Actinic Keratosis - Cynthia Rogers, MD

About

Actinic keratosis (AK) also known as solar keratosis, is a precancerous lesion of the epidermis (outer layer of skin) that is caused by long-term exposure to sunlight. Chronic sunlight exposure alters the keratinocytes (cells that make up the majority of the epidermis) and causes areas of your skin to become scaly, rough, discolored, and sometimes tender to the touch.

AKs are most commonly found on sun-exposed areas such as the face, lips, ears, neck, scalp, forearms, and backs of hands. People who have fair skin and light-colored hair and eyes are at the greatest risk of developing AKs. Individuals who are immunosuppressed, whether by cancer chemotherapy treatments or organ transplants and who have an immunodeficiency disorder, are also considered high risk for developing AKs.

AKs are not life-threatening as long as they are diagnosed and treated in the early stages. If left untreated, aggressive AKs have the potential to progress into squamous cell carcinoma, a serious type of skin cancer.

Actinic keratosis is one of the most common skin conditions treated by dermatologists, particularly in individuals who have had significant exposure to ultraviolet (UV) light. These precancerous growths are rough, scaly patches that occur on skin that has been damaged by the sun or indoor tanning devices.

About

Symptoms

The appearance of actinic keratoses can vary widely:

Rough, scaly patches on sun-exposed areas such as the face, lips, ears, back of your hands, forearms, scalp or neck.
Flat to slightly raised spots that may be pink, red, or brown.
A sandpaper-like texture that can become more noticeable when the skin is rubbed.
Occasionally, they might develop a hard, wart-like surface, and can be easier to feel than to see.

Symptoms

Causes

Actinic keratosis results from long-term exposure to UV radiation, either from the sun or artificial sources like tanning beds. The risk increases with age, as the cumulative exposure to UV light increases, making the skin less able to repair itself.

Causes

Treatment

Physicians often diagnose and treat AKs based on clinical appearance alone, but sometimes a skin biopsy is needed. After a dermatopathologist assesses your skin tissue under a microscope and determines the lesion is an AK, your physician will discuss several treatment options with you. Your treatment may vary based on the location, size of the lesion, and the amount of AKs you have developed. Your age and general health will also be taken into consideration. Common treatment options are cryosurgery (freezing lesion with liquid nitrogen), topical chemotherapy creams, photodynamic therapy (PDT or blue light), chemical peels, and laser resurfacing. Your physician will help you decide which option is best for you.

Treatment of actinic keratosis is essential to prevent progression to squamous cell carcinoma, a type of skin cancer. Options include:

Cryotherapy – Cryotherapy involves applying liquid nitrogen to the actinic keratoses to freeze and destroy the abnormal tissue. It’s a quick procedure usually done during a clinic visit. The treated area might blister and peel off, allowing new, healthy skin to form. This method is most suitable for fewer and isolated lesions.

Topical Treatments – Several creams and gels are used to treat actinic keratosis, which can be applied directly to the lesions:

- 5-Fluorouracil (5-FU): A chemotherapy cream that destroys sun-damaged cells while sparing normal cells.
- Imiquimod: Boosts the immune system to fight against sun-damaged cells.
- Diclofenac: A non-steroidal anti-inflammatory drug (NSAID) in gel form, used to treat skin inflammation and damage.
- Ingenol mebutate: A gel that causes rapid lesion necrosis and promotes immune response.

These treatments may cause redness, swelling, and irritation during the course of therapy, reflecting the destruction of precancerous cells.

Photodynamic Therapy (PDT) – PDT is a two-step treatment that combines a light-sensitizing agent with a light source to destroy actinic keratosis. The agent, applied to the skin, becomes active when exposed to a specific wavelength of light, destroying the affected cells. PDT is particularly effective for patients with multiple lesions and has the added benefit of improving the overall skin appearance.

Curettage and Electrodesiccation – In this procedure, the skin lesion is scraped off with a curette (a sharp, ring-shaped instrument), and the base is burned with an electric current. This method is effective for thicker, more adherent lesions that do not respond well to topical treatments.

Chemical Peels – Chemical peels involve applying a strong chemical solution to the skin, which causes the top layers and any damaged cells to peel off. This process helps rejuvenate the skin surface but can require some downtime for healing.

Laser Resurfacing – This technique uses a concentrated beam of light to remove or evaporate skin layers selectively. It’s effective for treating both actinic damage and improving cosmetic appearance by reducing wrinkles and age spots.

Treatment

Preventive Measures

Preventing actinic keratosis involves reducing UV exposure:

Use broad-spectrum sunscreen with an SPF of 30 or higher.
Wear protective clothing, hats, and sunglasses.
Avoid sun exposure during peak hours from 10 a.m. to 2 p.m.
Stay away from indoor tanning beds.
Solicur is a supplement that leverages the properties of several active ingredients to help protect against sun damage and improve skin health. Key components include:

Nicotinamide (Vitamin B3): This is the star ingredient in Solicur, known for its skin-repairing properties. Nicotinamide has been shown to enhance DNA repair in sun-damaged skin and reduce the rate of new actinic keratosis and non-melanoma skin cancers. It operates by boosting the skin’s defense against UV radiation and improving cellular health.

Polypodium Leucotomos Extract: Derived from a tropical fern, this natural extract is recognized for its antioxidant properties. It offers photoprotection against UVA and UVB rays, potentially reducing the risk of sunburn, actinic keratosis, and the development of skin cancer.

Resveratrol: Found in red grape skin, resveratrol is a potent antioxidant that helps protect the skin from UV damage and oxidative stress, which can lead to premature aging and skin cancers.

Vitamin D3: Often referred to as the “sunshine vitamin,” Vitamin D3 is essential for maintaining healthy skin. It supports the skin’s immune system and promotes healthy cell development, which can be beneficial in preventing actinic keratosis and other forms of skin damage.

Solicur is designed to be taken daily and may be particularly beneficial for those with a history of sun damage or at higher risk of skin cancers due to environmental exposure.

Don’t Become a Statistic

One in six people will develop an AK in their lifetime. Since cumulative sun exposure increases with age, older people are more likely to develop AKs. Patients with multiple AKs have a risk of progression to squamous cell carcinoma of 5% to 9%.

Preventive Measures