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Actinic keratoses - also known as solar keratoses

This leaflet has been written to help you understand more about actinic keratoses. It tells you what they are, what causes them, what can be done about them, and where you can find out more about them. For convenience we shall use only the term ‘actinic keratosis’ in this leaflet.

What are actinic keratoses?

Actinic keratoses are rough areas of skin found in people who have been exposed to a lot of sunshine over the course of their lifetime. Actinic keratoses are very common (one third of men over the age of 70 in the UK have at least one actinic keratosis) and are usually harmless. A few actinic keratoses (estimates vary – but probably about 2%) will turn into a skin cancer (a squamous cell carcinoma) and this is the main reason for knowing about them.

What causes actinic keratoses?

They are caused by repeated sun damage over many years - from sun worship and sun-beds as well as from working or playing out of doors. They occur most often in fair-skinned people, with red or blond hair and blue eyes, who burn easily in the sun but tan poorly - and seldom in people with dark skins. Actinic keratoses are common in old people, but affect young ones too in sunny countries. Actinic keratoses cannot be caught from someone else.

Are actinic keratoses hereditary?

No, they are not; but some of the things that increase the risk of getting one, such as fair skin, a tendency to burn rather than tan, and freckling, do run in families.

What are the symptoms of actinic keratoses?

They are usually few and mild. Many people are not aware of them at all. Some actinic keratoses look ugly though; and if there are many of them the skin can look red and blotchy. The affected skin feels rough and dry, and a few actinic keratoses are slightly tender. A small minority turn into a skin cancer, and you should go to your doctor if an actinic keratosis starts to itch, grow, bleed, or looks different.

What do actinic keratoses look like?

Not all actinic keratoses look the same. At first they are tiny and hard to see, but the skin feels rough and sandpapery. Often several come up in the same area, starting small and growing slowly, some up to a centimetre or two across. Some are skin coloured, others are greyish, pink, red or brown. They can be flat and scaly, or raised, rough, hard and warty. A few even become so heaped up that they look like a small horn. Sometimes actinic keratoses go away, but most come back later. They arise on areas exposed to the most sunshine – for example, the nose, cheeks, forehead, the tops of the ears, the scalp (particularly in bald people), the backs of the hands and forearms. The skin on which they lie often looks sun-damaged - blotchy, freckled and wrinkled.

How are actinic keratoses diagnosed?

A doctor can usually identify an actinic keratosis just by looking at it. If there is any doubt, for example if an early skin cancer is suspected, the area should be removed under a local anaesthetic and checked in the laboratory.

Can actinic keratoses be cured?

Yes - but others may come up later.

How can actinic keratoses be treated?

The chance of an actinic keratosis turning into a skin cancer falls if the actinic keratosis is treated early. However some small actinic keratoses may go away by themselves and need no treatment if they are not causing problems.

Effective treatments include:

• Freezing them with liquid nitrogen (cryotherapy). This is the usual treatment when there are only a few, smallish actinic keratosis. It can be painful, but often the actinic keratoses go away without leaving a scar.
• Removing them under a local anaesthetic. Actinic keratoses can be scraped off with a sharp spoon-like instrument (a curette), or they can be cut out, the wound being stitched up afterwards. Both techniques leave scars but provide specimens of skin that can be checked in the laboratory.
• Other techniques. If your doctor sends you to a skin department, a cream containing a strong chemical (5-fluorouracil) may be used for a few weeks if your skin is covered with many actinic keratoses. The cream does not attack healthy skin but destroys the sun-damaged cells in actinic keratoses, allowing them to be replaced by healthy cells. This process may make the affected areas red and sore before they go away. Other applications include retinoic acid, diclofenac, or imiquimod. Photodynamic therapy (putting a chemical on and then treating the area with the right wavelength of visible light) is available in a few centres.

What can I do?

Even though your skin is already damaged, protecting it from the sun from now on will reduce the number of new actinic keratoses you get, and cut the risk of getting a sun-induced skin cancer. You should now be extra cautious and always:

• Protect yourself from the sun the sun from 10.00 a.m. to 3.0 p.m. Fix up your work and sport with this in mind. Also avoid tanning parlours.
• Apply a sunscreen (of sun protection factor 30 or more, and able to block both UVA and UVB light) at least half an hour before going into the sun, and again every two hours when you are out in the sun. Use it in sunny weather in the winter too.
• Wear protective clothing (hats, long sleeved shirts, long skirts, or trousers).
• Protect your children from the sun in the same way.
• See your doctor if an actinic keratosis starts to itch, bleed, or thicken, in case it has changed into a skin cancer.

Where can I get more information about actinic keratoses?

Links to other Internet sites:

www.skincarephysicians.com/actinickeratosesnet

www.emedicine.com/derm/topic9.htm

www.aadassociation.org/Guidelines/actkeratoses.html

(While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Your own doctor will be able to advise in greater detail)

BAD PATIENT INFORMATION LEAFLET

PRODUCED AUGUST 2004