Actinic keratosis: focus

Actinic keratosis, or solar keratosis, is a precancerous lesion of the skin that appears mainly after the age of 40 and is due to the cumulative effect of sun exposure. The lesions, which are usually covered with a scale or crust that is rough to the touch, generally appear on the areas of the body most frequently exposed to the sun: the face, ears, scalp, lips, backs of hands, forearms, shoulders, and neck.

Description

The lesion initially presents as a small erythematous plaque covered with reddish-brown scales or crusts. Development of the lesion is very slow, with each plaque eventually reaching an average diameter of 1 to 2.5cm. Actinic keratosis often causes the formation of multiple lesions. While around a quarter (26%) of actinic keratoses regress spontaneously, about two thirds (60%) may evolve into squamous cell carcinomas.

Causes

The main cause of actinic keratosis is prolonged exposure to UV rays (either from the rays of the sun or from artificial tanning lamps), coupled with an individual’s own levels of photosensitivity.
People who are most at risk of developing actinic keratosis are those with fair to very fair skin, blond or red hair, and blue or green eyes. People who work or play sports for many hours outdoors, those who have weakened immune systems and people who live in tropical or equatorial countries are also particularly vulnerable.

Symptoms

Particular attention should be paid to the formation of actinic keratosis plaques. The plaques are small, erythematous and desquamate. While often times they are asymptomatic, they can also cause itching and burning.

Diagnosis

A diagnosis of actinic keratosis can be easily done by a dermatologist.
Thanks to a specialist examination, the doctor will be able to distinguish actinic keratosis from other skin conditions.
If the doctor deems it necessary, a biopsy may be performed to ensure that the lesion has not turned cancerous.

Treatment

If left untreated, actinic keratosis can develop into squamous cell carcinoma. It is therefore important to seek treatment for actinic keratosis to prevent the development of neoplasms.
Available treatment options include:

• ablative therapies (curettage, diathermocoagulation) are used to treat a single lesion or a small number of scattered lesions
• topical photodynamic therapy
• topical immunomodulatory drug therapies

Typically, ablative therapies are used to treat single lesions or a limited number of scattered lesions. Topical therapies, on the other hand, are used in the case of multiple, scattered lesions.

Prevention

The most effective way of preventing actinic keratosis is to protect yourself from the sun. Some preventative measures include:

• expose yourself to the sun responsibly by wearing protective clothing, sunglasses, hats and, for the parts that remain uncovered, apply a natural mineral photo reflector. Avoid sun exposure between 11am and 4pm
• avoiding burning and the use of sunbeds or UV lamps
• regularly examining the entire surface of the body, including the scalp, and notifying a doctor if a new lesion appears.
  seeking medical attention if a skin lesion:

1. causes pain, itches or burns
2. oozes or bleeds
3. becomes scaly
4. changes in size, shape, color or elevation