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Actinic keratoses

ACTINIC KERATOSES - ALSO KNOWN AS SOLAR KERATOSES

What are the aims of this leaflet?

This leaflet has been written to help you understand more about actinic keratoses. It describes what they are, what causes them to develop, how they can be treated and where you can find out more information.

What are actinic keratoses?

Actinic keratoses are areas of sun-damaged skin found predominantly on sun-exposed parts of the body, particularly the forearms, backs of the hands, face, ears, bald scalp and the lower legs. They may also occur on the lips. The terms actinic andsolar arefrom the Greek and Latin respectively, meaning ‘sunlight-induced’. The term keratosis refers to thickened skin.

What causes actinic keratoses to develop?

They are caused by cumulative sun exposure over many years, from sunbathing, sunbed use, outdoor work or recreational activities. They are therefore more common in older people. Fair-skinned, blue-eyed, red- or blonde-haired individuals, who burn easily in the sun, are at particular risk. Actinic keratoses are not contagious.

What do actinic keratoses look and feel like?

Actinic keratoses can be variable in appearance but most often look like a change in colour or texture of a small patch of skin. At first, they may be hard to see, but can simply feel rough or scaly, looking like dry skin. They are often pink, but can be skin coloured or red. They can grow to a centimetre or two in diameter and occasionally develop a thicker warty layer. The surrounding skin often looks sun-damaged (blotchy, freckled and wrinkled).

They often do not cause any trouble, but can be itchy or sore. There is a very small risk that an actinic keratosis can progress into a form of skin cancer, called a squamous cell carcinoma. People with actinic keratoses are also at higher risk of developing other types of skin cancer, compared to someone of the same age without any actinic keratoses.

If an actinic keratosis develops into a lump, grows very quickly, becomes tender, forms an ulcer or starts to bleed, then medical advice should be sought as these changes could indicate the early onset of skin cancer (squamous cell carcinoma). People most at risk are those who have numerous patches of actinic keratosis and those on immunosuppressive drugs for accompanying conditions. 

Are actinic keratoses hereditary?

No, but some of the risk factors for developing actinic keratoses do run in families – for example, a tendency to burn easily in the sun rather than tan (skin type), red or fair hair and freckling.

How are actinic keratoses diagnosed?

Usually the appearance of an actinic keratosis is sufficient to enable the diagnosis to be made by a doctor who manages skin problems, for example a GP or dermatologist. In cases of doubt, a sample (biopsy) or the whole affected area may be removed surgically under local anaesthetic for microscopic examination in the laboratory.

Can actinic keratoses be cured?

An individual actinic keratosis can be cured, but many return in future years. People who have developed one actinic keratosis are at risk of developing more in the future. In general terms, the tendency to get actinic keratoses is a long term problem

How can actinic keratoses be treated?

Some actinic keratoses will resolve without treatment, especially if they are smaller and milder. Others will need treatment, and the choice of correct treatment can be discussed with your doctor. This will depend on the number and location of actinic keratoses, and other important factors which will differ between people.

Self-care:

  • Sun protection using sunscreen will help reduce further sun-related damage to skin, and may help improve the actinic keratoses that are present.
  • Moisturiser can be used on scaly patches of actinic keratosis.

Treatments that your doctor can provide for actinic keratoses:

  • Creams (topical treatments): Several types of cream or gel can be prescribed for use at home. These include 5-fluorouracil or imiquimod which are effective treatments. However, they often cause temporary redness and soreness of the treated areas. Diclofenac and retinoic acid are other drugs in cream or ointment form that are helpful when applied to milder actinic keratoses. Please note that the marketing authorisation for ingenol mebutate has been suspended by the Medicines and Healthcare products Regulatory Agency. Doctors have been instructed to stop prescribing it and consider other treatment options as appropriate.
  • Freezing with liquid nitrogen (cryotherapy):This is an effective treatment which does not normally leave a scar but may make the area lose its natural pigment. Cryotherapy can be painful. (See Patient Information Leaflet on Cryotherapy)
  • Surgical removal:This requires an injection into the affected skin with anaesthetic, after which the actinic keratosis can be scraped off with a sharp spoon-like instrument (a curette), or it can be cut out and the wound closed with stitches. Surgical removal leaves a scar, but provides a skin sample that can be analysed in the laboratory to confirm the diagnosis.
  • Photodynamic therapy: A special wavelength of light is shone on to the affected areas after a medicated cream has been applied; the light activates a chemical in the cream which then treats the actinic keratosis. This treatment is only available in certain hospitals(see Patient Information Leaflet on Photodynamic Therapy).
  • Laser treatment

How can I protect my skin?

Protecting your skin from the sun will help reduce the number of new actinic keratoses you get and will reduce the risk of developing a sun-induced skin cancer. You should be extra cautious in the sun by following these recommendations:

  • Protect yourself from the sun between 11am to 3pm when the sun is at its strongest.
  • Wear protective clothing - hats, long sleeves, long skirts or trousers.
  • Apply a sunscreen that blocks both UVA and UVB light and with a sun protection factor of 30 or above regularly to exposed skin before going into the sun. Re-apply the sun cream according to the manufacturer’s recommendations, especially if sweating or after swimming, when you are out in the sun.
  • Protecting your children from the sun in the same way may reduce their risk of developing actinic keratoses and skin cancers in the future
  • Avoid artificial sunlamps, including sunbeds and UV tanning cabinets.
  • Be skin aware - examine your own skin every few months and see your doctor if you notice something new that appears abnormal. If an actinic keratosis starts to develop into a lump or starts to bleed, then visit your GP. These symptoms can indicate that it has changed into a skin cancer. Early treatment is usually curative. 
  • People who actively avoid sun exposure should have their vitamin D levels checked and monitored. You may be advised to take a vitamin D supplement by your GP

 

Vitamin D advice

The evidence relating to the health effects of serum Vitamin D levels, sunlight exposure and Vitamin D intake remains inconclusive. Avoiding all sunlight exposure if you suffer from light sensitivity, or to reduce the risk of melanoma and other skin cancers, may be associated with Vitamin D deficiency.

Individuals avoiding all sun exposure should consider having their serum Vitamin D measured. If levels are reduced or deficient they may wish to consider taking supplementary vitamin D3, 10-25 micrograms per day, and increasing their intake of foods high in Vitamin D such as oily fish, eggs, meat, fortified margarines and cereals. Vitamin D3 supplements are widely available from health food shops.

 

Where can I find out more about actinic keratoses?

References:

British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis

https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.15107

Web links for further information:

For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk).

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED MAY 2007
UPDATED MAY 2010, SEPTEMBER 2013, NOVEMBER 2016, DECEMBER 2020
REVIEW DATE DECEMBER 2023

 

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