Actinic Keratosis

Symptoms

An actinic keratosis is a lesion that is often felt before it is seen. The skin feels dry or like sandpaper. There may be a pink or red bump. They commonly appear on sun-exposed skin like the balding scalp, face, tops of the ears, backs of the hands, arms, and front of the legs.

There are often a few bumps in one area. Sometimes, actinic keratosis can become thick with a white dry scale. These are known as hypertrophic actinic keratosis.

• Rough scaly pink or red bump on the skin
• Skin may feel rough like sandpaper without any noticeable spots or redness
• Occasionally they can be painful, but they don’t usually cause pain.

Is actinic keratosis cancer?

Actinic keratoses are precancers, meaning that if  not treated they may turn into a squamous cell carcinoma, a type of skin cancer.

About 10% of actinic keratosis will develop into a squamous cell carcinoma, which can take anywhere from 2–10 years. Although many actinic keratoses will not turn into skin cancer, doctors can’t know which ones will or won’t, so they will want to treat all of them.

Causes

Actinic keratoses are caused by exposure to ultraviolet (UV) rays from the sun or from tanning beds. Exposure to UV over time damages the skin’s DNA, causing skin cells to multiply unchecked. When the cells multiply, it causes an actinic keratosis. If not treated, further DNA damage causes it to develop from a precancer to a skin cancer.

Treatment

It’s important to treat an actinic keratosis to prevent it from turning into skin cancer. There are several good options for removing them.

A dermatologist can treat them with liquid nitrogen (cryosurgery) or photodynamic therapy, or remove them surgically. You can also apply a prescription cream that destroys and removes the precancerous cells.

Cryosurgery

Cryosurgery uses liquid nitrogen to freeze the actinic keratosis. It feels cold and you may have some throbbing for a few seconds. The bump will turn white, and over the next few days become crusty and fall off. You will have a small scab for about 5–7 days.

Biopsy

A dermatologist may remove the actinic keratosis with a shave biopsy procedure. After you are numbed with a lidocaine shot, a small razor blade is used to shave off the lesion. You will wear a bandage for about 7 days as the skin heals. The lesion is sent to a lab to be tested for precancerous or malignant cells.

If the biopsy finds that you have actinic keratosis, you will need a followup visit in about 4–6 weeks. If it was not completely removed, your doctor may do cryosurgery on the remaining lump or recommend a prescription medicated cream.

Medication

There are a few medications your doctor can choose from. You should not use these if pregnant or breastfeeding.

• Fluorouracil cream (Efudex, Carac) is a chemotherapy cream that your dermatologist may prescribe to treat your actinic keratosis at home. It kills precancerous cells. The treatment will make the area red and crusty, and it can sometimes start to hurt. This means the medication is working.
• Imiquimod cream (Aldara) works by stimulating the immune system to attack precancerous cells. During treatment, your skin may become red, inflamed, and crusty.
• Tirbanibulin (Klisyri) is a new prescription medication that works by interrupting the cell cycle, so precancerous cells cannot multiply. It causes redness on the skin or irritation.

Photodynamic therapy

Photodynamic therapy (also called blue light treatment) is a procedure that combines medication and exposure to blue light. Aminolevulinic acid (Levulan) is applied to your actinic keratosis for about an hour (sometimes longer). The area with the lesion goes under a blue light, which activates the medication to destroy the precancerous cells.

Preventative tips

The best way to prevent actinic keratosis is to wear daily sunscreen and avoid sun exposure. Apply broad-spectrum 50+ SPF sunscreen daily and re-apply as recommended. UV protective clothing, hats, and gloves can also protect skin from the sun.

A large study, published in the New England Journal of Medicine, found that taking niacinamide (500 mg twice a day), a form of vitamin B3, reduced the risk of actinic keratosis in people who are more likely to get them.