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Actinic keratoses

Published by Bupa's health information team, November 2008.

This factsheet is for people who have actinic keratoses, or who would like more information about it.

Actinic keratoses are patches of scaly, rough skin that sometimes develop if you have been exposed to a lot of sunlight throughout your life.

The patches occur on areas of your skin that are in the sun most, such as your nose, ears, face, scalp, neck or forearms. They are also called solar keratoses, but throughout this factsheet we will refer to them as actinic keratoses.

About actinic keratoses
Symptoms of actinic keratoses
Complications of actinic keratoses
Causes of actinic keratoses
Diagnosis of actinic keratoses
Treatment of actinic keratoses
After your treatment for actinic keratoses
Prevention of actinic keratoses
Further information
Questions and answers
Related topics
Sources

About actinic keratoses

Actinic keratoses are very common. They occur in over a third of men over the age of 70 in the UK. Usually they are harmless. However, sometimes they develop into a type of skin cancer called squamous cell carcinoma. Estimates vary on how frequently this happens, but it's thought to occur in about one in 50 people who develop them. Actinic keratoses are more likely to become cancerous if your immune system is weakened - for example if you have had an organ transplant and are taking medicines that suppress your immune system, or if you have human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS).

Who gets actinic keratoses?

Actinic keratoses are about twice as common in men than women. They are more common as you get older, but can arise at any age.

Actinic keratoses are more common in people who:

have fair skin
burn easily
don't tan easily

They are rare in people with dark skin. The more you are exposed to sunlight, the more likely you are to develop actinic keratoses. Because of this they are most common in hot and sunny countries like Australia.

Symptoms of actinic keratoses

Usually, several actinic keratoses develop around the same area, although rarely one may develop on its own. They tend to be about 0.5 to 1cm wide, but can sometimes be as big as 2cm.

Actinic keratoses vary from person to person. Often they aren't obvious, and you might not even be aware of them. The skin could be rough and dry in the affected area. Or it may be red, blotchy and wrinkled. Sometimes actinic keratoses become hardened and wart-like. Alternatively they may remain soft or flat. Actinic keratoses can be:

scaly
rough
crusted
reddish
brownish
skin-coloured
flattish
irregular
circular

Actinic keratoses develop on areas of your skin that are exposed to the sun a lot. Some common places include the:

scalp
face
forehead
ears
neck and upper chest area
arms
back of hands
lower lip

Complications of actinic keratoses

A small percentage of actinic keratoses may develop into a skin cancer called squamous cell carcinoma (SCC). If left untreated SCC can spread to other parts of the body and grow into surrounding tissue, which can in the worst cases prove fatal.

Skin cancer is usually treated with surgery. This is usually minor surgery to remove the area of affected tissue. A combination of radiotherapy and chemotherapy may also be used to treat skin cancer.

Causes of actinic keratoses

Actinic keratoses are caused by exposure to ultraviolet (UV) radiation from the sun. The more time you have spent in the sun throughout your life, the more likely you are to develop actinic keratoses.

Over time the UV rays can damage the DNA in the skin cells, causing them to divide and grow abnormally.

Diagnosis of actinic keratoses

If you think you have actinic keratoses, you should see your GP. He or she will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may decide to refer you to a dermatologist (a doctor who specialises in identifying and treating skin conditions). If you have been diagnosed with actinic keratoses and they change in appearance, become itchy, inflamed or bleed, you should also see your GP.

Treatment of actinic keratoses

There are several different ways of treating actinic keratoses. Your GP will decide on the best treatment for you depending on what the keratosis looks like, how quickly it developed, the amount of sun exposure you have had and your medical history.

Actinic keratoses will sometimes disappear on their own. Because of this, treatment isn't always needed. However, if the keratoses look unsightly, or if your GP thinks there is a risk that they will become cancerous, he or she will recommend treatment.

Some examples of treatments for actinic keratoses are given below.

Medicines

Several different types of medicine can be used to treat actinic keratoses. These are applied as creams or gels to the affected area. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

5-Fluorouracil (5-FU) is a cream that works by killing the damaged cells in actinic keratoses so that healthy skin cells can grow in their place. It clears most actinic keratoses for up to a year. You apply it for about six weeks, twice a day. Your GP may prescribe a smaller dose because it can make your skin inflamed.
Diclofenac gel (eg Solaraze) can be effective in clearing mild actinic keratosis. It can cause mild itching and rashes while you use it.
Imiquimod cream boosts your body's immune system and can help clear actinic keratoses. However, it can cause itching and burning while you use it.
Retinoic acid, also called tretinoin (eg Retin-A) is a derivative of vitamin A and may clear mild actinic keratosis.
Your doctor is likely to recommend sun avoidance (wearing of broad brimmed hat, long sleeves) as well applying sun block once or twice a day, particularly in the summer months or when on sunny holidays. Sun protection can help reduce the number of actinic keratoses and prevent more developing. (See Prevention).

Surgery

Your GP or dermatologist may decide to surgically remove the actinic keratoses. This is done under a local anaesthetic. They can be scraped off with an instrument called a curette, or cut out. The wound may need stitches and will leave a scar.

Samples are sent to a laboratory for testing to determine the type of cells and if they are benign (not cancerous) or cancerous.

Cryosurgery

Cryosurgery involves freezing the actinic keratoses off with liquid nitrogen. This is less likely to leave a scar than surgery. It's usually done when there are only a few small actinic keratoses.

Photodynamic surgery

Photodynamic surgery involves applying a special cream containing a chemical which is only absorbed by sun-damaged cells in actinic keratoses. A light of a particular wavelength is then shone on the area, which activates the chemical and causes it to destroy the sun-damaged cells. The cream is usually applied about three hours before the light is used.

After your treatment for actinic keratoses

Once treated, individual keratoses will be cured. However, the risk is attached to lifetime sun exposure, so that even if careful attention is paid to sun protection, actinic keratoses may come back. If more actinic keratoses develop, or if they change in appearance (see Diagnosis), you should see your GP. Alternatively, you may be asked to come back for a follow-up appointment a few months after treatment.

Prevention of actinic keratoses

Developing actinic keratoses is a sign that your skin has been damaged by the sun. However, you can help prevent more actinic keratoses, and keep your risk of developing skin cancer at a minimum, by avoiding more exposure to the sun and using UV sun block. Below are some tips.

Stay out of the sun between 10am and 3pm, when the sun is at its strongest.
Use at least factor 30 sunscreen when in the sun, even if it's winter. Make sure that it protects you from UVA and UVB radiation. Re-apply it every two hours.
Wear clothes that cover you up from the sun. Wear a sun hat.
Use sun glasses that provide UV protection.
Never use a sunbed.

Further information

British Association of Dermatologists
www.bad.org.uk
Cancer Research UK
www.cancerresearchuk.org