Actinic Keratosis (also known as Solar Keratosis)

An actinic keratosis (AK) is a precancerous lesion and develops due to damage caused by ultraviolet (UV) rays from sun exposure or indoor tanning. When we are young, the body can repair some (not all) of the damage. Over time, the damage accumulates, and the body is less able to repair itself. We eventually see UV-damaged skin. If UV rays continue to hit the skin, people get AKs. Most people get more multiple AKs and continue to get new lesions over their lifetime. They are considered precancerous, and if left untreated, may turn into a type of skin cancer called squamous cell carcinoma. By seeing a dermatologist for checkups, the AKs can be treated before they become skin cancer; anyone with these lesions should be under a dermatologist’s care.

An AK can appear on the skin, remain for months, and then flake off and disappear but re-appear in a few days to a few weeks. When present it has a scaly rough texture like sandpaper, and is often felt before seeing it.
Even if an AK does not re-appear, you should see your dermatologist. AKs form when the top layer of skin is badly damaged. If the damage grows deeper, skin cancer can develop. If skin cancer does develop, it can be caught early when treatment often cures skin cancer.

A condition of AKs on the lips (usually lower lips) is termed actinic cheilitis. When this turns into skin cancer, it may be more aggressive than other parts of the body. When it occurs, the lips feel constantly dry, rough and peeling.

People who are most at risk of developing AKs have one or more of the following traits:
◦ Fair skin.
◦ Hair color is naturally blonde or red.
◦ Eyes are naturally blue, green, or hazel.
◦ Skin freckles or burns when in the sun.
◦ 40 years of age or older.
◦ Weak immune system.
◦ Have a medical condition that makes the skin very sensitive to UV.
◦ Work with substances that contain polycyclic aromatic hydrocarbons (PAHs), such as coal or tar. Roofers have a higher risk of getting AKs because they work with tar and spend their days outdoors.

Treatment
There are many treatments for AKs. Some treatments your dermatologist can perform in the office, whereas other treatments can be done at home.
In-office procedures:
◦ Cryotherapy: Destroys visible AKs by freezing them. The treated skin often blisters or crusts, and peels off within a few days to weeks. This is the most common treatment.
◦ Photodynamic therapy (PDT): A medicine is applied to make the skin more sensitive to light. After a certain amount of time (determined by your doctor), the treated skin is exposed to a visible light, such as blue or laser light. The light activates the solution and destroys the sun damaged and pre-cancerous cells of the AK. As the skin heals, new healthy skin appears.
◦ Chemical peel: This is a medical chemical peel. You cannot get this peel at a salon or from a kit sold for at-home use. This strong peel destroys the top layers of skin. The treated area will be inflamed and sore, but healthy new skin will replace it. This is not covered by insurance.
◦ Laser resurfacing: Much like a chemical peel, a laser can remove the surface layer of the skin. This destroys AK cells. After treatment, the skin will be raw and sore. The skin heals within 1 or 2 weeks, revealing healthier new skin. This is not covered by insurance.
◦ Your dermatologist may prescribe a topical medicine that you can use at home to treat AKs. These creams destroy the precancerous/sun damaged cells over the course of a few weeks. The damaged areas crust up and peel off and heal with softer healthier skin.