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Skin: Understanding actinic keratosis

Actinic keratosis is a skin condition in which lesions form on the face or other sun-exposed areas. Although the condition itself isn't a health threat, it can progress to skin cancer, so treatment may be advised.

If you have rough, scaly spots or lesions on your face or other sun-exposed skin, they may be more than a cosmetic concern.

Actinic keratoses are lesions or spots that typically appear on the face, hands, neck, ears or arms—areas that generally receive a lot of exposure to the sun's harmful ultraviolet (UV) rays.

The condition is becoming increasingly common. Although many people seek treatment because of concerns about how they look, actinic keratosis is also a health concern, notes the American Academy of Dermatology (AAD). That's because the condition can sometimes lead to a type of skin cancer called squamous cell carcinoma. Although it's less dangerous than the more aggressive skin cancer melanoma, without treatment squamous cell carcinoma sometimes spreads to other parts of the body.

Signs of damage

According to the AAD, while actinic keratoses are generally dry, scaly and rough, they can have various forms. The following may be signs of the condition:

  • Bumps or scaly patches that may be red, pink, brown or flesh-colored.
  • Crusted lesions that may be various colors, including red, yellow and black.
  • Skin on the lower lip that cracks and peels.
  • An area of skin that feels like sandpaper.

Who's at risk?

As is the case with skin cancer, you have an increased risk of actinic keratosis if you have spent a lot of time in the sun over the years, especially if you have fair skin.

Other risk factors include increasing age—being 50 or older—and having a weakened immune system due to diseases or medications.

Diagnosis and treatment

If you think you might have actinic keratosis, tell your doctor. Actinic keratoses can often be diagnosed based on their physical features.

Because some actinic keratoses can become cancerous, treatment may be needed. The right treatment depends on many factors, including the size and location of the lesions.

According to the AAD and the National Cancer Institute, treatment options may include:

  • Cryosurgery—using liquid nitrogen to freeze and destroy lesions.
  • Curettage—scraping away lesions with a spoon-shaped instrument. This may be combined with heat from an electric current to destroy tissue.
  • Chemical peeling—using chemicals to take off damaged skin so that healthy skin can grow.
  • Laser skin resurfacing—using a laser to remove damaged skin.
  • Medications applied to the skin to destroy the lesions over time.
  • Surgery to remove the lesions.

After treatment, your doctor may want to examine your skin regularly to check for any actinic keratoses that may return and also to check for signs of skin cancer.

Protect your skin

Reducing your risk of both actinic keratoses and skin cancer is partly a matter of protecting your skin from excessive sun exposure. Sun protection also helps keep actinic keratoses from returning after treatment.

According to the AAD, these are some key steps:

Limit sun exposure. Stay out of the sun between 10 a.m. and 2 p.m., when UV rays are strongest.

Use sunscreen. Apply lots of water-resistant, broad-spectrum sunscreen with an SPF (sun protection factor) of at least 30. Use more every two hours or after swimming or sweating.

Cover up. Long-sleeved shirts, pants, a wide-brimmed hat and sunglasses can help protect against UV damage.

It's also important to check your skin regularly and report any new or changing lesions or other suspicious areas to your doctor. Of course, not every skin blemish is a health concern, but it's wise to play it safe and head off potential problems.

Reviewed 1/9/2022

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