Actinic keratosis is a skin disease in which rough, scaly or dry lesions develop on parts of the body that are exposed to the sun or UV rays. If left untreated, these areas of the skin can develop a serious form of skin cancer. You can find more information below.
What is actinic keratosis?
Actinic keratosis appears on the skin as reddish to brownish patches and horny deposits with a scaly, rough surface. Typical symptoms are red-brown, rough and flaky patches on areas more frequently exposed to the sun. This includes the face, forehead, head, ears, décolleté and forearms, and the back of the hand.
Even if the skin damage is benign and only progresses slowly, it is considered a preliminary stage for squamous cell carcinoma , a type of white skin cancer .
Actinic keratosis mainly affects those who have been exposed to sunlight and UV radiation for many years in middle and older age , and most importantly in their professional and private lives.
Since one in ten affected people develop skin damage from skin cancer, the disease should not be treated without delay. Keratoses rarely regress spontaneously and with continuous sun protection.
Five subgroups of actinic keratosis
In uncertain cases, a tissue sample (biopsy) should be taken to rule out advanced skin cancer. On the basis of histology (microscopic tissue structure), five different subgroups of actinic keratosis can be distinguished:
- Hypertrophic AK
- Artofik AK
- Bowenoid AK
- Akantolitik AK
- Pigmentli Ak
Who is it seen in?
Actinic keratosis occurs mainly in the elderly over 50 years of age . For this reason, typical skin changes are also called senile keratosis or age keratinization.
Young people under the age of 30 are also increasingly affected, due to changing habits such as outdoor activities, sunbathing and increased visits to the solarium .
What causes actinic keratosis?
Various causes and risk factors for actinic keratosis are known. These are:
- skin exposure to UV rays
- sensitive skin type
- advancing age
- hereditary predisposition
- Tar products (eg tobacco smoke)
- Continuous administration of immunosuppressive (immunosuppressing) drugs
Main cause: UV rays
Continuous exposure to UV rays, with high sensitivity, alters the genetic material of skin cells and weakens the immune defense against cancer cells. Sunlight also contains a certain level of UV, and constant exposure is likewise an important risk factor.
Dr. Hendrike Durani says: “The skin forgets nothing. That is why actinic keratosis often occurs in old age. Minor skin injuries caused by sunlight clump until cells lose their regenerative power and eventually break out.”
What are the symptoms of actinic keratosis?
Skin changes such as raised and red patches of certain areas of the skin may be actinic keratosis, but this is not certain. Because a mild keratosis is not that easy to recognize even for a professional.
The first symptoms are small reddish spots that appear after too much sun exposure, when the skin becomes thinner and enlarged blood vessels become more prominent .
A typical feature of actinic keratosis is that the spots no longer heal on their own, often remaining permanent.
In addition, the following are the manifestations of actinic keratosis:
- Actinic keratosis in the first stage presents with areas of rough, scaly skin that feel like sandpaper.
- The color of the affected skin areas varies from yellowish to reddish, unlike skin tones.
- Most affected are areas that come in frequent contact with UV rays, such as the forehead, ears, cheeks and bridge of the nose.
- In the later stage, thick horny deposits form on the skin, which can be yellowish or brownish.
- Actinic keratosis does not cause itching, but the affected areas are particularly sensitive.
Actinic keratosis usually does not appear as a single blemish or single skin injury, there are small groups of these skin changes on the scalp or in a cut, or they are widely distributed.
When should you see a doctor?
Anyone who discovers a suspicious skin change or area of skin that is no longer healing should be examined by a specialist.
How is actinic keratosis diagnosed?
Because actinic keratosis is associated with typical skin changes, the diagnosis is usually successful based on these symptoms. Even before changes in the skin appear, you may feel them as rough, the affected skin feels like sandpaper.
However, actinic keratosis can resemble other skin diseases, especially in the early stages. During diagnosis, it is important to rule out other causes of skin changes. For example these are:
- age spots
- fungal infection
- skin cancers
To reliably detect actinic keratosis and determine how far it has penetrated, a tissue sample is usually taken from the affected skin when diagnosed and examined under a microscope, this is called a biopsy.
In the case of minor skin changes, they usually remove the tissue immediately with surgery and then examine it microscopically.
How is actinic keratosis treated?
There are many methods for the treatment of actinic keratosis. The decision as to which one should be made individually for each patient. This depends on a variety of factors, including the number and size of affected skin areas, previous illnesses, and the patient’s personal wishes and opinions.
International guidelines recommend dividing it into four subgroups for the treatment of this disease:
- Patients with a maximum of five identifiable skin changes in one area of the body
- Patients with at least six different skin changes in one area of the body (multiple actinic keratosis)
- Patients with chronic UV damage and cornification, with at least six skin changes in one area of the body
- Patients with additional immunodeficiency (immunosuppression due to medication or disease)
An overview of the various treatment options with advantages and disadvantages is presented below:
If only regional skin areas are affected by actinic keratosis, they can be removed with a scalpel (shaving excision) or a sharp spoon (curettage).
The removed tissue is then examined histologically – so this method of treatment is also used to rule out invasive squamous cell carcinoma.
The disadvantages are the usual risks of surgery such as wound infection and scarring.
Icing with liquid nitrogen ( cryotherapy ) is an effective alternative to the surgical treatment of regional actinic keratoses. Local anesthesia is not necessary, but the procedure can be painful.
Possible side effects include blister formation, skin irritation, and permanent bright discoloration of the treated skin area. Because pigment-forming cells can also be destroyed during icing.
In addition, histological examination is not possible and therefore treatment is not appropriate if an invasive skin tumor is suspected.
Laser therapy is suitable for removal of single and multiple actinic keratoses and for patients with area cancer. The advantage is that the skin can be removed in a large area. Thus, early, not yet visible skin changes are also detected. However, histological examination is not possible.
However, laser therapy can also be painful and also carries a risk of scarring and skin discoloration. In addition, the risk of infection increases due to the large wound area, so laser therapy is not recommended for patients with weakened immune systems.
In photodynamic therapy, the affected skin areas are pretreated with an ointment or chemical stuff. Then, light with a certain wavelength and the treated skin area interact and aim to treat the affected area.
After a treatment period of about four hours, the skin is irradiated with a special light source, which leads to the destruction of the affected tissue. Pain, burning and skin irritation may occur.
The treatment is particularly suitable for skin where a large area is affected. The risk of recurrence and skin discoloration appear to be lower than with other treatments.
Local treatment with creams
Studies show that drugs used for the treatment of actinic keratosis are more effective than placebos (dummy drugs) and lead to improvement of changes in about 50% of cases.
The disadvantage of these forms of treatment is their length, reddening of the skin, tenderness and a relatively large number of side effects.
All affected skin areas are suitable for local treatment with suitable creams, especially if larger areas are to be treated.
Your doctor will decide which medicine to take and how.
Can actinic keratosis be prevented?
To prevent the development of actinic keratosis, very little and gentle use of sunlight and artificial UV light is recommended. Therefore, the following measures are appropriate to prevent actinic keratosis:
- Always avoid the midday sun. The same applies to artificial UV radiation in solariums.
- If possible, prefer shady places while staying outdoors.
- If the sun is strong, use high-quality sunscreen and wear opaque clothing or sun hats to protect the skin.
- Protect children especially from sunburn.
Additionally, to prevent actinic keratosis, it’s important to examine your skin regularly and see a doctor if you notice any changes in your skin. It is also beneficial to have regular examinations for the early detection of skin cancer ( skin cancer screening ).