Actinic Keratoses

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What is Actinic Keratoses?

Actinic keratoses (AKs) are rough-textured, dry, scaly patches on the skin that are caused by excessive exposure to ultraviolet light (UV) such as sunlight. More than 10 million American have AKs.

• AKs are often called “sun spots” or “solar keratoses”
• They occur most often on the face, scalp, ears, neck, hands and arms
• They can range in color from skin toned to reddish brown
• They can be as small as a pinhead or larger than a quarter

Who gets AKs?

AKs are seen primarily in Caucasians with pale skin living in sunny climates. Areas of the skin with the most sun exposure, such as the head, neck, forearms, and hands account for more than 80 percent of AKs.

AKs develop as the result of years of sun exposure. Because the effect of sun exposure is cumulative, it is your lifetime exposure that increases your risk. Even if you didn’t suntan much, years of just doing simple tasks outside can add up to significant amount of sun exposures.

Because AKs take a long time to develop, they generally appear after the age of 40. The American Academy of Dermatology estimates that 60 percent of persons apt to get AKs will indeed get at least one AK in their lifetime.

Your risk of developing AKs increases if you have one or more of the risk factors.

What are some of the risk factors?

• A history of cumulative sun exposure
• Fair skin
• Blond or red hair, in particular if combined with blue, hazel or green eyes
• A tendency to freckle or burn after sun exposure
• A weakened immune system

What do AKs look like?

AKs generally begin as rough spots of skin that may be easier to feel than see. Common complaints include a lesion that has increased in size or one that is raised, bleeding, poor in healing, discolored, or associated with discomfort such as pain or itching.

While a lesion may initially appear skin colored to pink, red, or brown, lesions on darker skin may be more pigmented. AKs may feel soft, rough, or “gritty,” but in any case, they feel different from the surrounding healthy skin.

Since there are many clinical variants of AKs, it is best to consult a dermatologist if you suspect a lesion.

How to Recognize Actinic Keratosis

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple: Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly.

Numerous actinic keratoses on bald scalp revealing chronic sun damage. They are elevated, rough in texture, and resemble warts.
Two typical keratoses on rim of ear. The top lesion is crusted, the lower one rough in appearance.
While most keratoses have a fine sandpapery roughness, others such as this lesion have an obviously scaly, crusty surface.
Lower lip with cracks filled with dried blood and horn-shaped scale covering large keratosis.

Why treat AKs?

AKs are considered to be the first step in the development of skin cancer. They have the potential to progress to squamous cell carcinoma (SCC). While most AKs remain benign, a study has shown that approximately 10 percent develop into SCC within an average of 2 years.1 Since there is no way to know ahead of time which AKs will develop into SCC, it is very important for individuals with AKs to be under a dermatologist’s care. Frequent skin examinations are the key to early detection and prevention.

How are AKs treated?

When treating AKs, dermatologists may use one therapy or combine therapies. Some available treatments for actinic keratoses are:

• Cryosurgery: The most common treatment for AKs, cryosurgery involves applying a cryogenic (extremely cold) substance, usually liquid nitrogen, to the lesion. This freezes the surface skin, causing the skin to flake off. New skin forms. The main side effect is skin redness; blistering may occur.
• Topical Chemotherapy: To destroy AKs, patients apply a cancer-fighting cream or lotion (e.g., 5-fluoruracil,) to their skin. Red spots may remain on the treated skin for a while. Another treatment option such as cryosurgery may be necessary to treat thicker lesions that a cream or lotion cannot fully penetrate.
• Topical Immunotherapy: When applied to the skin, this medication (e.g., imiquimod) stimulates the patient’s own immune system to destroy the AKs and accompanying damaged skin cells. Patients apply this medication at home as directed by their dermatologist.
• Topical NSAID (non-steroidal anti-inflammatory drug): Patients apply this medication (e.g., sodium diclofenac gel) to the lesions as directed. During treatment, patients should avoid the sun. The medication works to destroy the AKs and accompanying solar damage.
• Photodynamic Therapy (PDT): A solution that makes the skin more sensitive to light is applied and left on the skin. After a few hours, the treated skin is exposed to ‘blue” or “red” light, which activates the solution and destroys the AKs. Areas of redness may develop in treated regions. These will fade after several days.
• Chemical Peeling: A chemical solution is applied to the skin in order to peel away the AKs and damaged skin. As the treated skin peels off, new healthy skin replaces it. It is common to experience discomfort, redness, and crusting in the treated areas.
• Laser Skin Resurfacing: A laser may be used to remove AKs and damaged skin. A common side effect is redness immediately afterward. It may take a week or two for the skin to heal.

Research and development of other treatments for AKs is ongoing. No one therapy works on all AKs or in all individuals.

Other resources

• AAD pamplet on Actinic Keratoses
• WebMD overview of Actinic Keratoses
• SkinCancer.org overview of Actinic Keratoses