Actinic keratoses are areas of sun-damaged skin found predominantly on sun- exposed parts of the body, particularly the backs of the hands and forearms, the face and ears, the scalp in balding men and the lower legs in women. The terms actinic and solar are from Greek and Latin, respectively, for ‘sunlight- induced’, and the term keratosis refers to thickened skin. They are usually harmless but there is a very small risk of some actinic keratoses progressing to a form of skin cancer called squamous cell carcinoma (see Patient Information Leaflet on Squamous Cell Carcinoma). Actinic keratoses are not contagious.
They are caused by excessive sun exposure over many years (from sunbathing, sunbed use, outdoor work or recreational activities) and are therefore more common in older people. Fair-skinned, blue-eyed, red- or blonde-haired individuals, who burn easily in the sun but tan poorly, are at particular risk.
No, but some of the factors that increase the risk of getting actinic keratoses such as a tendency to burn rather than tan, and freckling, do run in families.
They often cause little trouble. Many affected individuals are not aware of them at all. The affected skin feels rough and dry. However, if an actinic keratosis starts to grow into a lump, becomes itchy, tender or starts to bleed, medical advice should be sought as these changes could indicate the development of skin cancer (a squamous cell carcinoma).
Actinic keratoses can be variable in appearance, even differing from one another within a single individual. At first they can be hard to see, and are more easily felt, being rough, like sandpaper. They may grow up to a centimetre or two in diameter. Some are skin coloured, others are pink, red or brown. They can become raised, hard and warty, and may even develop a small horny outgrowth. The surrounding skin often looks sun-damaged - blotchy, freckled and wrinkled.
Usually the appearance of an actinic keratosis is sufficient to enable the diagnosis to be made, but in cases of doubt, for example if an early skin cancer is suspected, a sample (or the whole lesion) may be removed under a local anaesthetic for microscopic examination in the laboratory.
Yes, but others may develop in the future from the surrounding sun-damaged skin.
It is advisable to protect the skin from further sun damage (for example, by wearing a hat, long sleeves and a sunscreen with a high sun protection factor).
Occasionally, small actinic keratoses may go away spontaneously, but generally it is advisable to treat them as there is a small risk that some might transform into a skin cancer.
Treatments used for actinic keratoses include the following:
Protecting your skin from the sun will reduce the number of new actinic keratoses you get, and also reduce the risk of getting a sun-induced skin cancer. You should be extra cautious in the sun by following these recommendations:
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.