (vesicles), itching, burning, bleeding, pain, stinging, skin thickening (induration), irritation and soreness, sin bumps (papules), infection, loss of pigmentation (hypopigmentation), rash, sensitivity, and others.imiquimod (Aldara, Zyclara)
Imiquimod (Aldara, Zyclara) is a topical cream used in the treatment of genital warts. The medication works by stimulating the immune system cells and chemicals to attack the affected area. The medicine may also be prescribed to fight different types of skin cancer. Side effects, drug interactions, and patient safety information should be reviewed prior to taking this medication.Klisyri (tirbanibulin)
Klisyri (tirbanibulin) is a prescription cream used on the skin to treat actinic keratosis on the face or scalp. Typically caused by years of sun damage, actinic keratosis can later turn into skin cancer if left untreated. The most common side effects of Klisyri include itching or pain in the treatment area.Photodynamic Therapy
Photodynamic therapy (PDT) is a procedure that treats precancerous cells, in addition to other types of cancer cells. The medical treatment does this with the help of a photosensitizing drug and a light source that activates the applied drug, destroying cancer cells. PDT is approved to treat non-small cell lung cancer, esophageal cancer, and Barrett's esophagus. It treats actinic keratosis, as well as acne, rosacea, skin cancer, sun damage, oily skin, wrinkles, warts, psoriasis, and enlarged sebaceous glands.Psoriasis
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.Severe Psoriasis Pictures
Explore the different types of psoriasis such as plaque psoriasis, inverse psoriasis, and scalp psoriasis. Discover what causes psoriasis and many psoriasis treatment options.Skin Rash
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.Skin Biopsy
During a skin biopsy, a piece of skin is removed under a local anesthesia and examined using a microscope. The different types of skin biopsy include shave biopsy, punch biopsy, and excisional biopsy. Skin biopsies are performed to diagnose skin growths, skin conditions, and skin cancers.Skin Cancer (Nonmelanoma Skin Cancer or Keratinocyte Cancer)
Skin cancers occur when skin cells undergo malignant transformations and grow into tumors. The most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, are highly curable when they are diagnosed and treated early. Sun exposure, tanning beds, depressed immune system, radiation exposure, and certain viral infections are risk factors for skin cancer. Skin cancers are treated with surgery or radiation. The prognosis of nonmelanoma skin cancers is generally very good.Sun-Damaged Skin
See how sun damaged skin can cause wrinkles, moles, melanoma (skin cancer) and more. Explore images of squamous cell carcinoma and the early signs of skin cancer.Sunburn (Sun Poisoning)
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk of scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) includes nausea, fever, chills, rapid pulse, dizziness, and more. Home remedies can help relieve sunburn pain, blisters, and peeling. Severe sunburns may need medical treatment. Sun protection and sunscreen for a person's skin type are recommended to decrease the chance of severe sunburn and sun poisoning.Tolak (fluorouracil) Cream
Tolak (fluorouracil) is a prescription cream used to treat skin lesions on the face, ears, or scalp called actinic keratosis caused by sun damage on the skin. Serious side effects of Tolak Cream include skin reactions, possible allergic reactions, and eye problems when the eyes are exposed to the cream.urea
Urea is an emollient used in the treatment of many skin disorders that cause dry, rough, thick, and scaly skin, including dermatitis, eczema, psoriasis, keratosis pilaris, corns, calluses, ingrown nails, and more. Common side effects of urea include local irritation, transient stinging of the skin, transient burning sensation, itching (pruritus), redness, and rash. Applying too much urea products on the skin can cause irritation, redness, itching and pain.Wrinkles
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.